Combat Methamphetamine Epidemic Act (CMEA) of 2005-Requirements for purchase: photo ID, sign written or electronic log per purchaseoMust keep personal records for at least two years-**it is a national database = National Precursor Log Exchange (NPLEx)-Limitationso3.6 g per dayo9 g per monthEfficacy and Safety of Phenylephrine (PE)-Efficacy: patients report no difference in decongestion between PE and placebo; 10 mg dose did not show to be more effective than placebo (only higher 25 mg dose did)-Safety: oral PE showed no consistent effect on heart rate or blood pressure at dose under 25 mgBottom Line with Oral Decongestants-Phenylephrine: not very effective, not many side effects, very easy to purchaseoNot recommended for children under 6 years of age-Pseudoephedrine: more effective, more side effects, more concern over CV and other side effects, harder to purchase due to regulationsoNot recommended for children under 12 years of age-Ask a doctor before use if you have:oHeart diseaseoHTNoThyroid diseaseoDMoDifficulty urinating due to enlargement of prostateoCan still recommend if disease states are under controlTopical Nasal Decongestants → arteriolar vasoconstrictors, direct on receptorsDrug Duration of actionDoseNaphazolineShort acting1 to 2 sprays every 6 hoursPhenylephrineShort acting2 to 3 sprays every 4 hours
OxymetazolineLong acting2 to 3 sprays every 12 hoursAll of these lose potency after 2-3 months of opening and need to be discarded afterwardsLocal effects: stinging burningRhinitis Medicamentosa= rebound congestion-In order to prevent, limit use to 72 hours-Discontinue 1 nostril at a time, use saline or topical steroids-Generally takes 1 to 2 weeks to recoverBottom line: can be used safely in many people, effect is usually shorter than oral decongestants, less side effects than oral decongestants, NOT recommended for childrenRhinorrhea (runny nose) = Treatment with 1stGeneration Antihistamines-DiphenhydramineoMarketed for allergies but effective for cold symptomsoAlso effective for cough symptoms as cough suppressantoMarketed as a sleep aid-ChlorpheniramineoMarketed for allergies but may be effective for cold symptoms-Others: brompheniramine, doxylamine, triprolidine-Class: Histamine-1 Receptor antagonists-MOA: competitively inhibit histamine-1 receptors (non-selective)-PK: wide Vd, hepatic metabolism and renal elimination-Precautions: Beers Criteria, Exacerbation of certain disease states like glaucoma, BPH, thyroid disorders-Side note: there is no histamine involvement in the pathophysiology of a cold-ADEs (really important to know these!! Anticholinergic effects)oPeripheral Effects▪Decreased salivation▪Decreased bronchial secretions▪Decreased sweating▪Pupil dilation, inhibition of accommodation▪Increased heart rate▪Difficulty urinating▪Decreased GI motilityoCentral Effects▪Drowsiness▪Impaired concentrations, confusion▪Attention deficit▪Memory impairmentoOther effects▪Paradoxical effects in children →
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- Fall '15
