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Antihistamines are the drugs of choice for treatment of allergic contact dermatitis and acute urticaria (a vascular reaction of the skin charac- Jane Morgan is admitted to the oncology unit for chemotherapy buy isoniazid 300 mg without a prescription medicine technology. Urticaria often occurs because the skin has cause allergic symptoms in some patients purchase 300 mg isoniazid otc medications ok for pregnancy, diphenhydramine many mast cells to release histamine. If ana- for use include drug-induced skin reactions, pruritus phylaxis developed in this client, would administering additional ani, and pruritus vulvae. With pruritus, oral • Assess every client for a potential hypersensitivity reac- cyproheptadine (Periactin) and hydroxyzine (Atarax) tion. For example, it is standard practice on first contact to are especially effective. The health care provider is likely to get more com- for nonallergic disorders, such as motion sickness, nau- plete information by asking clients about allergic reactions sea and vomiting (eg, promethazine, hydroxyzine; see to specific drugs (eg, antibiotics such as penicillin, local Chap. The active anesthetics) rather than asking if they are allergic to or ingredient in OTC sleep aids (eg, Compoz, Sominex) is cannot take any drugs. Antihistamines are also com- If a drug allergy is identified, ask about specific signs mon ingredients in OTC cold remedies (see Chap. With previous exposure and sensitization to the same or a simi- lar drug, immediate allergic reactions may occur. With a Contraindications to Use new drug, antibody formation and allergic reactions usu- ally require a week or longer. Most reactions appear within Antihistamines are contraindicated or must be used with cau- a month of starting a drug. In addition, evaluate all the drugs a client is taking as a potential cause of the reaction. This assess- ment may involve searching drug literature to see if the Nursing Process suspected drug is associated with allergic reactions and discussion with physicians and pharmacists. For the client with known antihistamines allergies, try to determine the factors that precipitate or • Deficient Knowledge: Safe and accurate drug use relieve allergic reactions and specific signs and symptoms • Deficient Knowledge: Strategies for minimizing exposure experienced during a reaction. For most people, a second- Planning/Goals generation drug is the first drug of choice. If costs are prohibitive for a • Experience relief of symptoms client, a first-generation drug may be used with mini- • Take antihistamines accurately mal daytime sedation if taken at bedtime or in low ini- • Avoid hazardous activities if sedated from antihistamines tial doses, with gradual increases over a week or two. Overall, safety should or other sedative drugs be the determining factor. Some studies have shown cognitive and performance impairment with the first- Interventions generation drugs even when the person does not feel • For clients with known allergies, assist in identifying and drowsy or impaired. If it is a • For treatment of acute allergic reactions, a rapid-acting drug allergy, encourage the client to carry a medical alert agent of short duration is preferred. A client may respond better to one antihistamine known to cause sedation. Thus, if one does not relieve symp- • Encourage a fluid intake of 2000 to 3000 mL daily, if not toms or produces excessive sedation, another may be contraindicated. Use in Children • For clients who have experienced an allergic or pseudo- allergic drug reaction, assist them in learning about the First-generation antihistamines (eg, diphenhydramine) may drug thought responsible (including the generic and com- cause drowsiness and decreased mental alertness in children as monly used trade names), suitable alternatives for future in adults. Young children may experience paradoxical excite- drug therapy, and potential sources of the drug. In Evaluation overdosage, hallucinations, convulsions, and death may occur. Close supervision and appropriate dosages are required for safe • Observe for relief of symptoms. Diphenhydramine is not recommended for use in new- • Interview and observe for excessive drowsiness. When used in young children, doses should be small because of drug effects on the brain and ner- vous system. Prevention of Histamine- The second-generation drugs vary in recommendations Releasing Reactions for use according to age groups. Syrup formula- When possible, avoiding exposure to known allergens can tions are available for use in younger children. If antihistamine therapy is re- may be used in children 5 years and older; fexofenadine may quired, it is more effective if started before exposure to aller- be used in children 6 years of age and older; and deslorata- gens because the drugs can then occupy receptor sites before dine may be used in children 12 years and older.

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