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Ipratropium (Atrovent, Atrovent HFA) Ipratropium, which is chemically related to atropine, has antisecretory properties. When applied locally, it inhibits secretions from serous and seromucous glands lining the nasal mucosa. These agents act by competitively inhibiting histamine at the H1 receptor. This effect mediates bronchial constriction, mucus secretion, smooth muscle contraction, and edema. Diphenhydramine (Benadryl, Benylin) Diphenhydramine is a first-generation antihistamine with anticholinergic effects. Chlorpheniramine (Chlor-Trimeton) Chlorpheniramine is a first-generation agent that competes with histamine or H1-receptor sites on effector cells in blood vessels and the respiratory tract. It is one of the safest antihistamines to use during pregnancy. Brompheniramine (Bromphen) This oral H1 blocker is used for allergic conjunctivitis and rhinitis, angioedema, pruritus, and urticaria. It does not tend to cause drowsiness and is suitable to use on a day-to-day basis. Several agents (eg, codeine, guaifenesin, dextromethorphan) are intended for the symptomatic relief of cough. However, evidence is mixed regarding the effectiveness of these agents. Cough and cold medicines should be used with caution in children younger than 2 years because serious adverse reactions and fatalities have occurred with over-the-counter preparations. Many over-the-counter cough and cold preparation labels state that the product should not be used in children younger than 4 years. Guaifenesin and dextromethorphan (Robitussin DM, Mucinex DM, Duratuss DM, Robafen DM, Guaifenex DM) This compound treats minor cough resulting from bronchial and throat irritation. Opioid analgesics bind to opioid receptors in the central amoxicillin 125 mg price nervous system, thus inhibiting pain pathways. In addition, these agents cause cough suppression by direct central action in the medulla. Codeine is a centrally acting antitussive that also helps to manage the pain of intercostal muscle strain associated with cough. Alpha stimulation causes mucosal vasoconstriction, decreasing edema of the subglottic region of the larynx. Although inhaled epinephrine is sometimes given in epiglottitis, its benefit is unproven. Epinephrine (Adrenalin, EpiPen, Twinject) Epinephrine is used for severe bronchoconstriction, especially with underlying reactive airway disease. Its alpha-agonist effects include increased peripheral vascular resistance, reversed peripheral vasodilatation, systemic hypotension, and vascular permeability. Beta2-agonist effects include bronchodilatation, chronotropic cardiac activity, and positive inotropy. Steroids are used to decrease edema by suppressing local inflammation. They are frequently used to manage croup, and they may reduce the need for racemic epinephrine inhalation. Dexamethasone (Decadron, Dexasone) Dexamethasone decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reducing capillary permeability. Prednisone in equivalent doses may be substituted if administered over the course of 5 days. These drugs are typically amoxicillin for pid used to relieve nasal symptoms. Decongestants and antihistamines should be used with caution in children younger than 2 years because serious adverse reactions and fatalities have occurred with over-the-counter cough and cold preparations. In 2008, the Consumer Healthcare Products Association modified many over-the-counter cough and cold product labels to state "do not use" in children younger than 4 years. Pseudoephedrine (Sudafed) This agent causes vasoconstriction by directly stimulating alpha-adrenergic receptors in the respiratory mucosa. It is used for symptomatic relief of nasal congestion due to common cold, upper respiratory tract allergies, and sinusitis. Oxymetazoline (Allerest, Afrin, Dristan, Chlorphed) Stimulates alpha-adrenergic receptors and causes vasoconstriction when applied directly to mucous membranes. Decongestion occurs without drastic changes in blood pressure, vascular redistribution, or cardiac stimulation. These agents are typically used to relieve nasal symptoms. Phenylephrine nasal (NeoSynephrine Nasal) This agent is a strong postsynaptic alpha-receptor stimulant with little beta-adrenergic activity that produces vasoconstriction of arterioles in the body. Oxymetazoline (Afrin, Dristan 12 Hr Vicks Sinex 12 Hour) Oxymetazoline stimulates alpha-adrenergic receptors and causes vasoconstriction when applied directly to mucous membranes. Decongestion occurs without drastic changes in blood pressure, vascular redistribution, or cardiac stimulation. [Guideline] Bisno AL, Gerber MA, Gwaltney JM Jr, Kaplan EL, Schwartz RH. Diagnosis and management of group A streptococcal pharyngitis: a practice guideline. [Guideline] Shulman ST, Bisno AL, Clegg HW, Gerber MA, Kaplan EL, Lee G, et al. Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. [Guideline] Wald ER, Applegate KE, Bordley C, Darrow DH, Glode MP, Marcy SM, et al.
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