Quiz 45: Pharmacotherapy of Allergic Rhinitis and the Common Cold
From the given symptoms, we can observe that the blood pressure of the patient is low (88/60 mmHg), heart rate is high (tachycardia) and also suffering from difficulty in breathing. Anti-histamines cause CNS depression, which also includes the suppression of respiratory centre. These drugs also induce sedation and can cause respiratory failure. So, anti-histamines are not given to children, people suffering from palpitations, difficulty in breathing, pulmonary congestion, confusion and elderly people. As the patient is suffering from tachycardia and difficulty in breathing, anti-histamine is not preferable in this case.
Parkinson's disease (PD) is a neurodegenerative disorder characterized by the muscular rigidity, difficulty with movement (bradykinesia or akinesia), tremors and change in body posture. The pathophysiology of disease underlies the destruction of dopaminergic neurons in the substantia nigra and excess release of acetylcholine, which impairs the muscular movement and causes rigidity of muscles and tremor. Levodopa along with the carbidopa or benserazide is the drug of choice for the treatment of Parkinsonism. Levodopa is a prodrug, which is converted into dopamine in the central nervous system and replaces the neurotransmitter "dopamine." Levodopa is combined with carbidopa (dopa hydroxylase inhibitor) to prevent the hydrolysis of levodopa in the periphery by the dopa hydroxylase enzyme.
Based on the patient history and initial assessment, the following additional information needs to be obtained by the nurse practitioner: • History of allergy associated with an exposure to certain environmental conditions, foods, pollen, etc. (in suspicion of allergic rhinitis) • History of cardiovascular diseases (as her blood pressure is high, normal blood pressure is 148/88 mmHg). • History of medication, pregnancy, fever and other infections if any. • If she is suffering first time from the symptoms, the information regarding recent changes in food or area is needed.