Pseudoephedrine

INTRODUCTION

Indications

Symptomatic management of nasal congestion associated with acute viral upper respiratory tract infections. Used in combination with antihistamines in the management of allergic conditions. Used to open obstructed eustachian tubes in chronic otic inflammation or infection.

Action

Stimulates alpha- and beta-adrenergic receptors. Produces vasoconstriction in the respiratory tract mucosa (alpha-adrenergic stimulation) and possibly bronchodilation (beta₂-adrenergic stimulation). Therapeutic Effects: Reduction of nasal congestion, hyperemia, and swelling in nasal passages.

Adverse Reactions/Side Effects

CNS: SEIZURES, anxiety, nervousness, dizziness, drowsiness, excitability, fear, hallucinations, headache, insomnia, restlessness, weakness. Resp: respiratory difficulty. CV: CARDIOVASCULAR COLLAPSE, palpitations, hypertension, tachycardia. GI: anorexia, dry mouth. GU: dysuria. Misc: diaphoresis.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Be alert for new seizures or increased seizure activity, especially at the onset of drug treatment. Document the number, duration, and severity of seizures, and report these findings to the physician immediately.

• Watch for a sudden fall in blood pressure and related signs (dizziness, syncope, loss of consciousness) that might indicate cardiovascular collapse. Seek immediate medical assistance if patient develops these signs.

• Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendixes G, H). Report a rapid heart rate (tachycardia) or signs of other arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

• Assess blood pressure periodically and compare to normal values (See Appendix F). Report a sustained increase in blood pressure (hypertension) to the physician.

• Watch for signs of respiratory difficulties, including dyspnea, chest pain, shortness of breath, and cyanosis. Monitor pulse oximetry and perform pulmonary function tests (See Appendices I, J, K) to quantify suspected changes in ventilation and respiratory function.

• Monitor and report signs of CNS toxicity, including anxiety, nervousness, restlessness, fear, and hallucinations. Sustained or severe CNS signs may indicate overdose or excessive use of this drug.

Interventions

• Because of the risk of cardiovascular stimulation, use caution during aerobic exercise and endurance conditioning. Assess exercise tolerance frequently (blood pressure, heart rate, fatigue levels), and terminate exercise immediately if any untoward responses occur (See Appendix L).

Patient/Client-Related Instruction

• Remind patients that over-the-counter cold/flu products may contain pseudoephedrine. Patients should consult their physician or pharmacist to determine ...