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Pharmacology · chapter 39 · Otic Drugs

Otic Antihistamines, Decongestants, and Cerumenolytics

The 14 things this section of the textbook says that you are most likely to be asked about — quoted word for word, not retold. Then 6 practice questions with the reasoning.

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Key points

  1. How antihistamines help the ear

    Antihistamines decrease congestion of mucous membranes, which might decrease corresponding obstruction of tubes within the ear.

  2. Antihistamines and cardiac dysrhythmia

    Clients at risk for cardiac dysrhythmia, such as a prolonged QT interval on an electrocardiogram, should communicate with their provider before taking a first-generation antihistamine like diphenhydramine due to potential proarrhythmic effects (Williamson, 2022).

  3. Glaucoma and urinary retention

    Since antihistamines have a drying effect, clients with glaucoma and urinary retention should avoid taking an antihistamine.

  4. Sedatives and alcohol add up

    Antihistamines exacerbate the sedating effects of tranquilizers and alcohol, which can lead to respiratory depression and injuries from falls.

  5. No driving while on antihistamines

    Educate the client to refrain from driving or operating machinery while taking these medications because they can cause drowsiness and impair cognitive function.

  6. Dry mouth and constipation

    Keep fluids or hard candy on hand to manage symptoms of dry mouth. Maintain adequate fiber and fluid intake to reduce likelihood of experiencing constipation.

  7. Decongestants when flying

    They can be used to manage symptoms of an upper respiratory illness or prophylactically when flying to decrease discomfort associated with changes in air pressure.

  8. Decongestants raise blood pressure

    Decongestants should be avoided in clients who have a history of hypertension or heart disease because these medications can raise blood pressure and stimulate the heart.

  9. Glaucoma and enlarged prostate

    They can increase intraocular pressure in clients who have glaucoma; particularly among clients with benign prostatic hypertrophy, decongestants can inhibit the ability to void.

  10. Monitor glucose in diabetes

    Monitor the client’s blood glucose levels if the client has diabetes and report elevated readings to the provider.

  11. MAOIs and decongestants

    Take decongestants for the shortest amount of time possible and do not take multiple decongestants from different decongestant classes. Clients taking monoamine oxidase inhibitors (MAOI) and decongestants can experience hypertensive crisis (Edinoff et al., 2022).

  12. How carbamide peroxide works

    The drops work by releasing oxygen to soften and encourage spontaneous extrusion of cerumen. They also have a weak antibacterial effect.

  13. Examine the ear before cerumenolytics

    Examine the client’s ears before treatment for any evidence of drainage or other symptoms that would prevent safe administration. Consult with the provider if concerning finding are present.

  14. No drops after ear surgery

    The client taking an otic cerumenolytic should not: Instill cerumenolytic drops after recent ear surgery or if there is eardrum dysfunction.

Terms to know

Decongestant
Decongestant s are medications that shrink swollen blood vessels and tissues in the nose to reduce nasal congestion, which can facilitate drainage to relieve ear congestion.
Carbamide peroxide
A commonly prescribed cerumenolytic is carbamide peroxide (Debrox).

Practice questions

Stuck on select-all-that-apply? How to take them one option at a time.

The graded version needs JavaScript. Every question is below anyway, with the answer and why.

Every question here, with the answer

  1. A client who takes an MAO inhibitor for depression asks whether pseudoephedrine is safe for ear congestion before a flight. What is the nurse's best response?

    1. "Take double the dose to be sure it works during the flight."
    2. "Taking a decongestant with an MAOI can cause a hypertensive crisis, so check with your provider first."
    3. "Decongestants only interact with antibiotics."
    4. "It is safe if you take it only once."

    Answer: "Taking a decongestant with an MAOI can cause a hypertensive crisis, so check with your provider first."

    Clients taking MAOIs with decongestants can experience hypertensive crisis, and clients should talk to their provider before starting a decongestant. The other responses ignore or misstate this interaction.

  2. Which clients should avoid or use decongestants only with caution? Select all that apply.

    1. A client with hypertension
    2. A client with seasonal allergies and no other conditions
    3. A client with glaucoma
    4. A client with benign prostatic hypertrophy
    5. A client with heart disease

    Answer: A client with hypertension, A client with glaucoma, A client with benign prostatic hypertrophy, A client with heart disease

    Decongestants raise blood pressure and stimulate the heart, can increase intraocular pressure in glaucoma, and can inhibit voiding with an enlarged prostate. Allergies alone are not a listed concern.

  3. An older adult taking diphenhydramine for ear congestion also drinks alcohol every evening. What is the nurse's main concern?

    1. Hypoglycemia
    2. Ear wax buildup
    3. Hypertensive crisis
    4. Increased sedation leading to respiratory depression and falls

    Answer: Increased sedation leading to respiratory depression and falls

    Antihistamines exacerbate the sedating effects of tranquilizers and alcohol, which can lead to respiratory depression and fall injuries. Hypertensive crisis is the MAOI-decongestant interaction, and the other options are not described.

  4. A client with a history of glaucoma asks for an over-the-counter antihistamine for ear fullness. How should the nurse respond?

    1. Antihistamines are preferred in glaucoma.
    2. Antihistamines lower eye pressure.
    3. Glaucoma only matters for eye drops.
    4. Clients with glaucoma should avoid antihistamines because of their drying effect.

    Answer: Clients with glaucoma should avoid antihistamines because of their drying effect.

    Because antihistamines have a drying effect, clients with glaucoma and urinary retention should avoid them. The other statements are not supported by the section.

  5. A nurse is about to give carbamide peroxide ear drops for impacted ear wax. Which actions are appropriate? Select all that apply.

    1. Have the client remain lying down for 5 minutes after the drops.
    2. Consult the provider if concerning findings are present.
    3. Give the drops even though the client had ear surgery last week.
    4. Check the ear with an otoscope after treatment.
    5. Examine the ear for drainage before treatment.

    Answer: Have the client remain lying down for 5 minutes after the drops., Consult the provider if concerning findings are present., Check the ear with an otoscope after treatment., Examine the ear for drainage before treatment.

    The nurse examines the ear first and consults the provider for concerns, has the client lie for 5 minutes and checks results with an otoscope. Cerumenolytics should not be used after recent ear surgery.

  6. A client with diabetes starts pseudoephedrine for ear congestion. Which assessment should the nurse include?

    1. Monitor blood glucose and report elevated readings.
    2. Check serum potassium daily.
    3. Measure urine specific gravity.
    4. Monitor for hypoglycemia every hour.

    Answer: Monitor blood glucose and report elevated readings.

    Decongestants can elevate glucose, so the nurse monitors blood glucose in clients with diabetes and reports elevated readings. The other assessments are not described for decongestants.

Where every quote comes from

Section 39.3 Otic Antihistamines, Decongestants, and Cerumenolytics of Pharmacology for Nurses by Tina Barbour-Taylor, Leah Mueller (Sabato), Donna Paris, Dorie Weaver, OpenStax, 2024. Read the whole section free at openstax.org.

The textbook is licensed under CC BY-NC-SA 4.0. This page quotes it word for word and adds the headings, the order and the practice questions; references to the book's figures and stray spaces left by its formatting are removed. The page is shared under the same licence. Nothing here is sold.