Comprehensive Nursing Pharmacology Q 136
In infants and children, the side effects of first-generation over-the-counter (OTC) antihistamines, such as diphenhydramine (Benadryl) and hydroxyzine (Atarax) include:
A. Reye’s syndrome
B. Cholinergic effects
C. Paradoxical CNS stimulation
D. Nausea and diarrhea
Correct Answer: C. aspirin
Virus-infected children who are given aspirin to manage pain, fever, and inflammation are at an increased risk of developing Reye’s syndrome. Neither agent has been associated with the development of Reye’s syndrome.
Option A: The use of acetaminophen has not been associated with Reye’s syndrome and can be safely given to patients with fever due to viral illnesses. Acetaminophen use has been linked to liver failure and sometimes has led to liver transplants or death. The hepatotoxicity occurring with acetaminophen use typically correlates with high doses of acetaminophen that exceed the recommended maximum dose. This effect may involve the intake of more than one drug product that contains acetaminophen as an ingredient. Liver damage also has been seen in patients with chronic dosing of acetaminophen.
Option B: Ibuprofen adverse effects include GI irritation and bleeding, and in toxic doses, both renal and hepatic failure is reported. However, ibuprofen has not been associated with the onset of Reye’s disease. Gastrointestinal bleeding is a well-known adverse effect of ibuprofen usage and can lead to gastritis, ulceration, hemorrhage, or perforation. Inhibition of COX isoforms in ibuprofen usage leads to the a reduction of prostaglandins, which play a role in the secretion of gastroprotective mucus. This effect is more pronounced in non-selective NSAIDs, with COX-2 selective NSAIDs having a lower incidence of gastrointestinal complications, which is of particular concern in children, for which the use of ibuprofen is higher than other NSAIDs due to its comparative safety compared to other drugs in its class.
Option D: Brompheniramine/pseudoephedrine contains a first-generation OTC antihistamine and a decongestant. In the conscious patient, ephedrine may produce palpitations, headache, dizziness, nausea, vomiting, restlessness, and anxiety. Ephedrine is also arrhythmogenic, and caution should be used during administration to patients who are predisposed to arrhythmias or taking other arrhythmogenic medications, particularly digitalis. When used long-term, the catecholamine excess can result in contraction band necrosis of the myocardium which predisposes the heart to ventricular arrhythmias.