A student needs to take an antihistamine for chronic rhinitis. Which preparation is least likely to make the student sleepy in class?
1. Hydroxyzine (Atarax)
2. Cetirizine (Zyrtec)
3. Diphenhydramine (Benadryl)
4. Fexofenadine (Allegra)
Correct Answer: 4
Rationale 1: Hydroxyzine (Atarax) is a sedating first-generation antihistamine.
Rationale 2: Cetirizine (Zyrtec) is more sedating than other second-generation agents.
Rationale 3: Diphenhydramine (Benadryl) is a sedating first-generation antihistamine.
Rationale 4: Fexofenadine (Allegra) is the least sedating of the second-generation antihistamines.
Global Rationale: First generation antihistamines like hydroxyzine and diphenhydramine have sedation as a significant adverse effect. This effect is lessened in the second generation antihistamines such as cetirizine and fexofenadine. Cetirizine appears to be somewhat more sedating than other second-generation agents.
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