Introduction to Clinical Pharmacology Chapter 32Antitussives, Mucolytics, and Expectorants

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Antitussives: Actions and Uses

Some antitussives depress cough center located in medulla and are called centrally acting drugs Some antitussives are peripherally acting drugs, which act by anesthetizing stretch receptors in the respiratory passages, thereby decreasing coughing Antitussives are used to relieve nonproductive cough
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Herbal Alert
Eucalyptus Used as a decongestant and expectorant-found as a component in OTC products for tx of sinusitis and pharyngitis Should not be used during pregnancy and lactation, children younger than 2 years of age

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Antitussives: Adverse Reactions

Central nervous system reactions: Sedation; dizziness; lightheadedness

Gastrointestinal reactions:
Nausea; vomiting; constipation Nonprescription cough medicines containing two or more ingredients produce few adverse reactions when used as directed
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Precautions Contraindicated in patients with known hypersensitivity to drugs Opioid antitussives are contraindicated in premature infants or during labor when delivery of premature infant is anticipated Used with caution in patients: With persistent or chronic cough; cough accompanied by excessive secretions; high fever; rash; persistent headache or nausea or vomiting
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Antitussives: Contraindications and

Precautions (contd) Antitussives containing codeine are used with caution during pregnancy and labor and in patients with COPD; acute asthmatic attack; preexisting respiratory disorders; acute abdominal conditions Opioid antitussives are used cautiously in patients with head injury and increased intracranial pressure; acute abdominal disorders; convulsive disorders; hepatic or renal impairment; prostatic hypertrophy; asthma or other respiratory conditions
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Antitussives: Contraindications and

Antitussives: Interactions
Central nervous system (CNS) depressants and alcohol may cause additive depressant effects when administered with antitussives containing codeine When dextromethorphan is administered with monoamine oxidase inhibitors, patients may experience hypotension, fever, nausea, jerking motions to the leg, coma

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Nursing Process: Assessment

Preadministration assessment: Document type of cough and describe color and amount of any sputum present during preadministration assessment Record vital signs as some patients with productive cough may have an infection

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Nursing Process: Assessment

Ongoing assessment: Observe for therapeutic effect Auscultate lung sounds, takes vital signs periodically Describe and record in chart type of cough and frequency of coughing

Record whether cough interrupts sleep or causes pain in chest or other parts of body
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Nursing Process: Planning

Expected outcome includes: Optimal response to therapy

Support of patient needs related to managing adverse drug reactions

Understanding of and compliance with prescribed treatment regimen

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Nursing Process: Implementation

Promoting an optimal response to therapy: Administer antitussives orally Depression of cough reflex can cause secretions to pool in lungs Indiscriminate use of antitussives by general public may prevent early diagnosis and treatment of serious disorders, such as lung cancer and emphysema
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Nursing Process: Implementation

Monitoring and managing patient needs: Risk for injury:

Minimize risk for hospitalized patients by carefully orienting each patients to surroundings and closely supervising patient
Encourage patient to ask for assistance if he or she feels dizzy or unsteady
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Nursing Process: Implementation

Educating the patient and family: Advise patient to read label carefully, follow dosage recommendations, and consult primary health care provider if cough persists for more than 10 days or if fever or chest pain occurs If taking oral capsules, do not chew or break open the capsules, swallow them whole Do not use with alcohol or other CNS depressants-antidepressants, hypnotics, sedatives, tranquilizers
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Nursing Process: Evaluation

Therapeutic effect is achieved and coughing is relieved Patient reports no injuries related to adverse reactions Patient and family demonstrate an understanding of drug regimen

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Mucolytics and Expectorants: Actions

Drug with mucolytic activity appears to reduce viscosity of respiratory secretions by direct action on mucus

Expectorants increase production of respiratory secretions, which in turn appears to decrease viscosity of mucus, helps to raise secretions from respiratory passage

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Mucolytics and Expectorants: Uses

Acute bronchopulmonary disease Pulmonary complications of cystic fibrosis Pulmonary complications associated with surgery Post-traumatic chest conditions

Atelectasis due to mucus obstruction

Acetaminophen overdosage
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Mucolytics and Expectorants: Adverse ReactionsContraindications and Precautions

Adverse reaction-drowsiness Expectorants and mucolytics are contraindicated in patients with known hypersensitivity Expectorant potassium iodide is contraindicated during pregnancy Expectorants are used cautiously during pregnancy and lactation and in patients with: Persistent cough; severe respiratory insufficiency or asthma; older adults or debilitated patients
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Mucolytics and Expectorants: Interactions

Patient may experience hypokalemia; cardiac arrhythmias; or cardiac arrest when potassium-containing medications and potassium-sparing diuretics are administered with iodine products Thyroid function tests may also be altered by iodine

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 Preadministration assessment:

Nursing Process: Assessment

Assess respiratory status of patient before administering drug Documents lung sounds, amount of dyspnea, and consistency of sputum

Ongoing assessment:

Note any increase in sputum or change in consistency

Immediately before and after tx with acetylcysteine, Auscultate lungs and record findings of both assessments on clients chart Between txs, evaluate patients respiratory status and record these findings on patients chart
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Nursing Process: Planning

Expected outcome includes: Optimal response to therapy

Support of patient needs related to management of adverse drug reactions

Understanding of and compliance with the prescribed treatment regimen

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

 Promoting an optimal response to therapy: Explain treatment to patient and demonstrates how nebulizer will be used Remain with patient during first few treatments If acetylcysteine is ordered to be inserted into a tracheostomy, make sure suction equipment is at bedside to be immediately available for aspiration of secretions
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Nursing Process: Implementation

Nursing Process: Implementation

Managing and monitoring patient needs: Ineffective airway clearance:

Encourage patient to take deep, diaphragmatic breaths

Monitor amount and consistency of sputum

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Nursing Process: Implementation

Educating the patient and family:

Provide full instruction to patient or family member about use and maintenance of equipment, as well as technique for administration of acetylcysteine Instruct patient to take drug as directed and contact primary health care provider if any unusual symptoms occur during use of drug or if drug appears to be ineffective See Box pg. 290*
Return demonstrate Continue tx2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Copyright until entire drug gone

Nursing Process: Evaluation

Therapeutic effect is achieved, and secretions are thinned and easily expectorated
Patient has an easy, unlabored breathing pattern Adverse reactions are identified, reported, successfully with nursing interventions

patient and family demonstrate an understanding of the drug regimen and use of equipment to administer the drug
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