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Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Introduction to ClinicalPharmacology

Chapter 32-Antitussives, Mucolytics, andExpectorants

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Antitussives: Actions and Uses

Some antitussives depress cough centerlocated in medulla and are called centrally

acting drugs Some antitussives are peripherally acting

drugs, which act by anesthetizing stretchreceptors in the respiratory passages,thereby decreasing coughing

Antitussives are used to relievenonproductive cough

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Herbal Alert

Eucalyptus

Used as a decongestant and expectorant-found as acomponent in OTC products for tx of sinusitis andpharyngitis

Should not be used during pregnancy andlactation, 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 containingtwo or more ingredients produce fewadverse reactions when used as directed

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Antitussives: Contraindicationsand

Precautions

Contraindicated in patients with knownhypersensitivity to drugs

Opioid antitussives are contraindicated inpremature infants or during labor whendelivery of premature infant is anticipated

Used with caution in patients:

With persistent or chronic cough; coughaccompanied by excessive secretions;high fever; rash; persistent headache ornausea or vomiting

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Antitussives: Contraindicationsand

Precautions (contd)

Antitussives containing codeine are usedwith caution during pregnancy and labor andin patientswith COPD; acute asthmaticattack; preexisting respiratory disorders;acute abdominal conditions

Opioid antitussives are used cautiously in

patients with head injury and increasedintracranial pressure; acute abdominaldisorders; convulsive disorders; hepatic orrenal impairment; prostatic hypertrophy;asthma or other respiratory conditions

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7/24Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Antitussives: Interactions

Central nervous system (CNS) depressantsand alcohol may cause additive depressanteffects when administered with antitussivescontaining codeine

When dextromethorphan is administered

with monoamine oxidase inhibitors, patientsmay experience hypotension, fever, nausea,jerking motions to the leg, coma

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Nursing Process: Assessment

Preadministration assessment:

Document type of cough and describecolor and amount of any sputum presentduring preadministration assessment

Record vital signs as some patients withproductive cough may have an infection

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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 ofbody

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Nursing Process: Planning

Expected outcome includes:

Optimal response to therapy

Support of patient needs related tomanaging adverse drug reactions

Understanding of and compliance withprescribed treatment regimen

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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 bygeneral public may prevent earlydiagnosis and treatment of seriousdisorders, such as lung cancer andemphysema

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Monitoring and managing patient needs:

Risk for injury:

Minimize risk for hospitalized patientsby carefully orienting each patients tosurroundings and closely supervisingpatient

Encourage patientto ask for assistanceif he or she feels dizzy or unsteady

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Educating the patient and family:

Advise patient to read label carefully, followdosage recommendations, and consult primaryhealth care provider if cough persists for morethan 10 days or if fever or chest pain occurs

If taking oral capsules, do not chew or breakopen the capsules, swallow them whole

Do not use with alcohol or other CNSdepressants-antidepressants, hypnotics,sedatives, tranquilizers

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Nursing Process: Evaluation

Therapeutic effect is achieved and coughingis relieved

Patient reports no injuries related to adversereactions

Patient and family demonstrate anunderstanding of drug regimen

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Mucolytics and Expectorants: Actions

Drug with mucolytic activity appears toreduce viscosity of respiratory secretions bydirect action on mucus

Expectorants increase production ofrespiratory secretions, which in turn appears

to decrease viscosity of mucus, helps toraise secretions from respiratory passage

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Mucolytics and Expectorants: Uses

Acute bronchopulmonary disease

Pulmonary complications of cystic fibrosis

Pulmonary complications associated withsurgery

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 knownhypersensitivity

Expectorant potassium iodide iscontraindicated during pregnancy

Expectorants are used cautiously duringpregnancy and lactation and in patients with:

Persistent cough; severe respiratoryinsufficiency or asthma; older adults ordebilitated patients

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Mucolytics and Expectorants:Interactions

Patient may experience hypokalemia;cardiac arrhythmias; or cardiac arrest whenpotassium-containing medications andpotassium-sparing diuretics are administeredwith iodine products

Thyroid function tests may also be altered byiodine

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Preadministration assessment:

Assess respiratory status of patient beforeadministering drug

Documents lung sounds, amount of dyspnea,and consistency of sputum

Ongoing assessment:

Note any increase in sputum or change inconsistency

Immediately before and after tx withacetylcysteine, Auscultate lungs and recordfindings of both assessments on clients chart

Between txs, evaluate patients respiratory

status and record these findings on patientschart

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Nursing Process: Planning

Expected outcome includes:

Optimal response to therapy

Support of patient needs related tomanagement of adverse drug reactions

Understanding of and compliance with theprescribed treatment regimen

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Nursing Process: Implementation Promoting an optimal response to therapy:

Explain treatment to patient and

demonstrates how nebulizer will be used Remain with patientduring first few

treatments

If acetylcysteine is ordered to be insertedinto a tracheostomy, make sure suctionequipment is at bedside to beimmediately available for aspiration of

secretions

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Managing and monitoring patient needs:

Ineffective airway clearance:

Encourage patient to take deep,diaphragmatic breaths

Monitor amount and consistency ofsputum

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Nursing Process: Implementation Educating the patient and family:

Provide full instruction to patient or familymember about use and maintenance of

equipment, as well as technique for administrationof acetylcysteine

Instruct patient to take drug as directed andcontact primary health care provider if any

unusual symptoms occur during use of drug or ifdrug appears to be ineffective

See Box pg. 290*

Return demonstrate

Continue tx until entire drug gone

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Nursing Process: Evaluation Therapeutic effect is achieved, and

secretions are thinned and easilyexpectorated

Patient has an easy, unlabored breathingpattern

Adverse reactions are identified, reported,

successfully with nursing interventions patient and family demonstrate an

understanding of the drug regimen and useof equipment to administer the drug

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