Antitussives

To suppress cough reflex Indicated for nonproductive coughs! Drugs used to stop or reduce coughing Opioid and non-opioid (narcotic and non-narcotic) Two Basic types of cough Productive cough o Congested, excessive secretions Nonproductive cough o Dry cough Antitussives: Mechanism of Action Opioids o Suppress the cough reflex by direct action on the cough centre in the medulla Examples: codeine (Robitussin A-C, Dimetane- DC) Hydrocodone o Onset: 15-30 min Non-opioids/non-narcotic (less effective) o Suppress the cough reflex by anesthetizing the stretch receptors in the respiratory tract and preventing the cough reflex from being stimulated by the medulla center in the brain Examples: benzonatate (Tessalon Perles) Dextromethrophan (Vicks Formula 44, Robitussin-DM) o Onset: 15-30 min Antitussives: Indications Used to stop the cough reflex when the cough in non-productive and/or harmful Non-opioids (dextromethorphan) o Dizziness, drowsiness, nausea Opioids o Sedation, nausea, vomiting, lightheadedness, constipation Antitussives: Contraindications/Cautions Drug allergy Patients who need to cough to maintain the airways Careful use for patients with asthma and emphysema Caution for patients with history of addiction Antitussives: Nursing Implications Perform respiratory and cough assessment and assess for allergies Instruct patients to avoid driving or operating heavy equipment due to possible desation, drowsiness, or dizziness Provide thorough patient teaching Avoid alcohol Report any signs of the following symptoms to the caregiver:

o Cough that lasts more than a week o A persistent headache o Fever o Expectorants Drugs that aid the expectoration (removal) of mucus Reduce the viscosity of secretions Disintegrate and thin secretions Expectorants: Mechanism of Action Direct stimulation o The secretory glands are stimulated directly to increase their production of respiratory tract fluids Examples: iodine-containing products such as iodinated glycerol and potassium iodide Reflex stimulation o Agent causes irritation of the GI tract o Loosening and thinning of respiratory tract secretions occur in response to this irritation Example: Guaifenesin (Robitussin) Final result: thinner mucus that is easier to remove Expectorants: Drug Effects By loosening and thinning sputum and bronchial secretions, the tendency to cough is indirectly diminished Expectorants: Indications Used for the relief of nonproductive coughs associated with o Common cold o Bronchitis o Laryngitis o Pharyngitis o Pertussis o Influenza o Measles o Coughs caused by chronic paranasal sinusitis Expectorants: Nursing Implications Expectorants should be used with caution in the elderly or those with asthma or respiratory insufficiency Clients taking expectorants should receive more fluids, If permitted, to help loosen and liquefy secretions Report a fever, cough, or other symptoms lasting longer than a week Monitor for intended therapeutic effects

Mucolytics
Reacts directly with mucus to make it more watery. This should help make the cough more productive

Mucolytics: Indications Patients with difficulty mobilizing secretions COPD, pneumonia, TB Used during diagnostic bronchoscopy to clear the airway In patients with tracheostomies to facilitate airway clearance and suctioning Mucolytics: cough preparation Dosage o Acetylcysteine 100mg two to four times daily 200mg two to three times daily 600mg once daily o Bromhexine 8-16mg three times daily p.o. o Carbocysteine 750mg three times daily, then 1.5g daily in divided doses Adverse effects o GI upset, rhinorrhea (rhinitis medicamentosa), bronchospasm Mucolytics: Contraindications/Cautions Caution in cases of acute bronchospasm, peptic ulcer and esophageal varices because the increase secretions could aggravate the problem