Ppt chapter032

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Introduction to Clinical Pharmacology

Chapter 32-Antitussives, Mucolytics, and

Expectorants


Antitussives: Actions and Uses 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

Added "some" to 2nd statement


Antitussives: Adverse Reactions 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


Antitussives: Contraindications and PrecautionsAntitussives: Contraindications and 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

change "patient" to "client"


Antitussives: Contraindications and Precautions (cont’d)Antitussives: Contraindications and Precautions (cont’d)• 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



Antitussives: Interactions 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



Nursing Process: AssessmentNursing 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



Nursing Process: AssessmentNursing 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

added "s" to cause


Nursing Process: Planning 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



Nursing Process: ImplementationNursing 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



• 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




• Educating the patient and family:

– Discourage indiscriminate use of nonprescription cough medicines

– 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



Nursing Process: Evaluation 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

change "patient" to client"


Mucolytics and Expectorants: Actions 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


Mucolytics and Expectorants: Uses 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


Mucolytics and Expectorants: Contraindications and PrecautionsMucolytics and Expectorants: Contraindications and Precautions• 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



Mucolytics and Expectorants: Interactions 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



Nursing Process: Assessment Nursing Process: Assessment • Preadministration 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

– Auscultate lungs and record findings of both assessments on patient’s chart

– Evaluate patient’s respiratory status and record these findings on patient’s chart



Nursing Process: Planning 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



Nursing Process: Implementation Nursing Process: Implementation

• Promoting an optimal response to therapy:

– Explain treatment to patient and demonstrates how nebulizer will be used

– Remain with patient during first few treatments

– Make sure suction equipment is at bedside to be immediately available for aspiration of secretions




• Managing and monitoring patient needs:

– Ineffective airway clearance:

•Encourage patient to take deep, diaphragmatic breaths

•Monitor amount and consistency of sputum



Nursing Process: ImplementationNursing 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



Nursing Process: Evaluation 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



End of Presentation

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Ppt chapter032