Antitussives Nursing Implaications
Antitussives Nursing Pharmacology
Coughing is a protective reflex of the body in order to clear obstructions in the respiratory tract. It happens through the stimulation of the sensory receptors present in the glossopharyngeal and vagus nerves that line the mucus membranes of the respiratory system (lower pharynx, larynx, trachea, etc.).
The receptors then signals the cough center in the brain, consequently triggering a reflex response, resulting to the contraction of muscles near the glottis and muscles of expiration. This effect causes sudden pressure increases in the thorax, followed by the easing of the vocal cords and rapid ejection of air.
However, in the event of persistent triggering of this reflex, it may lead to patient exhaustion and irritation of the respiratory tract. To counteract this, antitussives are utilized to control the coughing reflex. Antitussives are a class of medications used to suppress the cough reflex.
They come in different forms and are readily available over-the-counter. Because of this, antitussives may be used excessively and is potential for drug abuse.
Indications for Antitussives
Indicated below are the instances in the use of antitussives, either centrally or peripherally acting:
- as a local anesthetic for the respiratory passages, blocking the receptors that stretches and stimulate the cough reflex
- relief of moderate to moderately severe pain
- treatment of dry cough, drug withdrawal syndrome and opioid-type drug dependence
Actions of Antitussives
The beneficial actions of antitussives are mentioned below:
- Centrally acting antitussive. It acts on the cough center of the brain, located in the medulla oblongata of the brainstem, which in turn weakens the cough reflex and elevates the coughing threshold. Since antitussives have depressing and generalized effects, caution is warranted for patients with head injury or central nervous system disorders.
- Peripherally acting antitussive. It acts on the local nerve endings, causing an anesthetizing effect. It also has a soothing effect to the patient’s throat (demulcent effect)
Pharmacokinetics of Antitussives
Antitussives are readily absorbed in the body with an onset of within 25 to 30 minutes. The peak of effectivity of antitussives is reached after 2 hours, with duration of 3 to 6 hours.
This class of medication is readily metabolized in the liver and excreted via the urine. Antitussives also cross the placenta and can be secreted in a mother’s breast milk.
Side Effects and Adverse Effects of Antitussives
The side effects of antitussives may include:
- Central nervous system – dizziness, headache, drowsiness, nervousness, trouble sleeping
- Gastrointestinal – nausea, constipation, stomach upset
Adverse effects of antitussives are as follows:
- Sleep apnea
- Feelings of euphoria
- Dissociative effects, associated with drug abuse
- Mental or mood changes (e.g., hallucinations)
- Urinary issues
- Generalized weakness
- Respiratory depression (rare)
- Severe drowsiness
- Slow or shallow breathing
- Allergic reaction – rash, itching, swelling (particularly on the tongue, face), etc.
Contraindications and Cautions for Antitussives
The following are the contraindications and cautions when prescribing or administering antitussives:
- Patent airways. It is in contraindicated for patients that would need to maintain patent airways to avoid respiratory distress. Examples are postoperative patients after abdominal or thoracic surgery.
- Asthma and emphysema. It is contraindicated for patients with asthma and emphysema because inhibiting the cough reflex would lead for the pooling of respiratory secretions and losing of respiratory reserve (difference between volume of air breathed while at rest versus the maximum breathing capacity).
- Addiction. Patients with a history of narcotic addiction are cautioned in taking antitussives for some types have components that can induce addiction.
- Sedation. Because of the sedative and drowsiness effect of antitussives, caution should be observed for patients that needs to be alert (will use machineries, will drive, etc.). Also avoid alcoholic beverages for it will add up to the sedative effect of antitussives.
- Pregnancy. Caution is implored for pregnant and lactating mothers, for these drugs can cross the placenta and secreted together with breast milk.
- Various diseases. Caution should be considered for patients with abdominal problems (eg. constipation, ileus, gall bladder disease, pancreatitis), adrenal problems (eg. Addison’s disease), Peripheral vascular issues (e.g. Raynaud’s disease), brain disorders (eg. head injury, increased intracranial pressure), breathing problems (eg. asthma, sleep apnea), diabetes, glaucoma, heart problems, renal issues, liver disease, mental/mood disorders, thyroid problems (eg. Hyperthyroidism), prostate issues, history of substance abuse and obesity.
- Antitussives may also contain aspartame, hence caution is advised for patients with phenylketonuria.
Drug Interactions with Antitussives
Drug interactions involving antitussives are as follows:
- Monoamine oxidase inhibitors – These drugs, when used in tandem with antitussives, may cause hypotension, fever, nausea, myoclonic jerks, and coma.
- Anti-hyperacidity medications – May further increase the effect of antitussives
- Blood pressure medications, anticholinergic drugs, beta blockers – May counteract the therapeutic effect of blood pressure medications.
- Tricyclic antidepressants – Both drug types increases serotonin levels
- Other pain and cough relievers, muscle relaxants, antihistamines – May further potentiate the sedative effect of antitussives
- Antifungals, macrolide antibiotics, HIV medications, certain seizure drugs, antidepressants – May interact with the excretion of antitussives in the body
- Urine laboratory tests (eg. 5-HIAA levels, VMA levels, Amylase/lipase levels) – The use of antitussives would possibly cause false test results.
Nursing Considerations with Antitussives
Listed below are the considerations on the use of antitussives throughout the Nursing process:
Nursing assessment should include:
- Careful history taking, focusing on possible contraindications and cautions (history of allergy, etc.)
- Establish baseline data through performing physical examination
- Monitor temperature changes, looking for possible underlying conditions (i.e., infections)
- Assess quality, depth, and rate of respirations. Take note of adventitious sounds.
- Gauge patient’s orientation, mood and affect.
The possible interventions and focus of nursing action could be:
- Prevention of over dosage
- Assessment of underlying conditions that would warrant for further evaluation
- Considering of other measures in relieving cough
- Patient education with regards to side effects, warning signs, therapy compliance, etc.
- Providing emotional support to the patient in coping with the disease and regimen.
Possible evaluation outcomes are:
- Patient response to the medication
- Assessment of adverse effects
- Effectiveness of health teachings
- Evaluation of effectiveness of other relief measures for cough.
Nursing Care Plan for Patients on Antitussives
Possible Nursing Diagnoses
- Ineffective airway clearance related to localized effects of antitussives
- Disturbed sensory perception related to localized effects of antitussives (CNS)
- Acute Pain related to localized effects of antitussives (GI)
- Disturbed sleep pattern related to the side effect of antitussives
- Risk for injury related to side effects of antitussives (dizziness or drowsiness)
- Constipation related to GI effects of antitussives
- Deficient knowledge related to new drug therapy
|Assess the patient for signs and symptoms of excessive cough, common colds, and/or respiratory tract condition. Auscultate the lungs and assess the respirations and adventitious sounds.||To confirm the indication for administering antitussives.|
|Check the patient’s allergy status.||Alternatives to antitussives should therefore be considered in case of allergy.|
|Assess if the patient is pregnant or lactating.||Pregnant and breastfeeding women with nasal congestion or seasonal rhinitis can continue taking their Category B antitussives daily but will be closely monitored by their physician.|
|Assess the patient’s ability to self-administer the drug.||To check for any potential problems with administration.|
To ensure that the right form of antitussives is given through the right route (usually oral).
|Check for current medications that include monoamine oxidase inhibitors (MAOIs) as these should not be used with antitussives.||MAOIs are not recommended to be used alongside antitussives as the interaction may result to decreased blood pressure levels or hypotension, nausea, myoclonic jerks, fever, or coma.|
Nursing Planning and Intervention
|Administer antitussives at the same time each day, ideally before meals.||Antitussives taken before meals can help the patient eat or drink without being interrupted by excessive coughing.|
|Advise the patient that the antitussives should not be used over a long period of time.||Overdosage of antitussives may result to serious adverse effects in various body systems such as respiratory, CNS, and GI. Persistent symptoms may be clinical manifestations of a more serious condition.|
|Educate the patient about the action, indication, common side effects, and adverse reactions to note when taking antitussives. Instruct the patient on how to self-administer antitussives.||To inform the patient on the basics of antitussives, as well as to empower him/her to safely self-administer the medication.|
|Monitor the patient’s sleep pattern and provide comfort measures that promote better sleep.||Long-term or potent antitussives may cause drowsiness and insomnia.|
|Educate the patient on other measures to relief excessive coughing, such as:Humidifying the roomIncreasing oral fluid intakeCooling the room temperatureUsing lozenges||Non-pharmacologic measures can also help relieve excessive coughing without the need to totally depend on antitussive drugs.|
|Ask the patient to repeat the information about antitussives.||To evaluate the effectiveness of health teaching on antitussives.|
|Monitor the patient’s respiratory rate and routinely auscultate the lungs.||To ensure that the antitussives did not cause any adverse effect on breathing as evidenced by untoward respiratory changes.|
|Monitor the patient’s response to antitussives.||To check if the antitussives are effective or if the dose needs to be adjusted.|
|Monitor for constipation or gastrointestinal upset and treat these symptoms as they appear.||To provide symptomatic relief of the side effects of antitussive drugs once they occur.|
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Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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