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Transcript of chapter 32
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Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Introduction to Clinical Pharmacology
Chapter 32-Antitussives, Mucolytics, and
Expectorants
Introduction to Clinical Pharmacology
Chapter 32-Antitussives, Mucolytics, and
Expectorants
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Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
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Herbal AlertHerbal 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 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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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
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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
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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
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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
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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
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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
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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
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Nursing Process: ImplementationNursing 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: ImplementationNursing 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 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 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 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 PrecautionsMucolytics 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 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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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
– Immediately before and after tx with acetylcysteine, Auscultate lungs and record findings of both assessments on client’s chart
– Between tx’s, evaluate patient’s respiratory status and record these findings on patient’s chart
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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
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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
– 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: ImplementationNursing 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: 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
– See Box pg. 290*
• Return demonstrate
• Continue tx until entire drug gone
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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