ANTITUSSIVE
·
It suppresses the
cough reflex by acting on medulla’s cough-control center.
·
Indications:
o
Nonproductive
cough, cough that interferes with sleep or daily activities
·
Contraindications:
o
Hypersensitivity, pregnancy, breastfeeding, used
cautiously in patients with benign prostatic hyperplasia, debilitation,
thoracotomy, laparotomy, or a history of drug or alcohol abuse
Narcotics
( Opioid)
|
Nonnarcotics(
Nonopioid)
|
codeine phosphate, codeine
sulfate (Codeine®)
|
benzonatate (Tessalon®)
|
hydrocodone (Hycodan®)
|
dextromethorpan (Robitussin DM®)
|
diphenhydramine (Benadryl®, Benylin®)
|
Side Effects:
·
Dizziness,
drowsiness
·
GI irritation,
nausea
·
Dry mouth
·
Constipation
·
Respiratory
depression
Nursing Considerations:
ü
Assess breath
sounds, cough characteristics, frequency and bronchial secretions.
ü
Maintain patent
airway, suction if necessary.
ü
Maintain a fluid
intake of 2-3 L a day for adults.
ü
Instruct patient
if cough lasts longer than 1 week, and a fever or rash occurs, notify the
physician.
ü
Place the patient
with the head of the bed elevated.
ü
Stress the
importance of smoking cessation, and maintain adequate environmental humidity.
ü
Avoid alcohol and
other over-the-counter products.
ü Avoid administration to the patient using narcotics,
sedative hypnotics, barbiturates, or anti-depressants, due to CNS depression
can occur.
ü Advise the patient that possible dependency can occur
if an opioid drug is used.
ü Encourage compliance with the therapy, and take the
drug as prescribed.
ü Stress the need of follow up care and repeat laboratory
test if necessary to monitor condition.
EXPECTORANTS
(bronchomucotropic agents)
·
Used to assist in
the removal of secretions or exudates from the trachea, bronchi, or lungs.
·
It acts by liquefying viscid mucus or mucopurulent
exudates
·
Indications:
o
Common cold, upper
respiratory tract infections, minor bronchial irritations, bronchitis,
influenza, sinusitis, emphysema, bronchial asthma, relieve dry hacking cough
·
Contraindications:
o
Hypersensitivity,
used cautiously with ineffective cough reflex or respiratory insufficiency,
pregnancy, breastfeeding
Example:
|
guaifenesin (Humibid®
Mucinex®, Robitussin®,
Tussin®)
|
Side effects:
·
Drowsiness
·
GI irritations
·
Skin rash
·
Oropharyngeal
irritation
Nursing Considerations:
ü
Take medication
with a full glass of water to enhance effects of expectorants by making
secretions less viscous.
ü Inform health care provider before taking any
over-the-counter or herbal medications.
ü Instruct the patient not to take guaifenesin for a
persistent cough associated with smoking, asthma, emphysema, or excessive
secretions.
MUCOLYTICS
·
Reduce the
viscosity of the bronchial secretions by liquefying and loosening thick mucous
secretions by cleaving disulphide bonds cross-linking mucus glycoprotein
molecules.
·
Indications:
o
Treat abnormal,
viscid, or thick and hard mucus, antidote for acetaminophen overdose
·
Contraindications:
o
Hypersensitivity;
cautiously used in elderly, debilitated, pregnant, or breastfeeding, and patients
with asthma
Example:
|
acetylcysteine (Mucomyst®)
|
dornase alfa (Pulmozyme®)
|
Side effects:
·
Nausea, vomiting
·
Drowsiness
·
Stomatitis
·
Rhinorhhea
·
Chest tightness
Nursing Considerations:
ü Assess the respiratory status before and after each
dose.
ü Administer acetylcysteine (Mucomyst) by nebulizer
because this drug reacts with iron, copper, and rubber; frequently monitor the patient’s
nebulizer equipment for reactive effects.
ü Avoid contamination of the solution and refrigerate an
opened vial. Discard opened vials after 4 days.
ü Provide chest physiotherapy, postural drainage and
encourage coughing and deep breathing to facilitate removal of respiratory
secretions.
ü Instruct the patient to gargle after administration of
the drug to relieve unpleasant odor and dryness.
ü Keep suction equipment available for emergency use.
ü Seek medical help if condition worsens.
DECONGESTANTS
·
Used to reduce the
swelling of the nasal passages by stimulating the alpha-adrenergic receptors,
thus producing vasoconstriction of the capillaries within the nasal mucosa.
·
Indications:
o
Common cold, hay
fever, sinusitis, allergic rhinitis, cough, congestion associated with rhinitis
·
Contraindications:
o
Hypersensitivity,
used cautiously patients with hypertension, cardiac disease, hyperthyroidism,
or diabetes mellitus
Example:
|
oxymetazoline hydrochloride ( Afrin®)
|
phenylephrine hydrochloride (Neo-Synephrine®)
|
phenylproponalamine hydrochloride (Dimetapp®)
|
pseudoephedrine hydrochloride (Sudafed®)
|
xylometazoline hydrochloride (Otrivin®)
|
Side effects:
·
Nervousness
|
·
Nausea, vomiting
|
·
Restlessness
|
·
Hypertension
|
·
Tachycardia
|
·
Hyperglycemia
|
·
Blurred vision
|
Nursing Considerations:
ü Monitor for cardiac dysrhythmias, and blood glucose
levels.
ü Avoid over-the-counter products, and herbal remedies.
ü Inform the patient that the drug may interfere with
sleep, therefore take the drug a few hours before bedtime.
ü Do not break, cut, crush, or chew the capsule or
tablet; take the drug in its complete form.
ü Teach the patient how to administer topical
decongestant properly in the lateral head-low position for drops; in the
upright position for sprays.
ü Instruct patient the importance of limiting the use of
nasal sprays or drops, and not to exceed the recommended amount, frequency,
duration of topical decongestants.
ü Topical administration may cause rebound congestion if
used for more than 5 days in a row.
ü Encourage use of humidifier if nasal dryness occurs.
CORTICOSTEROIDS
·
Act as
anti-inflammatory agents which inhibit the production of cytokines,
leukotrines, and prostaglandins, the recruitment of eosinophils, and the
release of other inflammatory mediators.
·
It works by
decreasing the number and activity of inflammatory cells in the respiratory
tract while inhibiting bronchoconstriction.
·
Indications:
o
Chronic asthma,
chronic bronchitis, allergic rhinitis, and prophylactic treatment for
exercise-induced asthma
·
Contraindications:
o
Hypersensitivity,
acute bronchospasm, status asthmaticus, acute episodes of asthma; cautiously
used in patients with compromised immune systems, glaucoma, kidney disease,
liver disease, convulsive disorders, and diabetes.
Example: (Inhaled corticosteroids)
|
|
beclomethasone dipropionate (Vabceril®,
Beclovent®)
|
|
triamcinolone (Azmacort®)
|
(Oral corticosteroids)
|
fluticasone (Flonase®, Flovent®)
|
prednisolone
|
flunisolide ( AeroBid®)
|
prednisone
|
( I.V. corticosteroids)
|
|
methylprednisolone sodium
|
(DepMedalone®,Depojec®t)
|
hydrocortisone sodium succinate
|
(Cortef® ,Hydrocortone®)
|
(See also Endocrine System Drugs)
Adverse Reactions:
·
Throat irritation
·
Hoarseness
·
Cough
·
Fungal infection
of the mouth and throat
·
Vertigo
·
Headache
·
Hyperglycemia
·
|
·
Immunosuppression
Nursing Considerations:
ü Assess the respiratory condition regularly and assess
peak flow readings before starting treatment
ü Monitor the patient on signs & symptoms of
oropharyngeal fungal infection.
ü Instruct patient to rinse mouth with water after dose.
ü Monitor the growth especially in children receiving
systemic agents or higher doses of inhaled agents. Use the lowest effective
dose to reduce the risk of adverse reactions.
ü For elderly patients, suggest ways to prevent
osteoporosis such as increased calcium intake and weight-bearing exercise.
ü Instruct the patient to follow the prescribed
administration and dosage of the drug.
ü Give oral doses with food to prevent GI irritation.
ü Teach the patient on how to administer the inhaled form
properly via inhalation with the use of a spacer.
ü Recognize early signs & symptoms of adrenal
insufficiency such as fatigue, muscle weakness, fever, anorexia, dyspnea, and
fainting; if these occur notify the physician.
ü Do not stop the drug abruptly.
General Instructions for Metered-Dose
Inhalers:
o
Shake the inhaler
well, with the canister in place, for 5 to 10 seconds immediately after use.
o
Remove the cap and
hold the inhaler system upright.
o
Tilt your head
back slight and breathe out to the end of a normal breath.
o
Hold the inhaler
on preferred method use: holding the
lips around the mouthpiece, holding the inhaler away from the mouth, and use
spacer or extender (Spacers are useful for all patients, especially young
children and older adults).
o
Position the
mouthpiece 2 to 3 finger-widths from open mouth or use spacer.
o
Activate the
inhaler, press down the inhaler to release the medicine, while taking a slow,
deep breath for 3 to 5 seconds.
o
Hold the breath
for about 10 seconds to allow the medicine goes deeply into the lungs and
exhale slowly.
o
If more than one
inhalation is required, wait about 1 minute between inhalations. Two minutes
are allowed between inhalations for metaproterenol (see manufacturer’s
directions for specific times).
o
Rinse or gargle
the mouth after each dose to relieve dry mouth and throat irritation and
prevent fungal infection.
o
If applicable,
rinse the extender and mouthpiece daily in warm water and store them away from
heat.
o
To monitor the
amount of drug remaining in the canister, test the canister by placing it in a
container of water (i.e. a full canister sinks; an empty canister floats).
o
Remember if two
different inhaled medications are prescribed, and one of the medications
contains glucocorticoids (corticosteroid), administer the bronchodilator first
and the corticosteroids second, wait 5 minutes following the bronchodilator
before inhaling the corticosteroids.
