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Pharmacology · chapter 24 · Upper Respiratory Disorder Drugs

Antitussives

The 14 things this section of the textbook says that you are most likely to be asked about — quoted word for word, not retold. Then 6 practice questions with the reasoning.

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Key points

  1. How antitussives are thought to work

    Although their exact mechanism of action is unknown, it is thought that these medications inhibit the cough center in the brain or soothe nerve receptors around airways to reduce transmission of cough signals to the brain.

  2. Not for productive coughs

    Antitussives are not recommended for productive coughs where the client is coughing up mucus due to the infection risk that can result from the buildup of mucus in the respiratory system.

  3. Main concerns with opioid antitussives

    The main concern with opioid antitussives is the potential for dependence, respiratory depression, and gastrointestinal issues such as constipation. Due to the opioid component, addiction is a concern, as is overdose of the drug.

  4. How codeine suppresses cough

    The drug works by suppressing the cough reflex through direct action on the cough center in the medulla.

  5. Opioid antitussive adverse effects

    Opioid antitussives can cause drowsiness, dizziness, confusion, and hypotension. Dependence is also a concern due to the opioid portion.

  6. Who should avoid opioid antitussives

    Clients with angle-closure glaucoma, pyloric stenosis, peptic ulcer disease, and prostatic hyperplasia should also avoid opioid antitussives.

  7. Benzonatate adverse effects to report

    Clients should discuss with their health care provider any medications they are currently taking and inform the provider immediately if they experience rash, itching, or confusion because these are adverse effects (MedlinePlus, 2017).

  8. Why dextromethorphan is a common choice

    This drug is a common choice for relief of cough because it does not cause addiction and has little to no CNS depression.

  9. Caution in sedated or supine clients

    Clients with a hypersensitivity to nonopioid antitussives should avoid their use, and they should be used with caution in clients who are sedated or must remain supine.

  10. Lower doses for older adults

    Opioid antitussive doses may need to be reduced in older adults. Older adults are more sensitive to opioids and more likely to have adverse reactions.

  11. Watch respirations and driving

    Opioid antitussives can cause respiratory depression. Respirations should be monitored closely. Antitussives can cause drowsiness, and clients should avoid driving until they know how the drug will affect them.

  12. Assess respiratory status first

    Prior to administering, assess the client’s respiratory status for signs of respiratory distress that indicate additional evaluation and treatment is indicated.

  13. Vital signs with opioid antitussives

    For clients taking opioid antitussives, monitor vital signs for hypotension and respiratory depression before and after administration.

  14. Codeine black box warning

    Antitussives containing codeine have a high risk of addiction, abuse, and misuse.

Terms to know

Antitussives
Antitussives are drugs that are used to treat nonproductive coughs. They are more commonly referred to as cough suppressants.
Nonopioid antitussives
Nonopioid antitussives are antitussives that do not contain an opioid component.

Practice questions

Stuck on select-all-that-apply? How to take them one option at a time.

The graded version needs JavaScript. Every question is below anyway, with the answer and why.

Every question here, with the answer

  1. A client with pneumonia is coughing up thick yellow mucus and asks for a cough suppressant. What should the nurse consider?

    1. Antitussives are not recommended for productive coughs because mucus buildup raises infection risk.
    2. An opioid antitussive is the best choice for productive coughs.
    3. Any antitussive will help clear the mucus.
    4. Dextromethorphan will loosen the mucus.

    Answer: Antitussives are not recommended for productive coughs because mucus buildup raises infection risk.

    Antitussives treat nonproductive coughs; for productive coughs they are not recommended because the buildup of mucus increases infection risk. Suppressing the cough does not clear mucus.

  2. Before giving codeine/guaifenesin, the nurse notes a respiratory rate of 9 breaths/min and a drowsy client. What should the nurse do?

    1. Give the dose with a stimulant drink.
    2. Hold the dose and notify the health care provider.
    3. Give the dose; drowsiness is expected.
    4. Give half the dose.

    Answer: Hold the dose and notify the health care provider.

    Opioid antitussives can cause respiratory depression, so vital signs are checked before administration and respirations monitored closely. A slow rate and drowsiness are reasons to hold and report, not to give any amount.

  3. Which client conditions call for avoiding an opioid antitussive? Select all that apply.

    1. Prostatic hyperplasia
    2. Peptic ulcer disease
    3. Seasonal allergies
    4. Pyloric stenosis
    5. Angle-closure glaucoma

    Answer: Prostatic hyperplasia, Peptic ulcer disease, Pyloric stenosis, Angle-closure glaucoma

    Clients with angle-closure glaucoma, pyloric stenosis, peptic ulcer disease, and prostatic hyperplasia should avoid opioid antitussives. Seasonal allergies are not a listed contraindication.

  4. A client asks why the provider recommended dextromethorphan instead of a codeine cough syrup. Which explanation is accurate?

    1. Dextromethorphan has no side effects at all.
    2. Dextromethorphan works on productive coughs only.
    3. Dextromethorphan does not cause addiction and has little to no CNS depression.
    4. Dextromethorphan is safe for children under age 4.

    Answer: Dextromethorphan does not cause addiction and has little to no CNS depression.

    Dextromethorphan is a common choice because it does not cause addiction and has little to no CNS depression. It still causes drowsiness, dizziness, and nausea, treats nonproductive coughs, and is contraindicated in children under 4.

  5. A nurse is teaching a client who is going home with an antitussive. Which instructions should be included? Select all that apply.

    1. Take extra doses if the cough keeps you awake.
    2. Increase fluid intake to help loosen secretions.
    3. Avoid smoking and other irritants.
    4. Report a cough that lasts longer than 1 week.
    5. Keep the medication out of the reach of children.

    Answer: Increase fluid intake to help loosen secretions., Avoid smoking and other irritants., Report a cough that lasts longer than 1 week., Keep the medication out of the reach of children.

    Clients report a cough lasting more than 1 week, increase fluids, keep antitussives away from children, and avoid irritants such as smoking. Recommended doses should not be exceeded.

  6. An older client is prescribed an opioid antitussive. Which nursing action is most important?

    1. Give the maximum adult dose.
    2. Initiate fall precautions.
    3. Encourage the client to drive to appointments.
    4. Restrict fluids.

    Answer: Initiate fall precautions.

    Opioid antitussives cause hypotension, dizziness, and drowsiness, and older adults are more sensitive to opioids, so fall precautions are started. Driving, maximum doses, and fluid restriction are not appropriate.

Where every quote comes from

Section 24.2 Antitussives of Pharmacology for Nurses by Tina Barbour-Taylor, Leah Mueller (Sabato), Donna Paris, Dorie Weaver, OpenStax, 2024. Read the whole section free at openstax.org.

The textbook is licensed under CC BY-NC-SA 4.0. This page quotes it word for word and adds the headings, the order and the practice questions; references to the book's figures and stray spaces left by its formatting are removed. The page is shared under the same licence. Nothing here is sold.