NURS 309: MEDS TO TREAT UPPER RESPIRATORY DISORDERS

Antitussives – Class & Action

A client with a persistent dry cough is prescribed dextromethorphan. The nurse explains that this medication works by doing what?

It is an antitussive that acts on the cough center in the medulla to raise the cough threshold, reducing the urge to cough.

Antitussives – Therapeutic Use

A client asks why they were given an antitussive instead of an expectorant. What is the best response?

Antitussives are used to suppress dry, nonproductive coughs, especially when coughing is irritating or interferes with sleep.

Antitussives – Key Assessment

Before administering an antitussive, what is the priority nursing assessment?

Assess whether the cough is dry or productive, since suppressing a productive cough can lead to mucus retention and respiratory complications.

Antitussives – Opioid vs Non-opioid

A client is prescribed codeine for cough. What additional effect should the nurse monitor for compared to non-opioid options?

Codeine is an opioid antitussive, so it can cause CNS depression, respiratory depression, and has a risk for dependence.

Antitussives – Administration

A client is prescribed an antitussive for nighttime use. Why is this timing appropriate?

Antitussives suppress coughing, which helps improve sleep by reducing nighttime cough interruptions.

Antitussives – Common Side Effects

A client taking dextromethorphan reports feeling “a little off.” What common side effects should the nurse expect?

Common side effects include drowsiness, dizziness, & nausea.

Antitussives – Adverse Effects

A client taking codeine develops slowed breathing and excessive sedation. What is the nurse’s priority concern?

Respiratory depression, a serious adverse effect of opioid antitussives that requires immediate intervention.

Antitussives – Drug Interactions

A client taking dextromethorphan is also on an MAOI. What is the priority risk?

There is a risk of serotonin syndrome, which can be life-threatening.

Antitussives – Contraindication

Why should antitussives be avoided in clients with productive coughs?

Suppressing a productive cough can cause mucus buildup, leading to airway obstruction and infection.

Antitussives – Precautions

Why should antitussives be used cautiously in older adults?

They increase the risk of sedation, confusion, and falls, especially with opioid formulations.

Antitussives – Client Teaching

What should the nurse teach a client about safety while taking antitussives?

Avoid alcohol and other CNS depressants, and do not drive until the drug’s effects are known due to drowsiness.

Antitussives – Misuse Risk

A client is taking large amounts of dextromethorphan. What is the nurse’s concern?

Dextromethorphan can be abused at high doses, leading to euphoria, hallucinations, and toxicity.

Opioid Analgesic, Antitussive – Class & Action

A client is prescribed codeine for pain and cough suppression. How does this medication produce both effects?

It is an opioid that binds to receptors in the CNS, reducing pain perception & suppressing the cough reflex by acting on the medulla.

Opioid Analgesic, Antitussive – Therapeutic Use

A client is prescribed codeine. What are the primary indications for this medication?

It is used to treat mild to moderate pain & to suppress dry, nonproductive cough.

Opioid Analgesic, Antitussive – Key Assessment

Before administering codeine, what is the priority nursing assessment?

Assess RR, depth, & oxygenation, since opioids can cause respiratory depression.

Opioid Analgesic, Antitussive – Administration

A nurse is preparing to administer codeine. What is an important administration consideration?

Ensure RR is adequate (typically ≥12/min) & monitor closely after admin for sedation & breathing changes.

Opioid Analgesic, Antitussive – Common Side Effects

A client taking codeine reports feeling very sleepy and constipated. Are these expected?

Yes, common SEs include:

• drowsiness

• sedation

• constipation

• nausea

• dizziness

Opioid Analgesic, Antitussive – Adverse Effects

A client becomes difficult to arouse with slowed breathing after taking codeine. What is the nurse’s priority concern?

Respiratory depression & opioid overdose, which require immediate intervention.

Opioid Analgesic, Antitussive – Antidote

A client experiences opioid-induced respiratory depression. What medication should the nurse anticipate administering?

Naloxone, an opioid antagonist that reverses respiratory depression.

Opioid Analgesic, Antitussive – Drug Interactions

A client taking codeine also consumes alcohol. Why is this dangerous?

Alcohol & other CNS depressants can enhance sedation & significantly increase the risk of respiratory depression.

Opioid Analgesic, Antitussive – Contraindications

In which client should codeine be avoided?

Clients with:

• severe respiratory disorders

• acute asthma

• those w hypersensitivity to opioids

Opioid Analgesic, Antitussive – Precautions

Why should codeine be used cautiously in children and OAs?

They are more sensitive to respiratory depression & CNS effects, increasing the risk of serious complications.

Opioid Analgesic, Antitussive – Client Teaching

What should the nurse teach a client taking codeine about daily safety?

• Avoid ETOH

• do not drive until effects are known

• take precautions to prevent falls due to drowsiness

Opioid Analgesic, Antitussive – Constipation Management

A client on codeine reports constipation. What should the nurse recommend?

Increase fluid & fiber intake & consider stool softeners, as constipation is a common opioid effect.

Dextromethorphan – Class & Action

A client is prescribed dextromethorphan. How does this medication suppress coughing?

It is an antitussive & NMDA receptor antagonist that acts on the cough center in the medulla to suppress the cough reflex & reduce the urge to cough.

Dextromethorphan – Therapeutic Use

A client with a dry cough from a cold is taking dextromethorphan. What is the expected effect?

It provides short-term relief of nonproductive cough caused by minor throat & bronchial irritation.

Dextromethorphan – Nursing Assessment

Before administering dextromethorphan, what should the nurse assess?

• Assess cough characteristics (dry vs productive), lung sounds, & sputum

• Monitor for misuse & S/S of serotonin syndrome if taking serotonergic drugs

Dextromethorphan – Administration

A client is prescribed liquid dextromethorphan. What instructions should the nurse include?

• Shake the suspension well

• take PO as directed (ER q12 hr)

• avoid drinking fluids immediately after dosing to prevent dilution

Dextromethorphan – Common Side Effects

A client reports feeling dizzy after taking dextromethorphan. What other effects are expected?

• Nausea

• dizziness

• drowsiness

• mild sedation

• euphoria

Dextromethorphan – Adverse Effects

A client becomes agitated and confused while taking dextromethorphan. What is the priority concern?

Serotonin syndrome, as well as possible hallucinations, agitation, or anaphylaxis.

Dextromethorphan – Drug Interactions

A client is taking fluoxetine and begins dextromethorphan. What should the nurse monitor for?

Increased risk of serotonin syndrome due to interaction w SSRIs, MAOIs, & other serotonergic medications.

Dextromethorphan – CNS Depression Risk

Why should a client avoid alcohol while taking dextromethorphan?

ETOH & other CNS depressants increase sedation & can impair mental alertness.

Dextromethorphan – Contraindications

Which clients should not take dextromethorphan?

• Clients taking MAOIs within the past 14 days

• those w productive cough

• children < 4

• hypersensitivity

Dextromethorphan – Precautions

What conditions require caution with dextromethorphan use?

• hx of med misuse

• diabetes (some formulations contain sugar)

• liver impairment

• OAs

• persistent cough

Dextromethorphan – Client Teaching

What should the nurse teach a client about taking dextromethorphan?

• Use only for dry cough

• avoid ETOH & sedatives

• do not exceed recommended dose

• avoid driving if drowsy

Dextromethorphan – When to Notify Provider

When should a client contact their provider?

If cough lasts > 1 week or is accompanied by fever, rash, chest pain, or persistent headache.

Codeine – Class & Action

A client is prescribed codeine for pain and cough. How does this medication work?

It is an opioid analgesic & antitussive that binds to opioid receptors & acts on the medullary cough center to reduce pain perception & suppress the cough reflex.

Codeine – Therapeutic Use

A client is receiving codeine. What are the expected therapeutic uses?

Management of mild to moderate pain & suppression of persistent, nonproductive cough.

Codeine – Nursing Assessment

Before administering codeine, what should the nurse assess?

• Assess BP, HR, respiratory status, & level of sedation.

• Monitor for respiratory depression, constipation, effectiveness, & signs of dependence.

Codeine – Safety Monitoring

A hospitalized client is receiving codeine. What safety measures should the nurse implement?

Use fall precautions such as keeping side rails up & ensuring the call light is within reach due to sedation & dizziness risk.

Codeine – Administration

How should codeine be administered to reduce GI side effects?

Administer PO w food or milk, & carefully measure doses, especially w liquid formulations.

Codeine – Common Side Effects

A client reports constipation and nausea while taking codeine. Are these expected?

Yes, common side effects include:

• constipation

• N/V

• dizziness

• sweating

Codeine – Adverse Effects

A client becomes very drowsy with slow breathing after taking codeine. What is the priority concern?

Severe respiratory depression & CNS depression, which can be life-threatening.

Codeine – Cardiovascular Effects

What cardiovascular adverse effects can occur with codeine?

Hypotension & bradycardia, especially at higher doses.

Codeine – Drug Interactions

Why should codeine not be combined with alcohol or sedatives?

CNS depressants (including ETOH & MAOIs) can increase sedation & significantly raise the risk of respiratory depression.

Codeine – Contraindications

Which clients should not receive codeine?

Clients with:

• significant respiratory depression

• acute/severe asthma

• known allergy

• children < 12

• pediatric clients post-tonsillectomy or adenoidectomy

Codeine – Precautions

What conditions require caution when using codeine?

• Head trauma

• increased ICP

• renal or hepatic impairment

• OAs due to increased sensitivity to CNS depression & constipation

Codeine – Dependence Risk

Why must codeine be tapered after long-term use?

Abrupt discontinuation can lead to withdrawal symptoms due to physical dependence.

Codeine – Client Teaching

What should the nurse teach a client taking codeine?

• Take only as prescribed

• avoid ETOH & CNS depressants

• avoid driving until effects are known

• increase fluids/fiber to prevent constipation

Expectorants – Class & Action

A client is prescribed an expectorant for a cough. How does this medication help?

It is an expectorant that thins & loosens respiratory secretions, making mucus easier to cough up from the airways.

Expectorants – Therapeutic Use

A client with a productive cough is prescribed an expectorant. What is the expected benefit?

It helps clear mucus from the airways, improving breathing & reducing chest congestion.

Expectorants – Key Drug Example

A client is prescribed guaifenesin. What type of medication is this?

Guaifenesin is an expectorant used to help loosen & expel mucus from the respiratory tract.

Expectorants – Nursing Assessment

Before administering an expectorant, what should the nurse assess?

Assess cough characteristics (productive vs dry), lung sounds, sputum color/consistency, & hydration status.

Expectorants – Administration

What is an important administration instruction for expectorants?

Encourage increased fluid intake (if not contraindicated) to help thin mucus & improve effectiveness.

Expectorants – Additional Nursing Care

What nonpharmacologic measures enhance the effect of expectorants?

Humidified air, coughing techniques, & adequate hydration help mobilize secretions.

Expectorants – Common Side Effects

A client taking guaifenesin reports mild GI discomfort. Is this expected?

Yes, common side effects include:

N/V and mild GI upset.

Expectorants – Adverse Effects

What serious adverse effects can occur with expectorants?

Rarely, allergic rxs such as rash or anaphylaxis may occur.

Expectorants – Drug Interactions

Do expectorants have many significant drug interactions?

They have minimal major interactions but should be used cautiously with combination cough/cold products to avoid duplication.

Expectorants – Contraindications

When should expectorants be used cautiously or avoided?

Use caution in clients w chronic cough (e.g., asthma, smoking) unless directed by a provider.

Expectorants – Precautions

Why should hydration status be monitored with expectorants?

Dehydration reduces effectiveness because mucus will remain thick & harder to clear.

Expectorants – Client Teaching

What should the nurse teach a client taking an expectorant?

Drink plenty of fluids, use humidification, & practice effective coughing to clear mucus.

Expectorants – When to Notify Provider

When should a client taking an expectorant contact the provider?

If cough lasts > 1 week or is accompanied by fever, rash, or persistent chest pain.

Guaifenesin – Class & Action

A client is prescribed guaifenesin for chest congestion. How does this medication work?

It is an expectorant that stimulates vagal nerve endings to increase respiratory secretions, thinning mucus & making it easier to cough up.

Guaifenesin – Therapeutic Use

A client with thick mucus and congestion is taking guaifenesin. What is the expected benefit?

It helps loosen and thin mucus, improving airway clearance & relieving chest congestion.

Guaifenesin – Nursing Assessment

Before administering guaifenesin, what should the nurse assess?

Assess cough characteristics, lung sounds, sputum, hydration status, & hx of kidney stones.

Guaifenesin – Administration

A client is prescribed extended-release guaifenesin tablets. What instruction is most important?

Swallow tablets whole (do not crush or chew) & take w a full glass of water to enhance effectiveness.

Guaifenesin – Liquid Administration

What teaching is important for liquid guaifenesin?

Use a proper measuring device for dosing & avoid eating or drinking for 30 minutes after taking syrup.

Guaifenesin – Common Side Effects

A client reports mild stomach upset while taking guaifenesin. What other effects are expected?

• GI discomfort (N/V/D)

• dry mouth

• dizziness

• drowsiness

• headache

• rhinorrhea

Guaifenesin – Adverse Effects

A client develops flank pain and hematuria while taking guaifenesin. What is the concern?

Nephrolithiasis (kidney stones), along with possible allergic reactions or rare metabolic complications.

Guaifenesin – Serious Reactions

What severe reactions can occur with certain formulations of guaifenesin?

• Metabolic acidosis

• renal failure

• seizures

• CNS depression (esp. w propylene glycol-containing forms)

Guaifenesin – Drug Interactions

Why should a client avoid alcohol or sedatives while taking guaifenesin?

They can increase CNS depression, leading to drowsiness & impaired alertness.

Guaifenesin – High-Risk Interactions

What medications increase the risk of serious interactions with guaifenesin?

• MAOIs, SSRIs, SNRIs, TCAs (risk of serotonin syndrome)

• antiarrhythmics (e.g., amiodarone)

• diabetes meds

Guaifenesin – Contraindications

Which clients should not take guaifenesin?

Clients with:

• hypersensitivity

• hx of kidney stones

• those taking MAOIs, phenylketonuria (some forms)

• children < 4 (or < 12 for ER)

Guaifenesin – Precautions

What conditions require caution with guaifenesin?

• Kidney impairment

• unresolved cough lasting > 1 week

• use in young children

Guaifenesin – Client Teaching

What should the nurse teach a client taking guaifenesin?

• Increase fluid intake

• avoid ETOH & CNS depressants

• do not exceed dose

• avoid driving until effects are known

Guaifenesin – When to Notify Provider

When should a client contact the provider while taking guaifenesin?

If symptoms last > 7 days or occur w fever, rash, or persistent headache.

Sympathomimetic (Alpha-Adrenergic Agonist) – Class & Action

A client is prescribed a nasal decongestant like phenylephrine. How does this medication relieve congestion?

It is a sympathomimetic alpha-adrenergic agonist that causes vasoconstriction in nasal blood vessels, reducing swelling & congestion.

Sympathomimetic (Alpha-Adrenergic Agonist) – Therapeutic Use

A client with nasal congestion from a cold is using an alpha-adrenergic agonist. What is the expected benefit?

Relief of nasal congestion by decreasing mucosal edema & improving airflow.

Sympathomimetic – Common Drugs

A client is prescribed a decongestant. What are common examples in this class?

Phenylephrine, pseudoephedrine, & oxymetazoline.

Sympathomimetic – Nursing Assessment

Before administering this medication, what should the nurse assess?

Assess BP, HR, nasal congestion severity, & hx of HTN or CVD.

Sympathomimetic – Administration (Nasal)

A client is using oxymetazoline nasal spray. What instruction is most important?

Do not use for > 3–5 days to avoid rebound congestion.

Sympathomimetic – Administration (Oral)

What should the nurse teach about oral decongestants?

Take as directed & avoid taking close to bedtime due to stimulation & insomnia.

Sympathomimetic – Common Side Effects

A client reports feeling “jittery” after taking a decongestant. What is the cause?

Common side effects include:

• nervousness

• restlessness

• insomnia

• increased HR

Sympathomimetic – Cardiovascular Effects

What cardiovascular effects can occur with alpha-adrenergic agonists?

• HTN

• tachycardia

• palpitations due to vasoconstriction

Sympathomimetic – Adverse Effects

A client develops severe headache and very high blood pressure after taking a decongestant. What is the concern?

Hypertensive crisis, esp. in clients w uncontrolled HTN.

Sympathomimetic – Drug Interactions

Why should these medications not be combined with MAOIs?

They can cause severe HTN or hypertensive crisis.

Sympathomimetic – Contraindications

Which clients should avoid alpha-adrenergic agonists?

Clients with:

• severe HTN

• CAD

• those taking MAOIs

Sympathomimetic – Precautions

What conditions require caution when using these medications?

• HTN

• diabetes

• hyperthyroidism

• glaucoma

• OAs

Sympathomimetic – Client Teaching

What should the nurse teach a client taking a decongestant?

• Avoid caffeine

• monitor BP

• limit nasal spray use to 3–5 days

• report palpitations or severe headache

Sympathomimetic – Rebound Congestion

A client reports worsening congestion after stopping a nasal spray. What is the cause?

Rebound congestion from prolonged use of topical nasal decongestants.

Phenylephrine – Class & Action

A client is prescribed phenylephrine for nasal congestion. How does this medication work?

It is a sympathomimetic alpha₁-adrenergic agonist that causes vasoconstriction, shrinking swollen nasal mucosa & reducing congestion.

Phenylephrine – Therapeutic Use

A client with allergic rhinitis is taking phenylephrine. What is the expected benefit?

Relief of nasal congestion associated w colds, allergies, a&d sinusitis; IV form may also treat hypoTN.

Phenylephrine – Nursing Assessment

Before administering phenylephrine, what should the nurse assess?

• Monitor BP, HR, heart rhythm

• assess for HTN, CVD, & hypersensitivity

Phenylephrine – Rebound Monitoring

What should the nurse monitor with prolonged nasal use?

S/S of rebound congestion & chronic overuse.

Phenylephrine – Intranasal Administration

What teaching is important for nasal spray use?

• Use q4hr PRN

• clear nasal passages before use

• spray while gently inhaling

• limit use to 3–5 days

Phenylephrine – Oral Administration

What should the nurse teach about oral phenylephrine?

Use is typically short-term (no more than 7 days if not improving), & effectiveness may be limited compared to other decongestants.

Phenylephrine – IV Administration

When is IV phenylephrine used?

For hypoTN during anesthesia or shock via continuous infusion.

Phenylephrine – Common Side Effects

A client reports feeling nervous and having a headache after taking phenylephrine. Are these expected?

Yes, common side effects include:

• headache

• dizziness

• nervousness

• nausea

• rebound congestion

Phenylephrine – Nasal Side Effects

What local effects can occur with nasal phenylephrine?

• Burning

• stinging

• sneezing

• increased nasal discharge

Phenylephrine – Adverse Effects

A client develops chest pain and very high blood pressure after taking phenylephrine. What is the concern?

• Severe HTN

• dysrhythmias

• reflex bradycardia

• possible worsening of angina or HF