Cough & Cold Preparations Study Notes

Cough & Cold Preparations

Antitussives

Central Acting - Nonnarcotic
  • Example:
    • Dextromethorphan (deks troe meth OR fan)
  • Mechanism of Action (MOA):
    • Depresses the cough center in the medulla oblongata
  • Uses:
    • Suppress a _ cough
    • Assist in (nighttime)
  • Adverse Effects:
    • Drowsiness
    • Nausea/Vomiting (N/V)
  • Caution:
    • Pediatrics
    • Potential for behavior disturbance & abuse
    • Risk of respiratory depression at high doses
Central Acting - Narcotic
  • Examples:
    • Codeine (KOE deen)
    • Hydrocodone/chlorpheniramine (hye droe KOE done & klor fen IR a meen)
  • Use:
    • More , cough
  • Adverse Effects:
    • Drowsiness with possible respiratory depression
    • Constipation
    • Narcotic abuse
Peripherally Acting (Non-Prescription)
  • Examples:
    • Honey (dark)
    • Lozenges
    • Hard candy
  • Mechanism of Action (MOA):
    • Increases the flow of saliva
    • Soothes pharyngeal mucosa
    • Suppresses cough
  • Important Note:
    • Do not use honey in children < _ years old
Peripherally Acting (Prescription)
  • Example:
    • Benzonatate (ben ZOE na tate)
  • Mechanism of Action (MOA):
    • Anesthetizes respiratory passage and pleural stretch receptors, reducing the cough reflex
    • Dosage: 3 times a day
Nursing Implications
  1. Do not suppress a _ cough!
  2. Monitor use of controlled substances
  3. Wait 30 minutes after taking cough syrup before drinking liquid

Oral Decongestants

  • Example:
    • Pseudoephedrine (soo doe e FED rin)
  • Regulations:
    • Restrictions on OTC sales, kept behind the pharmacy counter due to potential use in meth production

Nasal Decongestants

  • Example:
    • Oxymetazoline (oks i met AZ oh leen) – nasal spray
  • Mechanism of Action (MOA):
    • Stimulates smooth muscle alpha adrenergic (arteries) receptors
    • Causes vasoconstriction
    • Reduces nasal congestion (mimics the sympathetic nervous system)
Adverse Effects of Oral/Nasal Decongestants
  • Increased _
  • __, palpitations
  • Tremor, nervousness
  • Nasal irritation/dryness (specifically for nasal spray)
  • Rebound _
  • Nasal spray dosages:
    • Do NOT use > _ days
  • Caution/Contraindications:
    • Hypertension, coronary artery disease (CAD)
    • May raise blood pressure (BP)
    • Can lead to tachycardia
    • Potential for addiction

Antihistamines

  • Examples:
    • Chlorpheniramine - ____ generation
    • Loratadine – _ generation
  • Mechanism of Action (MOA):
    • Competitively antagonizes the effect of histamine at the receptor
Uses of Antihistamines
  • Cold symptoms
  • Symptoms include sneezing, itching, watery eyes, runny nose
Adverse Effects of Antihistamines
  • Sedation (noted for first-generation antihistamines)
  • Anticholinergic effects which may include:
    • Dilated pupils
    • Glaucoma
    • Urinary retention
    • Dry mucous membranes
    • Constipation

Expectorants

  • Example:
    • Guaifenesin (gwye FEN e sin)
  • Mechanism of Action (MOA):
    • Stimulates respiratory tract secretions & reduces the viscosity of secretions
  • Adverse Effects:
    • Rare but may include N/V
  • Nursing Implications:
    • Encourage increased oral fluids to reduce viscosity

Combination Products

  • Example:
    • Chlorpheniramine/dextromethorphan (OTC)
  • Uses:
    • Relieves cough (antitussive - dextromethorphan)
    • Relieves allergies (antihistamine - chlorpheniramine)
  • Question:
    • What ingredient is it lacking to be safe for use with high blood pressure?
    • __

Learning Check

  • Question: Which client characteristic would cause the nurse to recommend against using dextromethorphan for a cough?
    • A. The client has a fever of 100.8°F
    • B. The cough is productive of thick green sputum.
    • C. The client has chronic hypertension.
    • D. The cough has been persistent for two days.