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Antitussives | 마이메르시 MyMerci
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Antitussives

NCLEX Review Guide: Antitussives for Respiratory Conditions

Antitussive Medications Overview

Classification and Mechanism

  • Antitussives are medications that suppress or reduce the frequency and intensity of coughing by acting on the cough center in the medulla oblongata. They are classified into two main categories: opioid (narcotic) and non-opioid (non-narcotic) antitussives.
  • Opioid antitussives like codeine and hydrocodone work by depressing the cough reflex center, while non-opioid antitussives like dextromethorphan achieve similar effects without the risk of respiratory depression or addiction potential.

Memory Aid: "COUGH"

Codeine (opioid)
Opioid vs non-opioid
Use for dry, nonproductive coughs
Give with caution in respiratory conditions
Hydrocodone (opioid alternative)

Key Points

  • Antitussives are indicated for dry, nonproductive coughs that interfere with sleep or daily activities
  • Never suppress productive coughs as this can lead to mucus retention and secondary infections
  • Opioid antitussives carry risk of respiratory depression, especially in elderly or compromised patients

Major Antitussive Medications

Opioid Antitussives

  • Codeine is the most commonly prescribed opioid antitussive, typically given in doses of 15-30mg every 4-6 hours for adults. Monitor for respiratory depression, especially when combined with other CNS depressants or in patients with compromised respiratory function.
  • Hydrocodone is often combined with other medications and provides effective cough suppression but requires careful monitoring for signs of abuse potential and respiratory complications.

Non-Opioid Antitussives

  • Dextromethorphan (DM) is the most widely used OTC antitussive, available in 15-30mg doses every 4 hours for adults. It's safer than opioid alternatives with minimal side effects, though high doses can cause CNS effects including dizziness and drowsiness.
  • Benzonatate (Tessalon Perles) works by anesthetizing stretch receptors in the lungs and is given as 100-200mg capsules three times daily. Capsules must be swallowed whole - never chewed or crushed as this can cause severe oral and throat numbness.

Nursing Considerations and Patient Education

Assessment and Monitoring

  1. Assess cough characteristics: frequency, productivity, timing, and associated symptoms before administering antitussives
  2. Evaluate respiratory status including rate, depth, oxygen saturation, and lung sounds
  3. Monitor for therapeutic effectiveness and adverse reactions, particularly respiratory depression with opioid antitussives
  4. Assess for contraindications such as productive cough, respiratory depression, or hypersensitivity

Clinical Scenario

A 68-year-old patient with COPD presents with a persistent dry cough keeping them awake at night. They're prescribed codeine 15mg every 6 hours. What are your priority nursing considerations?

Answer: Monitor respiratory status closely due to COPD and age-related decreased respiratory reserve. Assess baseline oxygen saturation, respiratory rate, and lung sounds. Educate about signs of respiratory depression and when to seek help.

Key Points

  • Always assess cough type before administration - productive coughs should not be suppressed
  • Monitor elderly patients closely as they're at higher risk for respiratory depression
  • Educate patients about proper dosing and potential interactions with alcohol or other CNS depressants

Commonly Confused Concepts

Antitussives Expectorants Mucolytics
Suppress cough reflex Promote productive cough Thin mucus secretions
Used for dry, nonproductive cough Used for thick, difficult to expectorate mucus Used for thick, tenacious secretions
Examples: Codeine, Dextromethorphan Examples: Guaifenesin Examples: Acetylcysteine

Memory Aid: "DRY vs WET"

DRY cough = Antitussives (suppress)
WET cough = Expectorants/Mucolytics (help clear)

Common Pitfalls and Study Tips

Frequently Missed Concepts

  • Never give antitussives for productive coughs - this is a common NCLEX trap. Always assess cough characteristics first.
  • Benzonatate capsules must be swallowed whole - chewing or crushing can cause dangerous oral/throat numbness and potential choking.
  • Opioid antitussives in respiratory-compromised patients require extreme caution and frequent monitoring for respiratory depression.

Quick Check Questions

  • □ Can you differentiate between opioid and non-opioid antitussives?
  • □ Do you know when antitussives are contraindicated?
  • □ Can you identify priority assessments for each medication type?
  • □ Do you understand the difference between suppressing vs. promoting cough?

Key Points

  • Antitussives are for dry, nonproductive coughs only
  • Opioid antitussives require respiratory monitoring
  • Patient education about proper administration is crucial for safety
  • Always assess cough characteristics before medication administration

Remember: You're preparing to be a safe, competent nurse! Master these antitussive concepts and you'll confidently handle respiratory pharmacology questions on the NCLEX. Every study session brings you closer to your nursing career goals!

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