Antitussives

Updated on February 11, 2021

Antitussives are drugs that suppress the cough reflex. Persistent coughing can be exhausting and can cause muscle strain and further irritation of the respiratory tract. Many disorders of the respiratory tract are accompanied by an uncomfortable, unproductive cough. Coughing is a naturally protective way to clear the airway of secretions or any collected material, and antitussives prevent these actions.

Learn about the uses and nursing care plan considerations needed for patients taking antitussives in this nursing pharmacology study guide.

Here is a table of commonly encountered antitussives, their generic names, and brand names:

Classification	Generic Name	Brand Name
Antitussives	benzonatate	Tessalon
	codeine	codeine
	dextromethorphan	Benylin
	hydrocodone	Hycodan

Disease Spotlight: The Common Colds

The viruses that cause the common cold invade the tissues of the upper respiratory tract, initiating the release of histamine and prostaglandins, causing an inflammatory response.

As a result of the inflammatory response, the mucous membranes become engorged with blood, the tissues swell, and the goblet cells increase the mucus production.
These effects cause the person with a common cold to complain of sinus pain, nasal congestion, runny nose, sneezing, watery eyes, scratchy throat, and headache.
The swelling can block the outlet of the eustachian tube, which drains the inner ear and equalizes pressure across the tympanic membrane.
If this outlet becomes blocked, feelings of ear stuffiness and pain can occur.

What are antitussives?

Antitussives act on the cough-control center in the medulla to suppress the cough reflex; if the cough is nonproductive and irritating, an antitussive may be taken.

Therapeutic actions of antitussives

The desired actions of antitussives are as follows:

Acts directly on the medullary cough center of the brain to depress the cough reflex.
Because they are centrally acting, they are not the drugs of choice for anyone who has a head injury or could be impaired by central nervous system depression.

Indication of antitussives

Antitussives are indicated for the following:

Local anesthetic on the respiratory passages, lungs, and pleurae, blocking the effectiveness of the stretch receptors that stimulate a cough reflex.
For relief of moderate to moderately severe pain.
For the treatment of dry cough, drug withdrawal syndrome, opioid type drug dependence, and pain.

Pharmacokinetics

Codeine, hydrocodone, and dextromethorphan are rapidly absorbed, metabolized in the liver, and excreted in urine; they cross the placenta and enter breast milk.

Route	Onset	Peak	Duration
Oral	25-30 minutes	2 hours	3-6 hours
Metabolism: Liver Excretion: Urine

Contraindications and Cautions

The following are contraindications and cautions for the use of antitussives:

Patent airways. Patients who need to cough to maintain the airways (e.g., postoperative patients and those who have undergone abdominal or thoracic surgery) to avoid respiratory distress.
Asthma and emphysema. Patients with asthma and emphysema are contraindicated because cough suppression could lead to accumulation of secretions and a loss of respiratory reserve.
Addiction. Patients who are hypersensitive to or have a history of addiction to narcotics; codeine is a narcotic and has addiction potential
Sedation. Patients who need to drive or be alert should use codeine, hydrocodone, and dextromethorphan with extreme caution because these drugs can cause sedation and drowsiness.
Pregnancy. Patients who are pregnant and lactating, because of the potential for adverse effects on the fetus or baby, including sedation and CNS depression.

Adverse Effects

Adverse effects from the use of antitussives include:

CNS: Drowsiness and sedation.
GI: Nausea, constipation, dry mouth, GI upset.

Interactions

Interactions involved in the use of antitussives are:

Monoamine oxidase inhibitors (MAOI). Dextromethorphan should not be used with MAOIs because hypotension, fever, nausea, myoclonic jerks, and coma could occur.

Nursing Considerations for Antitussives

The nursing considerations in administering antitussives include:

Nursing Assessment

Assessment and history taking in a patient using antitussives include the following:

Assess for possible contraindications and cautions (e.g., history of allergy to the drug, cough for more than 1 week, and pregnancy and lactation).
Perform a physical examination to establish baseline data.
Monitor the temperature to evaluate for possible underlying infection.
Assess respirations and adventitious sounds.
Evaluate orientation and affect.

Nursing Diagnosis and Care Planning

The following nursing diagnoses related to antitussive drug therapy may be included in your nursing care plans:

Ineffective airway clearance related to excessive drug effects.
Disturbed sensory perceptions related to CNS effects.
Deficient knowledge regarding drug therapy.

Nursing Interventions with Rationale

The nursing interventions essential for patients using antitussive medications are:

Prevent overdosage. Ensure that the drug is not taken any longer than recommended to prevent serious adverse effects and severity respiratory tract problems.
Assess underlying problems. Arrange for further medical evaluation for coughs that persist or are accompanied by high fever, rash, or excessive secretions; To detect the underlying cause of coughing, and to arrange for appropriate treatment of the underlying problem.
Provide other relief measures from cough. These nursing interventions may include humidifying the room, providing fluids, use of lozenges, and cooling room temperature.
Educate the patient. Provide thorough patient teaching, including the drug name and prescribed dosage, measures to help avoid adverse effects, warning signs that may indicate problems, and the need for periodic monitoring and evaluation, to enhance patient knowledge about drug therapy and promote compliance.
Provide emotional support. Offer support and encouragement to help the patient cope with the disease and the drug regimen.

Evaluation

Evaluation of a patient using antitussives include the following:

Monitor patient response to the drug (control of non-productive cough).
Monitor for adverse effects (respiratory depression, dizziness, sedation).
Evaluate the effectiveness of the teaching plan.
Monitor the effectiveness of other measures to relieve cough.

Practice Quiz: Antitussives

Here’s a 5-item exam for this antitussive study guide. Please visit our nursing test bank page for more NCLEX practice questions.

1. Stephanie will be having her exam in pharmacology tomorrow. She should be aware that antitussive is indicated to:

A. Encourage removal of secretions through coughing
B. Relieve rhinitis
C. Relieve a dry cough
D. Control a productive cough

1. Answer: C. Relieve a dry cough.

Option C: An antitussive is a cough suppressant.
Options A and D: Represents the action of an expectorant.
Option B: Describe the action of a decongestant.

2. Which of the following pathophysiological mechanisms that occur in the lung parenchyma allows pneumonia to develop?

A. Atelectasis
B. Bronchiectasis
C. Effusion
D. Inflammation

2. Answer: D. Inflammation.

Option D: The common feature of all type of pneumonia is an inflammatory pulmonary response to the offending organism or agent.

Options A and B: Atelectasis and bronchiectasis indicate a collapse of a portion of the airway that doesn’t occur in pneumonia.
Option C: An effusion is an accumulation of excess pleural fluid in the pleural space, which may be a secondary response to pneumonia.

3. Antitussives are useful in blocking the cough reflex and preserving the energy associated with prolonged, nonproductive coughing. Antitussives are best used with the following except:

A. Postoperative patients
B. COPD patients who tire easily
C. Patients with a dry, irritating cough
D. Asthma patients

3. Answer: D. Asthma patients.

Option D: Patients with asthma need patent airways which coughing could provide.
Options A, B, and C: These conditions may warrant the use of antitussives.

4. Antitussives are indicated for which of the following patients?

A. Timothy who has difficulty of breathing
B. David who has just recovered from narcotine addiction
C. Aubry who has dry cough
D. Kelley who is pregnant

4. Answer: C. Aubry who has dry cough.

Option C: One of the indications of administration of antitussives is a nonproductive, irritating cough.
Option A: Antitussives suppress the cough reflex which could compromise the airway of someone who has difficulty of breathing.
Option B: Narcotine addiction is a contraindication for administering of antitussives.
Option D: Antitussives are contraindicated for a patient who is pregnant.

5. Use of antitussives is associated with which of the following adverse effects?

A. Drowsiness
B. Constipation
C. Nausea
D. All of the above

5. Answer: D. All of the above.

Options A, B, and C: All of these symptoms are adverse effects of antitussives.

Sources and References

The following are the recommended supplemental reading for this antitussive nursing pharmacology study guide:

Irwin, R. S., Curley, F. J., & Bennett, F. M. (1993). Appropriate use of antitussives and protussives. Drugs, 46(1), 80-91. [Link]
Lilley, L. L., Shelly Rainforth Collins, P., & Snyder, J. S. (2019). Pharmacology and the nursing process. Mosby. [Link]
SEVELIUS, H., & COLMORE, J. P. (1966). Objective assessment of antitussive agents in patients with chronic cough. The Journal of new drugs, 6(4), 216-223. [Link]