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Medications to control airway secretions: Nursing Pharmacology

Notes

Notes

MEDICATIONS TO CONTROL AIRWAY SECRETIONS, PART 1
DRUG NAME
oxymetazoline (e.g., Afrin nasal spray, Dristan spray), pseudoephedrine 
(e.g., Sudafed), fluticasone 
(e.g., Flonase)
codeine, dextromethorphan (e.g., Robitussin), diphenhydramine (e.g., Benadryl), benzonatate (Tessalon Perles)
CLASS
Nasal decongestants
Antitussives
MECHANISM OF ACTION
Constrict nasal mucosal blood vessels, reduce edema; shrink the nasal mucus membranes; decrease inflammation
Suppress cough reflex at the level of the cough control center
INDICATIONS
Rhinitis, nasal congestion
Non-productive cough
ROUTE(S) OF ADMINISTRATION
PO, NAS
PO
SIDE EFFECTS
  • Anxiety
  • Tremors
  • Insomnia
  • Hypertension
  • Increased blood glucose
  • Rebound nasal congestion (topical)
  • Dizziness
  • Sedation
  • Dry mouth
  • Nausea
  • Constipation

Opioids:
  • Respiratory depression
  • Addictive potential
CONTRAINDICATIONS AND CAUTIONS
  • Hypertension
  • Cardiac disease
  • Hyperthyroidism
  • Diabetes mellitus
  • Chronic productive cough

Non-opioids
  • Children < 12 years
  • Along with MAOIs and SSRIs
Opioids
  • Pregnancy
  • Breastfeeding
  • Along with barbiturates and alcohol
NURSING CONSIDERATIONS
All medications to control airway secretions:

Assessment and monitoring
  • Assess respiratory status, vital signs, and lung sounds before and after administration
  • Monitor for side effects
  • Evaluate therapeutic response
Intranasal decongestants

Assessment and monitoring
  • Assess nasal passages before administration

Client education
  • Gently blow nose before administration
  • Report adverse effects, including systemic effects like hypertension or tachycardia
  • Tolerance and dependence can develop; use medication for the prescribed duration

Oral decongestants

Client education

  • Avoid taking pseudoephedrine near bedtime
Assessment and monitoring
  • After administration, monitor for CNS effects like drowsiness or sedation

Client education
  • Increased hydration and humidifier use
  • If cough persists despite treatment, notify the health care provider
MEDICATIONS TO CONTROL AIRWAY SECRETIONS, PART 2
DRUG NAME
guaifenesin (e.g., Mucinex)
acetylcysteine (Acetadote), dornase alfa (Pulmozyme)
CLASS
Expectorant
Mucolytics
MECHANISM OF ACTION
Increases water content of respiratory secretions and decreases its viscosity
Break down components of mucus and decreases its viscosity
INDICATIONS
Chest congestion
ROUTE(S) OF ADMINISTRATION
PO
PO, nebulization
SIDE EFFECTS
  • Skin rash
  • Gastrointestinal irritation
  • Oropharyngeal irritation
CONTRAINDICATIONS AND CAUTIONS
Chronic cough
acetylcysteine - Asthma
NURSING CONSIDERATIONS
All medications to control airway secretions:

Assessment and monitoring
  • Assess respiratory status, vital signs, and lung sounds before and after administration
  • Monitor for side effects
  • Evaluate therapeutic response
Client education
  • Small, frequent meals can decrease GI discomfort 
  • Take as directed for short duration of time
Client education
  • Never combine medications in a nebulizer 
  • Store dornase alfa in the refrigerator, protected from light 
Memory Anchors and Partner Content
Transcript

There are certain medications that can be used to control airway secretions, which refers to the mucus secreted by the respiratory tract epithelium.

These medications are typically used when the airway secretions are either too much or too thick to be coughed out normally. They can broadly be divided into 4 classes; nasal decongestants, expectorants, mucolytics, and antitussives.

The most commonly used nasal decongestants include sympathomimetic medications like oxymetazoline and pseudoephedrine, and corticosteroids like fluticasone and mometasone; and can be administered orally or intranasally.

Nasal decongestants are usually used to treat a congested, or stuffy, nose, such as from allergic rhinitis. They act by constricting the blood vessels in the nasal mucosa, which ultimately reduces the local tissue edema and shrinks the congested mucosa; while corticosteroids also help decrease inflammation.

Nasal decongestants can lead to side effects like anxiety, tremors, insomnia, hypertension, and increased blood glucose. Prolonged use of decongestants, typically for more than 48 hours, may lead to rebound nasal congestion once the decongestant is stopped.

Additional side effects specific to corticosteroid nasal decongestants include a bad taste after administration, and dryness of the nasal mucosa following continuous use.

Nasal decongestants should be used with caution in clients with hypertension, cardiac disease, hyperthyroidism, or diabetes mellitus, due to their adverse effects on blood pressure and blood glucose.

On the other hand, commonly used expectorants include guaifenesin, usually given orally in the form of cough syrups; while common mucolytics include acetylcysteine and dornase alfa, which are usually given orally or by nebulizer.

Expectorants and mucolytics are used to relieve chest congestion due to infections like the common cold; chronic obstructive pulmonary disease, asthma, and cystic fibrosis.

Both classes of medications act by making the airway secretions thinner, and easier to cough out. Expectorants do that by stimulating the respiratory epithelium to increase the water content in the secretions.

Mucolytics, on the other hand, act by breaking down certain compounds in the airway secretions, making them less viscous.

Expectorants and mucolytics commonly cause side effects like skin rash, and irritation and ulcers of the oropharyngeal mucosa, as well as irritation of the gastrointestinal mucosa, which can result in vomiting or diarrhea.

Expectorants are contraindicated in chronic cough, while the mucolytic N-Acetylcysteine should be used with caution in asthma, as it can increase airway resistance and precipitate an exacerbation.

Finally, antitussives can include opioids like codeine, and non-opioid medications like dextromethorphan, diphenhydramine, and benzonatate.

Antitussives can be given orally, and are only used when the cough is non-productive and irritating to the client, like in the case of a sore throat and post-viral cough.

They directly act on the cough control center in the brain and dampen the cough reflex. That means that the person doesn't feel like coughing anymore.

Antitussives can cause side effects like dizziness, sedation, dry mouth, nausea, and constipation. Additionally, opioid antitussives can cause respiratory depression and also have addictive potential, so they should only be used for short periods.

Antitussives, in general, are contraindicated in chronic productive cough, as they may cause backing up of the secretions within the lungs.

Sources
  1. "Focus on Nursing Pharmacology" LWW (2019)
  2. "Pharmacology 8th Edition: A Patient-Centered Nursing Process Approach" Elsevier Health Sciences (2014)
  3. "Mosby's 2021 Nursing Drug Reference" Mosby (2020)
  4. "Saunders Comprehensive Review for the NCLEX-RN Examination" Saunders (2019)
  5. "Mucoactive drugs" European Respiratory Review (2010)
  6. "Goodman & Gilman's: The Pharmacological Basis of Therapeutics, 13e" McGraw-Hill Education (2018)