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Nneka Anyanwu Southern University School of Nursing

ANTITUSSIVES- CODEINE 2 Antitussives: Codeine There are many medications that affect the respiratory system, from bronchodilators, anti-inflammatory inhalants, antitussives, expectorants, mucolytics and decongestants with their own mechanisms of action. Antitussives suppress the cough reflex by acting on the cough center in the medulla. A primary example of an antitussive is codeine. Codeine (codeine phosphate and codeine sulfate) a narcotic, is found the opium poppy in low concentrations and is most often synthesized from morphine for medical purposes. (Mascavage, 2006, p.99) Codeine has many names, even street. Codeine only syrup is has the trade name Paveral, and other various forms are available, codeine phosphate syrup, codeine tablets, and codeine phosphate injection. Codeine is administered orally in the form of syrup for the relief of coughs, and as tablets for the relief of pain. Codeine phosphate is also given parenterally for the relief of pain. Codeine is mainly found in combination products like Robitussin AC (Guaifenesin and Codeine). (See Chart) Codeines mechanism of action along with other antitussives is to suppress the cough reflex by acting on the cough center in the medulla. Codeine is used in non-productive coughs and is metabolized by the liver and excreted in the urine. There are other uses for codeine, as with being a member of the opioid family, codeine has analgesic properties and is used in combinations with other medications to relieve pain. Codeine is also used as an anti-diarrhea medication in combination formulations, such as codeine and diphenoxylate.

ANTITUSSIVES- CODEINE 3 Nursing considerations include the common mix-up with name confusion with codeine and Cardene (nicardipine) and Lodine (etodolac), so caution should be used when administering these medications. Nurses should administer codeine with caution to a patient who is receiving a central nervous depressant, because this combination can be fatal. The nurse should closely monitor the patients level of consciousness and respiratory status. Nurses should maintain airways patency, access breath sounds, (cough and bronchial secretions). Nurses should also check if patient has any intake of alcohol, sedatives, MAOI, anticholinergic, or tranquilizers as codeine may fatally depress the respiratory system interacting with these drugs. Codeine is contraindicated in patients who are hypersensitive, pregnant or breastfeeding. Patients who have benign prostatic hyperplasia, debilitation, thoracotomy, laparotomy, or a history of drug or alcohol abuse, codeine must be used very cautiously with close monitoring. Close monitoring can show adverse reactions such as drowsiness, drying of respiratory secretions and constipation. Nursing teaching about this drug include dosage, frequency, duration and possible adverse effects, signs and symptoms to discuss with the physician, safety measures, fluid needs, possible physical dependency if a narcotic drug is used, avoidance of alcohol and other over the counter products, compliance with therapy, and follow up care, including laboratory tests and physician visits. (Lippincott, 2004, p. 111) Further nursing responsibilities is to advise the patient with a nonproductive cough to minimize talking, stop smoking, maintain adequate environmental humidity, and use chewing gum or sugarless candy to reduce coughing. Instruct the patient to consult the physician if the cough lasts more than 1 week or is accompanied by fever or chest pain. Instruct the patient not to

ANTITUSSIVES- CODEINE 4 consume liquids within 30 minutes of taking an antitussive because liquids may negate soothing local effects and tell the patient to check with his health care provider before taking any over the counter or herbal medications. (Lippincott, 2004, p. 111) With safe use and close monitoring, Codeine is an effective drug in managing cough, pain and diarrhea.

ANTITUSSIVES- CODEINE 5 Reference Page Lippincott Williams, S., & Wilkins, D. (2004).Straight a's in nursing pharmacology. (1st ed., pp. (110-111). Ambler: Lippincott Williams & Wilkins. Mascavage, L. M., Wilson, M. L., & Dalton, D. R. (2006). Syntheses of morphine and codeine. Current Organic Synthesis, 3(1), 99. Retrieved from Med net- codeine. (2007, May 12). Retrieved from ne_phosphate.htm Eddy, N. B., Friebel, H., & Halbach, H. (1970). Codeine and its alternates for pain and cough relief. Bull World Health Organ, 40(3), 425-444. Retrieved from