Codeine phosphate

Drug classes:
Antitussive
Opioid agonist analgesics

Therapeutic actions
Acts at opioid receptors in the CNS to produce analgesia, euphoria, sedation; acts in the
medullary cough center to depress cough reflex.

Indications
• Relief of mild to moderate pain in adults and children

• Suppression of coughing induced by chemical or mechanical irritation of the respiratory system

Contraindications and cautions

• Contraindicated with hypersensitivity to opioids, physical dependence on an opioid analgesic
(drug may precipitate withdrawal).
• Use cautiously with pregnancy, labor, lactation, bronchial asthma, COPD, respiratory
depression, anoxia, increased intracranial pressure, acute MI, ventricular failure, coronary
insufficiency, hypertension, biliary tract surgery, renal or hepatic impairment.

Available forms
Tablets – 15, 30, 60 mg; oral solution – 15 mg/5 mL; injection – 15, 30 mg/mL
Adverse effect
CNS (Central Nervous System): Sedation, clamminess, sweating, headache, vertigo, floating
feeling, dizziness, lethargy, confusion, light-headedness, nervousness, unusual dreams, agitation,
euphoria, hallucinations, delirium, insomnia, anxiety, fear, disorientation, impaired mental and physical
performance, coma, mood changes, weakness, tremor, seizures.
CV (Cardiovascular): Palpitation, increase or decrease in BP, circulatory depression, cardiac
arrest, shock, tachycardia, bradycardia, arrhythmia.
Dermatologic: Rash, hives, pruritus, flushing, warmth, sensitivity to cold.
EENT (eye, ear, nose, and throat): Diplopia, blurred vision
 GI (Gastrointestinal): Nausea, vomiting, dry mouth, anorexia, constipation, biliary tract spasm
GU (Genitourinary): Ureteral spasm, spasm of vesical sphincters, urinary retention or
hesitancy, oliguria, antidiuretic effect, reduced libido or potency
Local: Phlebitis following IV injection, pain at the injection site, tissue irritation, and induration
(subcutaneous injection)
Respiratory: Slow, shallow respiration apnea; suppression of cough reflex; laryngospasm;
bronchospasm
Other: Physical tolerance and dependence, psychological dependence

Side effects
https://www.rxlist.com/codeine-phosphate-side-effects-drug-center.htm#professional
Common side effects of codeine phosphate include:
• drowsiness
• lightheadedness
• dizziness
• sedation
• shortness of breath
• nausea
• vomiting
• stomach pain
• sweating
• constipation
• itching
• rash
Serious side effects of codeine phosphate include:
• dependence
• seizures
• confusion
• near-fainting
• slow heart rate and
• shallow breathing.
Nursing Considerations
Assessment
• History: Hypersensitivity to codeine, physical dependence on an opioid analgesic, pregnancy,
labor, lactation, bronchial asthma, COPD, increased intracranial pressure, acute MI, ventricular
failure, coronary insufficiency, hypertension, biliary tract surgery, renal or hepatic impairment
• Physical: Orientation, reflexes, bilateral grip strength, affect; pupil size, vision; pulse,
auscultation, BP; R, adventitious sounds; bowel sounds, normal output; LFTs, renal function
tests
Interventions
• Give to nursing women 4–6 hr before scheduled feeding to minimize drug in milk.
• WARNING: During parenteral administration, ensure that opioid antagonists and facilities for
assisted or controlled respirations are readily available.
• Use caution when injecting subcutaneously into chilled body areas or in patients with
hypotension or in shock; impaired perfusion may delay absorption; with repeated doses, an
excessive amount may be absorbed when circulation is restored.
• WARNING: Do not use IV in children.
• Instruct postoperative patients in pulmonary toilet; drug suppresses cough reflex.
• Monitor bowel function, arrange for laxatives (especially senna compounds—approximate dose
of 187 mg senna concentrate per 120 mg codeine equivalent), bowel training program if severe
constipation occurs.
Benzonatate

Drug class
Antitussive (nonopioid)

Therapeutic actions
Related to the local anesthetics tetracaine; anesthetizes the stretch receptors in the respiratory
passages, lungs, and pleura, hampering their activity and reducing the cough reflex at its source.

Indications
• Symptomatic relief of nonproductive cough

• Unlabeled use: May be used to reduce cough reflex during the procedures (ie, endoscopy)

Contraindications and cautions

• Contraindicated with allergy to benzonatate or related compounds (tetracaine); lactation.

• Use cautiously with pregnancy.

Available forms
Capsules – 100, 200 mgx

Adverse effects
• CNS: Sedation, headache, mild dizziness, hallucinations, nasal congestion, sensation of burning
in the eyes
• Dermatologic: Pruritus, skin eruptions

• GI: Constipation, nausea, GI upset

• Other: Vague “chilly” feeling, numbness in the chest

Side effects
https://medlineplus.gov/druginfo/meds/a682640.html
• nausea
• constipation
• drowsiness
• headache
• dizziness
• stuffy nose
• feeling chill
• burning in the eyes

Nursing considerations
Assessment
• History: Allergy to benzonatate or related compounds (tetracaine); lactation, pregnancy
• Physical: Nasal mucous membranes; skin color, lesions; orientation, affect; adventitious sounds

Interventions
• WARNING: Administer orally; caution patient not to chew or break capsules but to swallow
them whole; choking could occur if drug is released in the mouth.
Dextromethorphan hydrobromide

Drug class
Nonopioid antitussive

Therapeutic actions
Lacks analgesic and addictive properties; controls cough spasms by depressing the cough center
in the medulla; analogue of codeine.

Indications
• Control of nonproductive cough

Contraindications and cautions

• Contraindicated with hypersensitivity to any component (check the label of products for
flavorings, vehicles); sensitivity to bromides; cough that persists for more than 1 wk, tends to
recur, is accompanied by excessive secretions, high fever, rash, nausea, vomiting, or persistent
headache (dextromethorphan should not be used; the patient should consult a physician)
• Use cautiously with lactation, pregnancy.

Available forms
• Gelcaps – 15, 30 mg

• Lozenges – 7.5, 10 mg

• Liquid – 5 mg/5 mL, 10 mg/15mL, 15 mg/5 mL, 30 mg/5 mL

• Syrup – 5 mg/5 mL, 7.5 mg/5 mL, 10 mg/5 mL 20 mg/5 mL

• Sustained-action liquid – 30 mg/5 mL

• Oral disintegrating strips – 7.5, 15 mg

• Freezer pops – 7.5 mg/pop

Adverse effects
• Respiratory: Respiratory depression (with overdose)

Side effects
https://www.rxlist.com/consumer_dextromethorphan/drugs-condition.htm
• Nausea

• Vomiting

• Constipation

• Drowsiness

• Dizziness

• Sedation

• Confusion

• Nervousness

Nursing considerations
Assessment
• History: Hypersensitivity to any component, sensitivity to bromides; cough that persists for
more than 1 wk or is accompanied by excessive secretions, high fever, rash, nausea, vomiting,
or persistent headache, lactation, pregnancy
• Physical: T; R, adventitious sounds

Interventions
• Ensure the drug is used only as recommended. Coughs may be symptomatic of a serious
underlying disorder that should be diagnosed and properly treated; drugs may mask symptoms
of serious disease.