Expectorants and Mucolytics

Expectorants are drugs that liquefy the lower respiratory tract secretions. They are used for the symptomatic relief of respiratory conditions characterized by a dry, nonproductive cough.

Mucolytics work to break down mucus to aid high-risk respiratory patients in coughing up thick, tenacious secretions.

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

Table of Contents

• Expectorants and Mucolytics: Generic and Brand Names
• Disease Spotlight: Chronic Obstructive Pulmonary Disease
• Expectorants
  • What are Expectorants?
  • Therapeutic actions
  • Indications of Expectorants and Mucolytics
  • Pharmacokinetics
  • Contraindications and Cautions
  • Adverse effects
• Mucolytics
  • What are mucolytics?
  • Therapeutic Actions
  • Indications
  • Pharmacokinetics
  • Contraindications and Cautions
  • Adverse Effects
• Nursing Considerations for Expectorants and Mucolytics
  • Nursing Assessment
  • Nursing Diagnosis and Care Planning
  • Nursing Implementation with Rationale
  • Evaluation
• Practice Quiz: Expectorants and Mucolytics
• Recommended Resources
• See Also
• References and Sources

Expectorants and Mucolytics: Generic and Brand Names

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

• Expectorants
  • guaifenesin (Mucinex)
• Mucolytic
  • acetylcysteine (Mucomyst)
  • dornase alfa (Pulmozyme)

Disease Spotlight: Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is a permanent, chronic obstruction of the airways, often related to cigarette smoking.

• COPD is caused by two related disorders- emphysema and chronic bronchitis- both of which result in airflow obstruction on expiration, as well as overinflation of the lungs and poor gas exchange.
• Emphysema is characterized by loss of the elastic tissue of the lungs, destruction of alveolar walls, and resultant alveolar hyperinflation with a tendency to collapse with expiration.
• Chronic bronchitis is a permanent inflammation of the airways with mucus secretion, edema, and post inflammatory defenses.

Expectorants

What are Expectorants?

Expectorants increase productive cough to clear the airways.

• They liquefy lower respiratory tract secretions, reducing the viscosity of these secretions and making it easier to cough them up.
• Expectorants are available in many OTC preparations, making them widely available to the patient without advice from a health care provider.

Therapeutic actions

The desired actions of expectorants include:

• Enhances the output of respiratory tract fluids by reducing the adhesiveness and surface tension of these fluids, allowing easier movement of the less viscous secretions.

Indications of Expectorants and Mucolytics

Expectorants are indicated for the following:

• Symptomatic relief of respiratory conditions characterized by a dry, nonproductive cough.

Pharmacokinetics

Guaifenesin is rapidly absorbed, with an onset of 30 minutes and a duration of 4 to 6 hours.

Route	Onset	Peak	Duration
Oral	30 min	Unknown	4-6h
T 1/2: Unknown | Metabolization: Unknown | Excretion: Unknown

Contraindications and Cautions

The following are contraindications and cautions when using expectorants:

• Allergy. This drug should not be used in patients with a known allergy to the drug to prevent hypersensitivity reactions.
• Pregnancy or lactation. This drug should be used with caution in pregnancy and lactation because of the potential adverse effects on the fetus or baby.
• Cough. This drug should not be used with persistent coughs, which could be indicative of an underlying medical problem.

Adverse effects

Adverse effects from the use of expectorants:

• GI: Nausea, vomiting, anorexia.
• CNS: Headache, dizziness.
• Underlying cough: The most important consideration in the use of these drugs is discovering the cause of the underlying cough; prolonged use of the OTC preparations could result in the masking of important symptoms of a serious underlying disorder.
• Respiratory: Rhinorrhea, bronchospasm.
• Skin: Rash.

Mucolytics

What are mucolytics?

Mucolytics increase or liquefy respiratory secretions to aid the clearing of the airways in high-risk respiratory patients who are coughing up thick, tenacious secretions.

• Patients may be suffering from conditions such as chronic obstructive pulmonary disease (COPD), cystic fibrosis, pneumonia, or tuberculosis.

Therapeutic Actions

The desired actions of mucolytics include:

• Protect liver cells from being damaged during episodes of acetaminophen toxicity because it normalizes hepatic glutathione levels and binds with a reactive hepatotoxic metabolite of acetaminophen.
• Affects the mucoproteins in the respiratory secretions by splitting apart disulfide bonds that are responsible for holding the mucus material together.
• The result is a decrease in the tenacity and viscosity of the secretions.
• Dornase alfa is a mucolytic prepared by recombinant DNA techniques that selectively break down respiratory tract mucus by separating extracellular DNA from proteins.

Indications

Mucolytics are indicated for the following:

• Liquefaction of secretions in high-risk respiratory patients who have difficulty moving secretions including postoperative patients (e.g., patients with tracheostomies to facilitate airway clearance and suctioning).
• Clearing of secretions for diagnostic tests (e.g., diagnostic bronchoscopy).
• Used orally to protect the liver from acetaminophen toxicity.
• Treatment of atelectasis from thick mucus secretions.

Pharmacokinetics

Mucolytics may be administered by nebulization or by direct instillation into the trachea via an endotracheal tube or tracheostomy.

Route	Onset	Peak	Duration
Instilation inhalation	1 min	5-10 min	2-3h
Oral	30-60 min	1-2h	Unknown
T 1/2: 6.25 hours | Metabolization: Liver | Excretion: Urine

Contraindications and Cautions

The following are contraindications and cautions when using mucolytics:

• Medical conditions. Caution should be used in cases of acute bronchospasms, peptic ulcer, and esophageal varices because the increased secretions could aggravate the problem.

Adverse Effects

Adverse effects from the use of expectorants and mucolytics include the following:

• GI: Nausea, vomiting, anorexia.
• CNS: Headache, dizziness.
• Underlying cough: The most important consideration in the use of these drugs is discovering the cause of the underlying cough; prolonged use of the OTC preparations could result in the masking of important symptoms of a serious underlying disorder.
• Respiratory: Rhinorrhea, bronchospasm.
• Skin: Rash.

Nursing Considerations for Expectorants and Mucolytics

Nursing considerations when using expectorants and mucolytics include the following:

Nursing Assessment

History taking and physical examination of a patient using expectorants and mucolytics include:

• Assess for possible contraindications and cautions: any history of allergy to the drug; persistent cough due to smoking, asthma, or emphysema, which would be cautions to the use of the drug; and very productive cough, which would indicate an underlying problem that should be evaluated.
• Perform a physical examination to establish baseline data for assessing the effectiveness of the drug and the occurrence of any adverse effects associated with the drug therapy.
• Assess the skin for the presence of lesions and color to monitor for any adverse reactions.
• Monitor temperature to assess for underlying infection.
• Assess respirations and adventitious sounds to evaluate the respiratory response to the drug effects.
• Monitor orientation and affect to monitor CNS effects of the drug.
• Monitor blood pressure and pulse to evaluate cardiac response to drug treatment.

Nursing Diagnosis and Care Planning

Nursing diagnoses related to the use of expectorants or mucolytics are:

• Acute pain related to GI, CNS, or skin effects of the drug.
• Disturbed sensory perception (Kinesthetic) related to CNS effects.
• Deficient knowledge regarding drug therapy.
• Ineffective airway clearance related to bronchospasm.

Nursing Implementation with Rationale

The nursing interventions for patients using expectorants include:

• Proper administration. Caution the patient not to use these drugs for longer than 1 week and to seek medical attention if the cough persists after that time to evaluate for any underlying medical condition and to arrange for appropriate treatment.
• Prevent GI upset. Advise the patient to take small, frequent meals to alleviate some of the GI discomfort associated with these drugs.
• Ensure safety. Advise the patient to avoid driving or performing dangerous tasks if dizziness and drowsiness occur to prevent patient injury.
• Avoid overdosage. Alert the patient that these drugs may be found in OTC preparations and that care should be taken to avoid excessive doses.
• Provide health education. 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 to promote compliance.
• Offer support. Offer support and encouragement to help the patient cope with the disease and with the drug regimen.

Nursing interventions for patients using mucolytics include:

• Ensure drug effectiveness. Avoid combining other drugs in the nebulizer to avoid the formation of precipitates and potential loss of effectiveness of either drug.
• Proper drug delivery. Dilute concentrate with sterile water for injection if buildup becomes a problem that could impede drug delivery.
• Prevent skin breakdown. Note that patients receiving acetylcysteine by face mask should have the residue wiped off the face mask and off the face with plain water to avoid skin breakdown.
• Proper use of nebulizer. Review use of the nebulizer with patients receiving dornase alfa at home to ensure the most effective use of the drug.
• Proper storage. Patients should be cautioned to store the drug in the refrigerator, protected from light.
• Dornase alfa use. Caution cystic fibrosis patients receiving dornase alfa about the need to continue all therapies for their cystic fibrosis because dornase alfa is only a palliative therapy that improves respiratory symptoms, and other therapies are still needed.
• Provide health education. 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 to promote compliance.
• Provide support. Offer support and encouragement to help the patient cope with the disease and with the drug regimen

Evaluation

Evaluation of a patient using expectorants and mucolytics include the following:

• Monitor patient response to the drug (improved effectiveness of cough).
• Monitor for adverse effects (skin rash, GI upset, bronchospasm, CNS effects).
• Evaluate the effectiveness of the teaching plan (patient can name drug, dosage, adverse effects to watch for, specific measures to avoid them, and measures to take to increase the effectiveness of the drug).
•  Monitor the effectiveness of comfort and safety measures and compliance with the regimen.

Practice Quiz: Expectorants and Mucolytics

Here’s a 5-item quiz for this expectorants and mucolytics study guide. Please visit our nursing test bank page for more NCLEX practice questions.

1. A client is prescribed with Guaifenesin (Mucinex). The nurse determines that the client understands the proper administration of this medication if the client states that he or she will:

A. Take an additional dose once fever and cough persist
B. Limit oral fluid intake
C. Drink extra fluids while taking this medication
D. Take the medication with meals only

1. Answer: C. Drink extra fluids while taking this medication

• Option C: Guaifenesin is an expectorant. Drink extra fluids to help loosen the congestion and lubricate the throat while taking this medication
• Option A: Additional doses should not be taken without the prescription of the doctor.
• Option B: Fluids are needed to loosen the secretions.
• Option D: The medication does not have to be taken with meals.

2. A nurse is about to administer Albuterol (Ventolin HFA) 2 puff and Budesonide (Pulmicort Turbohaler) 2 puff by metered dose inhaler. The nurse plans to administer by?

A. Alternating with a single puff each, starting with albuterol.
B. Alternating with a single puff each, starting with budesonide.
C. Albuterol inhaler first then the budesonide.
D. Budesonide inhaler first then the albuterol.

2. Answer: C. Albuterol inhaler first then the budesonide.

• Option C: If two different inhaled medications are prescribed and one of the medications contains a corticosteroid, administer the bronchodilator (Albuterol) first and the corticosteroid (Budesonide) second; this will allow for the widening of the air passages by the bronchodilator, making the corticosteroids more effective.

3. A client with a chronic obstructive pulmonary disease is prescribed with Ipratropium (Combivent). Upon reviewing the medical history of the patient, the nurse questions the prescription if which of the following is noted?

A. History of a previous infection
B. History of allergy to peanut
C. History of allergy to egg
D. History of smoking

3. Answer: B. History of allergy to peanut.

• Option B: The client with a peanut allergy should not take ipratropium because the product contains soy lecithin, which is in the same plant family as peanuts.

4. The nurse should instruct a client who is taking an expectorant to:

A. Take antihistamines
B. Avoid vaporizers
C. Restrict fluids
D. Increase fluids

4. Answer: D Increase fluids.

• Option D: Increasing fluids will help liquefy secretions and facilitate removal.
• Option A: Taking antihistamines does not have any effect for the client.
• Option B: Avoiding vaporizers would not help in liquefying secretions.
• Option C: Restricting fluids could not help in mobilizing the secretions.

5. A nurse teaches a client about the use of a respiratory inhaler. Which action by the client indicated a need for further teaching?

A. Inhales the mist and quickly exhales.
B. Presses the canister down with finger as he breathes in.
C. Removes the cap and shakes the inhaler well before use.
D. Waits 1 to 2 minutes between puffs if more than one puff has been prescribed.

5. Answer: A. Inhales the mist and quickly exhales.

• Option A: The client should be instructed to hold his or her breath at least 10 to 15 seconds before exhaling the mist.
• Options B, C, D: These are all correct procedures when using an inhaler.

Recommended Resources

Our recommended nursing pharmacology resources and books:

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See Also

Here are other nursing pharmacology study guides:

• Nursing Pharmacology – Study Guide for Nurses
  Our collection of topics related to nursing pharmacology
• Pharmacology Nursing Mnemonics & Tips
  These nursing mnemonics aim to simplify the concepts of pharmacology through the use of a simple, concise guide.
• Generic Drug Name Stems Cheat Sheet
  Learn about these generic drug name stems to help you make sense of drugs easier!
• Common Drugs and Their Antidotes
  A guide to drug antidotes that nurses should be familiar about.
• IV Fluids and Solutions Guide & Cheat Sheet
  Get to know the different types of intravenous solutions or IV fluids in this guide and cheat sheet.
• Drug Dosage Calculations NCLEX Practice Questions (100+ Items)
  Care to take the challenge? This quiz aims to help students and registered nurses alike grasp and master the concepts of medication calculation.

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Individual drug guides and nursing considerations for the most common medications used in nursing pharmacology:

• Acetaminophen (Tylenol)
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• Furosemide (Lasix)
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• Hydromorphone (Dilaudid)
• Lisinopril
• Metoprolol
• Morphine

References and Sources

The following are the recommended supplemental reading for this expectorants and mucolytics nursing pharmacology study guide:

• Adams, M. P., & Urban, C. (2015). Pharmacology: Connection to Nursing. Pearson Education.
• Karch, A. M., & Karch. (2011). Focus on nursing pharmacology. Wolters Kluwer Health/Lippincott Williams & Wilkins. [Link]
• Katzung, B. G. (2017). Basic and clinical pharmacology. McGraw-Hill Education.
• Lehne, R. A., Moore, L. A., Crosby, L. J., & Hamilton, D. B. (2004). Pharmacology for nursing care.
• Smeltzer, S. C., & Bare, B. G. (1992). Brunner & Suddarth’s textbook of medical-surgical nursing. Philadelphia: JB Lippincott.