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Cough Syrup via PEG Tube

Specializes in geriatrics.

I am a fairly new LPN working in LTC. Several residents who are NPO have orders for cough syrup to be given via PEG tube for coughs. The cause of the cough varies with each resident. How does cough syrup given via PEG tube help control the cough? Also, when given PO, you don't want to give water after the cough syrup; does the water flush given after PEG tube administration impact its effectiveness?

I've asked my fellow nurses who work night shift with me and no one seems to know. I'm counting on the expertise here to help me understand. Thank you!

roser13, ASN, RN

Specializes in Med/Surg, Ortho, ASC.

The action of most cough syrups is systemic and it doesnt matter how it is administered. I'm not sure if that answers your question.....were you and your co-workers of the opinion that cough syrups are only topical?

indynurse '87

Specializes in Geriatrics/LTC.

I had this very discussion with an MD when he came to make rounds a couple of years ago, his statement to me was that the main active ingredient in the cough syrup worked on the "cough center" in the brain, so therefore worked when given per tube.

If the cough syrup were an expectornat, it would matter. :confused:

If you have any doubts look up the ingredients of the cough syrup and read up on their actions.

Good question. Have seen it ordered to give that way. I wondered myself, but feel it does probably work systemic, as coating the throat is only going to last so long anyways.

nurse2033, MSN, RN

Specializes in ER, ICU.

Cough syrup contains drugs. Those drugs are absorbed in the GI tract and distributed throughout the body in the blood, just like all medications.

DizzyLizzyNurse

Specializes in Peds Medical Floor.

I never understood why you can't give someone water to drink with cough syrup. I couldn't take it without a drink of water. It's always worked for me and the residents I give it to.

Altra, BSN, RN

Specializes in Emergency & Trauma/Adult ICU.

Some scary stuff being posted here ...

OP, get your drug guide and look up "guaifenisin", "dextromethorphan" or whatever the active ingredient is in the cough suppressant that you are administering. You'll have your answer.

BabyLady, BSN, RN

Specializes in NICU, Post-partum.

If it has codeine in it, which many of them do, you can give them water with it because it is a cough surpressant.

rn438

Specializes in Telemetry.

cough syrup doesnt work by coating the throat. it works by absorbing it systemically, so NG or PEG or swallowing it doesnt make a difference. You should know the mechanism of action for every drug you are giving, look it up in a good drug book. You can still expectorate with an NG or peg in place also. Doesnt matter . Cough syrup is very thick and clogs up tubes! Definitely give water afterward.

Altra said:
Some scary stuff being posted here ...

OP, get your drug guide and look up "guaifenisin", "dextromethorphan" or whatever the active ingredient is in the cough suppressant that you are administering. You'll have your answer.

That is what I was thinking.....I was taught in NS to give water with the cough syrup, r/t aiding in loosening secretions and that it acted centrally, no locally.....for that you want a lozenge..

Altra, BSN, RN

Specializes in Emergency & Trauma/Adult ICU.

BabyLady said:
If it has codeine in it, which many of them do, you can give them water with it because it is a cough surpressant.

?????

There are 3 concepts here:

1. The pharmacologic mechanism of action of the cough suppressant.

2. Whether the route of administration affects the mechanism of action.

3. And ... codeine, a morphine-derivative analgesic. It is not a cough suppressant.

Altra said:
?????

codeine, a morphine-derivative analgesic. It is not a cough suppressant.

It is used as an anti-tussive. As was Morphine back in the day.

JenniferSews

Specializes in Professional Development Specialist.

Altra said:
?????

And ... codeine, a morphine-derivative analgesic. It is not a cough suppressant.

Actually it is. Robitussin AC is guafenesin and codeine. In pharm we were taught codeine suppresses the cough center in the brain.

Route of administration of either guafenesin or guafenesin and codeine doesn't matter, nether does water administration. Maybe I could see not taking water with a cough drop, which sometimes contain a mild topical anesthetic (ie benzocaine) which can numb the throat a bit.

ETA- Yes, for your own sake and your patients please flush with water after! Otherwise the sticky mess created will be a huge issue later.

MisMatch, LPN

Specializes in geriatrics.

Thank you all for the information. Most of the residents get either guaifenesin or guaifenesin with dextromethorphan. I understand how the dextromethorphan can work systemically when given via PEG tube. I am still not sure how the guaifenesin alone does anything; my drug book shows it being given PO only.

Po is the same as per PEG tube with such meds. You are not getting any absorption in the mouth...the absorption occurs lower in the GI tract. Mucinex po will have the same effects (and has the same route of absorption) as mucinex via a PEG tube.

Altra, BSN, RN

Specializes in Emergency & Trauma/Adult ICU.

MisMatch said:
Thank you all for the information. Most of the residents get either guaifenesin or guaifenesin with dextromethorphan. I understand how the dextromethorphan can work systemically when given via PEG tube. I am still not sure how the guaifenesin alone does anything; my drug book shows it being given PO only.

Guaifenisin is an expectorant, absorbed through the GI tract. P.O. administration is the same as via PEG tube, except in the case of something topical (like Nystatin) that needs to work in the oral cavity.

Simply put: whether a patient swallows a med which then travels to the stomach & subsequent GI tract, or gets a med via PEG or other NG or enteral access which travels to the stomach & subsequent GI tract ... it is the same route of administration.

DizzyLizzyNurse said:
I never understood why you can't give someone water to drink with cough syrup. I couldn't take it without a drink of water. It's always worked for me and the residents I give it to.

OMGee me too. It kills me when there are residents that look at me like I'm stoopid.

Now...if you were taking honey or something to coat your throat and prevent coughing....thats another story.

BabyLady, BSN, RN

Specializes in NICU, Post-partum.

Altra said:
?????

3. And ... codeine, a morphine-derivative analgesic. It is not a cough suppressant.

Actually, it is. Like the other member stated, it supresses the cough center in the brain.

It is actually an opiate.

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