Can a patient with hypoxia and possible aspiration pneumonia be given an order for cough medication, as the patient is coughing but no PRN (pro re nata, or as needed) cough medication is listed on the electronic medical administration record (EMAR)?

From the Guidelines

I strongly recommend requesting an order for a cough suppressant such as hydrocodone 5-10 mg every 4-6 hours as needed for this newly admitted patient with hypoxia and possible aspiration pneumonia who is experiencing cough without a PRN cough medication order. When contacting Dr. Chengat, specify the patient's current cough severity, frequency, and whether it's productive or non-productive, as this will help determine the most appropriate medication 1. If the cough is productive and helping clear secretions, a suppressant might not be ideal. For a patient with possible aspiration pneumonia, positioning (head of bed elevated at least 30 degrees) and good oral care are also important supportive measures while waiting for the medication order. The cough may be related to the patient's hypoxia or developing pneumonia, so monitoring oxygen saturation and respiratory status is essential while addressing the symptom.

Some key points to consider when selecting a cough suppressant include:

• The patient's underlying condition, such as lung cancer, may require a different approach to cough management 1
• Opioids, such as hydrocodone, appear to be effective cough suppressants in patients with lung cancer 1
• Non-opioid options, such as benzonatate, may also be effective in certain cases 1
• The potential for adverse effects, such as somnolence, should be considered when selecting a medication 1

It is essential to weigh the benefits and risks of each medication option and consider the patient's individual needs and circumstances when making a decision. In this case, hydrocodone 5-10 mg every 4-6 hours as needed is a reasonable option to consider, given its efficacy in patients with lung cancer and its relatively good safety profile 1.

From the FDA Drug Label

BENZONATATE is indicated for the symptomatic relief of cough. The patient is coughing, and benzonatate is indicated for the symptomatic relief of cough.

• The patient can be given an order for benzonatate as needed for cough, as it is indicated for this use 2.
• The dosage for adults is one 100 mg or 200 mg capsule three times a day as needed for cough 2.

From the Research

Patient Care

• The patient is experiencing coughing, but there is no cough medicine ordered on the EMAR.
• The patient has been diagnosed with hypoxia and possible aspiration pneumonia.

Relevant Studies

• A study from 1998 3 found that benzonatate can be effective in treating opioid-resistant cough in advanced cancer patients.
• However, this study may not be directly relevant to the current patient's situation, as there is no mention of opioid-resistant cough.
• Other studies 4, 5, 6 focus on different topics, such as the use of chest CT imaging in COVID-19 patients, postmortem hydrocodone concentrations, and the added value of high-resolution CT beyond chest X-ray in determining the extent of physiologic impairment in sarcoidosis patients.
• None of these studies provide direct guidance on the management of cough in patients with hypoxia and possible aspiration pneumonia.

Potential Next Steps

• Consider consulting with the patient's healthcare team to determine the best course of action for managing the patient's cough.
• Review the patient's medical history and current medications to identify any potential underlying causes of the cough.
• Discuss the possibility of ordering a cough medicine or other treatment options with the patient's healthcare provider.