Expectorants & Mucolytics

Question 1

What is an expectorant?

Answer 1

helps loosen phlegm and thin bronchial secretions in respiratory tract (lungs, trachea, nose, sinus cavities); promotes cough

Question 2

Is Guaifenesin an expectorant or a mucolytic?

Answer 2

expectorant

Question 3

Robitussin DM is a combination of what two drugs?

Answer 3

guaifenesin and Dextromethorphan

Question 4

guaifenesin MOA

Answer 4

• Thought to act as expectorant by increasing the effective hydration of the respiratory tract, maintains the layer needed for ciliary clearance and reduces the viscosity of respiratory mucus, thereby further facilitating its removal by natural clearance processes
• Inhibits cough reflex sensitivity in subjects with upper respiratory tract infections whose cough receptors are transiently hypersensitive, but not in healthy volunteers

Question 5

guaifenesin ADRs

Answer 5

o GI: n/v/d
If pt is nauseous, take with food and should be fine
o CNS: drowsiness

Generally well tolerated

Question 6

what is a mucolytic used n cystic fibrosis?

Answer 6

Dornase Alfa (Pulmozyme)

Question 7

name 2 mucolytic drugs

Answer 7

Dornase Alfa (Pulmozyme)

Acetylcysteine

Question 8

what is Dornase Alfa (Pulmozyme) MOA

Answer 8

enzyme that selectively cleaves DNA

In cystic fibrosis, there are a lot of organisms that live in lungs and colonize there, and one of the problems in cystic fibrosis is that they can’t clear the mucous. It will cleave the organisms DNA and will make the molecule size smaller so the pt can clear it out easier.

Question 9

how is Dornase Alfa dosed?

Answer 9

nebulizer

Question 10

____has characteristic thick, purulent mucous made up of highly polymerized DNA from the nuclei of degenerating neutrophils

Answer 10

cystic fibrosis

Question 11

why are mucolytics used in treating cystic fibrosis

Answer 11

reduction of thick mucous will reduce infections and/or need for abx

Question 12

Dornase Alfa ADRs

Answer 12

irritation/pharyngitis, SOA

Question 13

what is the name of the mucolytic drug that also can be used as an antidote?

Answer 13

Acetylcysteine

Question 14

Acetylcysteine uses

Answer 14

o Cystic fibrosis (no good evidence that it is helpful)
o Acetaminophen overdose
o Renal protection for contrast dye (controversial and definitely off-label)
o OTC as nutritional supplement

Question 15

what kind of overdose is Acetylcysteine used to treat?

Answer 15

Acetaminophen overdose

Question 16

Acetylcysteine mucolytic MOA

Answer 16

free sulfhydryl group which opens up the disulfide bonds in mucoproteins

Question 17

Acetylcysteine Hepatic protection agent in APAP toxicity MOA

Answer 17

restores hepatic glutathione, serving as a glutathione substitute, and enhancing the nontoxic sulfate conjugation of acetaminophen

Question 18

Acetylcysteine Presumed prevention of contrast-induced nephropathy MOA

Answer 18

scavenge oxygen-derived free radicals and improve endothelium-dependent vasodilation

Question 19

what are the Acetylcysteine dosage forms?

Answer 19

IV, PO, nebulized solution

Question 20

what dosage form of Acetylcysteine is used for lungs?

Answer 20

nebulizer solution

Question 21

what dosage form of Acetylcysteine is used for Tylenol overdose?

Answer 21

IV, PO

Question 22

What are ADRs of Acetylcysteine?

Answer 22

o Anaphylaxis: can occur more with IV form, usually within first couple hours of tx
o GI: n/v especially

Question 23

what is used to predict liver toxicity and thus needed for tx with NAC?

Answer 23

Rumack-Matthew nomogram

Question 24

for treatment of cystic fibrosis, is Acetylcysteine or Dornase Alfa better?

Answer 24

Dornase Alfa

Question 25

when prescribing Acetylcysteine, you can pretreat the patient with a ______.

Answer 25

bronchodilator

Question 26

what is something that patients really complain about when using Acetylcysteine as a mucolytic?

Answer 26

Odor can be unpleasant, It cleaves sulfa groups so it smells like rotten eggs

Question 27

For Renal Protection, what form of Acetylcysteine would you use?

Answer 27

IV