Expectorants & Mucolytics Flashcards
What is an expectorant?
helps loosen phlegm and thin bronchial secretions in respiratory tract (lungs, trachea, nose, sinus cavities); promotes cough
Is Guaifenesin an expectorant or a mucolytic?
expectorant
Robitussin DM is a combination of what two drugs?
guaifenesin and Dextromethorphan
guaifenesin MOA
- 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
guaifenesin ADRs
o GI: n/v/d
If pt is nauseous, take with food and should be fine
o CNS: drowsiness
Generally well tolerated
what is a mucolytic used n cystic fibrosis?
Dornase Alfa (Pulmozyme)
name 2 mucolytic drugs
Dornase Alfa (Pulmozyme)
Acetylcysteine
what is Dornase Alfa (Pulmozyme) MOA
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.
how is Dornase Alfa dosed?
nebulizer
____has characteristic thick, purulent mucous made up of highly polymerized DNA from the nuclei of degenerating neutrophils
cystic fibrosis
why are mucolytics used in treating cystic fibrosis
reduction of thick mucous will reduce infections and/or need for abx
Dornase Alfa ADRs
irritation/pharyngitis, SOA
what is the name of the mucolytic drug that also can be used as an antidote?
Acetylcysteine
Acetylcysteine uses
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
what kind of overdose is Acetylcysteine used to treat?
Acetaminophen overdose
Acetylcysteine mucolytic MOA
free sulfhydryl group which opens up the disulfide bonds in mucoproteins
Acetylcysteine Hepatic protection agent in APAP toxicity MOA
restores hepatic glutathione, serving as a glutathione substitute, and enhancing the nontoxic sulfate conjugation of acetaminophen
Acetylcysteine Presumed prevention of contrast-induced nephropathy MOA
scavenge oxygen-derived free radicals and improve endothelium-dependent vasodilation
what are the Acetylcysteine dosage forms?
IV, PO, nebulized solution
what dosage form of Acetylcysteine is used for lungs?
nebulizer solution
what dosage form of Acetylcysteine is used for Tylenol overdose?
IV, PO
What are ADRs of Acetylcysteine?
o Anaphylaxis: can occur more with IV form, usually within first couple hours of tx
o GI: n/v especially
what is used to predict liver toxicity and thus needed for tx with NAC?
Rumack-Matthew nomogram
for treatment of cystic fibrosis, is Acetylcysteine or Dornase Alfa better?
Dornase Alfa
when prescribing Acetylcysteine, you can pretreat the patient with a ______.
bronchodilator
what is something that patients really complain about when using Acetylcysteine as a mucolytic?
Odor can be unpleasant, It cleaves sulfa groups so it smells like rotten eggs
For Renal Protection, what form of Acetylcysteine would you use?
IV
