Mucolytics Chap 9 Flashcards
Will mucolytics work on infected mucus?
no
What diseases increase the volume (or thickness) of mucus?
chronic bronchitis, asthma, cystic fibrosis, acute bronchitis, pneumonia, bronchiectasis,
When would you consider the use of mucolytics?
After patient has been adequately hydrated and has received therapy to decrease infection/ inflammation, and mucus causing irritants have been removed (like tobacco smoke)
Most mucolytic medications work by doing what?
irritating the airway and making the patient’s cough
Are goblet cells innervated?
no
What provides mucin along the airway surface?
submucosal glands
There are approximately _____ goblet cells in every square millimeter of normal airway
6000
T/F The sympathetic system controls submucosal glands
false
What is the physical composition of mucus?
95% water, 3% protein and carbohydrates, 1% lipids
Mucus forms______________ chains
polypeptide chains
What type of cells form mucosa?
pseudostratified columnar ciliated epithelial cells, goblet cells, serous cells and clara cells
The mucocilliary blanket lines the airways from the ____ to the _______.
nose to the terminal bronchi
What function do the cilla perform?
move mucus up the airway, protect lungs from inhaled debris
There are approximately ____ cilia per cell and they beat ____ times per minute.
up to 200 that beat 1000 x/min
T/F The mucosa is innervated.
false
T/F the submucosa is innervated
true
Which layer contains bronchial glands that produce the most mucus, and what is the daily production?
the submucosa; 100 mL/day
What are the two layers that make up the mucociliary blanket?
Gel, sol
What is the thickness of the gel layer?
0.5 to 20 microns
What is the thickness of the sol layer?
7 microns
Which layer is the top layer?
Gel- works like flypaper to trap debris
Which layer has the cilia?
sol layer
Mucus is held together by ____________ bonds.
disulfide.
What are factors that impair mucociliary transport?
diseases, infections, airway drying (moving ISB),extereme temp changes, narcotics, dehydration, ET suctioning, cig smoke, airway trauma, hyperoxia and hypoxia
What factor does mucus have that you want to keep when considering mucus clearing?
stretchability- the goal should be to decrease the viscosity of the mucus without decreasing what actually keeps it together- the stretchibility
Viscosity gives what property to mucus?
resistance to flow
Elasticity gives what property to mucus?
property of deforming under force and then resuming shape
What are the three approaches to secretion management?
1- increase the depth of sol layer (water, saline or expectorants)
2. alter the consistency of the gel layer (mucolytics)
3 Those that improve ciliary activity (brochodilators and corticosteroids
T/F Bland aerosols affect the mucus directly
false- they just dilute its water content and irritate the airway
What delivery methods are used with bland aerosol therapy?
SVN, LVN, USN, and direct instillation (lavage)
Name a hypotonic solution
sterile water, hypotonic saline
Name an isotonic solution
normal saline (0.9% sodium chloride)
Which is more likely to cause bronchospasm, hypertonic, isotonic or hypotonic solutions?
In order from least to most likely- isotonic, hypotonic, hypertonic
What is the difference between distilled water and sterile water?
distilled water contains no additives or minerals and is more irritating to the airways than sterile water
Name two mucolytics
mucomyst, pulmozyme
What is the mode of action for mucomyst?
disulfide bond breaker
Can mucomyst be used on thick/infected secretions?
NO. Can’t be used on infected secretions
What mucolytic is used to treat acetaminophen OD?
mucomyst
For what disease states is mucomyst used?
cystic fibrosis, chronic bronchitis, tuberculosis and acute tracheobronchitis
What is the dose for mucomyst?
10% sol- 3 to 5 ml TID/QID
20% sik- 3 to 5 ml TID/QID
What are the adverse reactions to mucomyst
bronchospasm (more likely at 20%)
nausea, runny nose, excess watery secretions in the airway, inflammation of the mucus lining in the mouth
T/F Mucomyst is a potent antidote that can be given via nasogastric tube
true
T/F Dornase alpha is considered a maintenance drug
True
T/F Dornase alpha only works on infected mucus
True
T/F Dornase alpha is used to manage viscous pulmonary secretions.
true
T/F Dornase alpha can be given alone or with a bronchodilator
false- should always be given in conjunction with bronchodilator
T/F Dornas alpha can be mixed with albuterol
False. Pulmozyme must have its own nebulizer. It can’t be mixed with other drugs. Must give the bronchodilator first then the pulmozyme
What are adverse reactions to pulmozyme?
voice alteration, pharyngitis, laryngitis, rash, chest pain, conjuctivitis
How do expectorants work?
increase the production and expectoration of mucus by increasing the amount of fluid in the respiratory tract and stimulating cough
Hypertonic saline, guaifenesin, terpin hydrate, ammonium chloride and potassium iodide are all examples of
expectorants
What is the mode of action for antitussives?
depress the cough center (located in the medulla)
What is the most common cough suppresent?
codeine is the most common narcotic
dextromethorphan is most common non narcotic
What purpose does ethanol (ethyl alcohol) have on mucokinetics?
it denatures bubbles that occur as in pulmonary edema. the bubbles occupy less space and increase area for diffusion
What is the mode of action for dornase alfa (pulmozyme)
it is a proteolytic enzyme that breaks down DNA material and decreases the viscosity of mucus
