Mucolytics Chap 9

Question 1

Will mucolytics work on infected mucus?

Answer 1

no

Question 2

What diseases increase the volume (or thickness) of mucus?

Answer 2

chronic bronchitis, asthma, cystic fibrosis, acute bronchitis, pneumonia, bronchiectasis,

Question 3

When would you consider the use of mucolytics?

Answer 3

After patient has been adequately hydrated and has received therapy to decrease infection/ inflammation, and mucus causing irritants have been removed (like tobacco smoke)

Question 4

Most mucolytic medications work by doing what?

Answer 4

irritating the airway and making the patient’s cough

Question 5

Are goblet cells innervated?

Answer 5

no

Question 6

What provides mucin along the airway surface?

Answer 6

submucosal glands

Question 7

There are approximately _____ goblet cells in every square millimeter of normal airway

Answer 7

6000

Question 8

T/F The sympathetic system controls submucosal glands

Answer 8

false

Question 9

What is the physical composition of mucus?

Answer 9

95% water, 3% protein and carbohydrates, 1% lipids

Question 10

Mucus forms______________ chains

Answer 10

polypeptide chains

Question 11

What type of cells form mucosa?

Answer 11

pseudostratified columnar ciliated epithelial cells, goblet cells, serous cells and clara cells

Question 12

The mucocilliary blanket lines the airways from the ____ to the _______.

Answer 12

nose to the terminal bronchi

Question 13

What function do the cilla perform?

Answer 13

move mucus up the airway, protect lungs from inhaled debris

Question 14

There are approximately ____ cilia per cell and they beat ____ times per minute.

Answer 14

up to 200 that beat 1000 x/min

Question 15

T/F The mucosa is innervated.

Answer 15

false

Question 16

T/F the submucosa is innervated

Answer 16

true

Question 17

Which layer contains bronchial glands that produce the most mucus, and what is the daily production?

Answer 17

the submucosa; 100 mL/day

Question 18

What are the two layers that make up the mucociliary blanket?

Answer 18

Gel, sol

Question 19

What is the thickness of the gel layer?

Answer 19

0.5 to 20 microns

Question 20

What is the thickness of the sol layer?

Answer 20

7 microns

Question 21

Which layer is the top layer?

Answer 21

Gel- works like flypaper to trap debris

Question 22

Which layer has the cilia?

Answer 22

sol layer

Question 23

Mucus is held together by ____________ bonds.

Answer 23

disulfide.

Question 24

What are factors that impair mucociliary transport?

Answer 24

diseases, infections, airway drying (moving ISB),extereme temp changes, narcotics, dehydration, ET suctioning, cig smoke, airway trauma, hyperoxia and hypoxia

Question 25

What factor does mucus have that you want to keep when considering mucus clearing?

Answer 25

stretchability- the goal should be to decrease the viscosity of the mucus without decreasing what actually keeps it together- the stretchibility

Question 26

Viscosity gives what property to mucus?

Answer 26

resistance to flow

Question 27

Elasticity gives what property to mucus?

Answer 27

property of deforming under force and then resuming shape

Question 28

What are the three approaches to secretion management?

Answer 28

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

Question 29

T/F Bland aerosols affect the mucus directly

Answer 29

false- they just dilute its water content and irritate the airway

Question 30

What delivery methods are used with bland aerosol therapy?

Answer 30

SVN, LVN, USN, and direct instillation (lavage)

Question 31

Name a hypotonic solution

Answer 31

sterile water, hypotonic saline

Question 32

Name an isotonic solution

Answer 32

normal saline (0.9% sodium chloride)

Question 33

Which is more likely to cause bronchospasm, hypertonic, isotonic or hypotonic solutions?

Answer 33

In order from least to most likely- isotonic, hypotonic, hypertonic

Question 34

What is the difference between distilled water and sterile water?

Answer 34

distilled water contains no additives or minerals and is more irritating to the airways than sterile water

Question 35

Name two mucolytics

Answer 35

mucomyst, pulmozyme

Question 36

What is the mode of action for mucomyst?

Answer 36

disulfide bond breaker

Question 37

Can mucomyst be used on thick/infected secretions?

Answer 37

NO. Can't be used on infected secretions

Question 38

What mucolytic is used to treat acetaminophen OD?

Answer 38

mucomyst

Question 39

For what disease states is mucomyst used?

Answer 39

cystic fibrosis, chronic bronchitis, tuberculosis and acute tracheobronchitis

Question 40

What is the dose for mucomyst?

Answer 40

10% sol- 3 to 5 ml TID/QID | 20% sik- 3 to 5 ml TID/QID

Question 41

What are the adverse reactions to mucomyst

Answer 41

bronchospasm (more likely at 20%) | nausea, runny nose, excess watery secretions in the airway, inflammation of the mucus lining in the mouth

Question 42

T/F Mucomyst is a potent antidote that can be given via nasogastric tube

Answer 42

true

Question 43

T/F Dornase alpha is considered a maintenance drug

Answer 43

True

Question 44

T/F Dornase alpha only works on infected mucus

Answer 44

True

Question 45

T/F Dornase alpha is used to manage viscous pulmonary secretions.

Answer 45

true

Question 46

T/F Dornase alpha can be given alone or with a bronchodilator

Answer 46

false- should always be given in conjunction with bronchodilator

Question 47

T/F Dornas alpha can be mixed with albuterol

Answer 47

False. Pulmozyme must have its own nebulizer. It can't be mixed with other drugs. Must give the bronchodilator first then the pulmozyme

Question 48

What are adverse reactions to pulmozyme?

Answer 48

voice alteration, pharyngitis, laryngitis, rash, chest pain, conjuctivitis

Question 49

How do expectorants work?

Answer 49

increase the production and expectoration of mucus by increasing the amount of fluid in the respiratory tract and stimulating cough

Question 50

Hypertonic saline, guaifenesin, terpin hydrate, ammonium chloride and potassium iodide are all examples of

Answer 50

expectorants

Question 51

What is the mode of action for antitussives?

Answer 51

depress the cough center (located in the medulla)

Question 52

What is the most common cough suppresent?

Answer 52

codeine is the most common narcotic | dextromethorphan is most common non narcotic

Question 53

What purpose does ethanol (ethyl alcohol) have on mucokinetics?

Answer 53

it denatures bubbles that occur as in pulmonary edema. the bubbles occupy less space and increase area for diffusion

Question 54

What is the mode of action for dornase alfa (pulmozyme)

Answer 54

it is a proteolytic enzyme that breaks down DNA material and decreases the viscosity of mucus