mucous controling agents, surfactants Flashcards
what is mucus
secretion from goblet cells and submucosal
glands composed of 95% water and proteins
What is sputum
expectorated secretions that contain resp.
tract, oropharyngeal and nasalpharyngeal secretions as well as bacteria and products of inflammation
what is Mucolytic
degrade mucus polymers (s-s bonds)
what is Mucokinetic
increases ciliary activity but anything
that increases the movement of sputum
what is expectorant
medicine to increase hydration
volume of secretions used to treat and cause a productive cough
what is Antitussive
cough medicine to suppress cough urge
what is surfactant
decrease surface tension, made
up of phospholipids and proteins
fxn of mucus
prevents infection with antimicrobial enzymes
protects against osmotic or inflammatory changes
lubrication (phospholipids)
what is the physical propertise of mucus?
- adhesion
- -> mucus to airway surface force - cohesion
- ->mucus to mucus force - viscosity
- ->resistance to flow (thickness of mucus) - elasticity
- ->returning shape
what is the function of the mucoilary escalator
Self-cleansing (trapping and mobilizing debris)
the amount, consistency/thickness, ciliary
activity affect function
what are the 3 layers of the escolator?
- mucus (gel)
- cili(sol)
- epithelialhttps://www.thoughtco.com/
what s the funciton of the gel layer
mucus moves towards larynx
whats the function of the sol llayer
ion transport
wht is the normal daily mucus production
100mls/day
composition of mucus
95 % h2o
5 % glycoprotein (mucin)
how does pharmcological treatment help with mucociliary transport?
- altering consistency of gel layer
- mucolytics
- improving ciliary beat
- sympathomimetics, cholinergics, xanthines
- increasing sol layer (more watery)
- hyperosmolar saline, expectorants
- improving cough
- bronchodilators
the effect of beta adrenegic, xanthines and cholinergic on mucus?
all increase cilia beat and mucus production
- they differ is in the transport of mucous
what is the effect of mucus
Steroids have no effect on beat, or transport but decrease mucus production
what s the function and MOA of mucolytics
fxn: Degrade complex molecular strands to thin mucous in airways and aid in “expectoration
MOA: - breaks disulfide bonds in mucous (gel layer) - mucolytic activity of drug increases with 7.0 - 9.0 in local pH
dose/frequency of mucolytic
- 10%, 20% solution; 3-5 mL
via aerosol - frequency: QID, TID
what is the adverse effect of mucolytic
- bronchospasm, cough,
- Ventolin “cocktail”
- Nausea
- rhinorrhea
- stomatitis
- inactivated if mixed with
antibiotics
**patient must be able to clear secretion
what is the Non-respiratory indications for
Mucomyst®
acetaminophen overdose
- anti-oxidant
- prevents hepato-renal toxicity
what is the indication and MOA of dorase alfa Pulmozyme®
FOR CF
–>clearance of secretion
DNase (pancreatic enzyme) digests extracellular DNA material found in cellular debris of infected mucous
- reproduced by recombinant DNA techniques
- breaks down the DNA material in enzymatic fashion; lowers viscosity and adhesiveness
what is the dose and adminstration of Pulmozyme
Unit Dose Vial - 2.5mg drug in 2.5mL of clear colourless solution
(refrigerated and
protected from light)
Adverse effects of Pulmozyme
dysphonia, rash, pharyngitis, chest
pain, conjunctivitis
what is an example of mucokinectic agent
beta agonist(bronchdilators)
- increase cilia beat frequency
- improve expiratory airflow clearance
when is mucokinectic agent not beneficial
patients with dynamic
airway collapse diseases
–>emphysema
what is the function of an expectorant
- pull water from airway tissues into the mucous making
it more watery and easier to clear - stimulant expectorants
what is an exmaple of expectorant?
guaifenesin
Benylin expectorant syrup ® or inhalational sol’n
what is the function of bland aerosols
Liquid particles suspended in a gas with or without oxygen
what is the MOA of bland aerosols?
Alters H2O content of mucous; not structure
what are 4 types of bland aersols
- 0.9% N/S - physiologically
compatible (isotonic)
2.hypotonic saline: 0.45% -
for patients who cannot
tolerate increase Na
3.sterile distilled water:
hypotonic compared with
tissue fluid
4.hypertonic saline (5% or
20% hypertonic saline)
generally used for
sputum induction
what is the fxn of Antitussives
decreases cough centre activity in medulla oblongata of brain
what is the indcaiton of Antitussives
Indicated for dry, unproductive (annoying)
cough only
what is some example of Antitussives
- CODEINE sulfate (narcotic)
- HYDROCODONE (narcotic)
what is fxn of surfactant
lowers surface tension
increase compliance
decreased WOB
what is the clincal application of surfactant
prophylaxis
rescue
wht is the composition of lipids?
1 . 90-95% lipids
- -> 80-85% phospholipids
- Phosphatidylcholine (PC) becomes DPPC when saturated, aka lecithin (surface tension lowering component)
- > 15- 20% phosphatidyglycerol, Sphingomyelin
- 5-10% proteins
- ->Hydrophilic
- -»Hydrophobic
how is surfactant produced?
- Type II pneumocytes
- ->lamella bodies - lamella bodies move to lumen of alveolus
- LB secretes tubular myelin then unravels , which is the precusor of DPPC
when is DPPC first seen?
24 wks during gestation
wt is the metabolism/clearance of surfactant in adult
adult: 2.5mg /kg
50% is recycled back to type 2 cells
half life 9 - 12 hrs
what is the metabolism/clerance of surfactantinbaby
- amount is 10x that of adult
- 90% is recycled to type 2, 10% becomes marcophages
- half life 6 days
what are some exogensis surfactant used
- bLES (natural)
- ->bovine or human source of aminotic fluid - Exosurf (synthetic)
what is the indication of exogensis surfactant
in the neonatal population to
decrease surface tension in the treatment of RDS in premature babies
how can exogensis surfactant ot be delivered
- install via ETT
- devlier via BVM
what is the side effect of exogensis surfactant
- rapid change in compliance
2. desaturation and bradycardia due to blocked ETT during
what is the side effect of exogensis surfactant
apnea, pulmonary hemorrhage, bronchospasm
what is some inhaled gas mixture used?
Nitric Oxide (NO): in pulmonary vascular endothelium
what is the fxn of NO
treats pulmonary hypertension including PPHN, ARDS/hypoxia, during neonatal cardiac sx,
RDS, pulmonary disease
- potent vasodilator
what monitor is needed for NO?
analyzer required for dose & toxic byproducts NO2 (5ppm) & methemoglobin
such as co-oximeter
