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RT104A-Pharmacology > Mucus-Controlling Drug Therapy > Flashcards

Mucus-Controlling Drug Therapy Flashcards

1
Q

KT: abhesive

A

substance that redcues adhesion

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2
Q

KT: expectorant

A

medication meant to increase the volume or hydration o airway secretion

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3
Q

KT: mucin

A

the principal constituent of mucus and a high-molecular-weight glycoprotein, it gives mucus its physical/chemical properties such as viscoelasticity

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4
Q

KT: mucoactive agent

A

term connoting any medication or drug that has an effect on mucus secretion: may include mucolytic, expectorant, mucospissic, mucoregulatory, or mucokinetic agents

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5
Q

KT: mucokinetic agent

A

medication that increases cough or ciliary clearance of respiratory secretions

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6
Q

KT: mucolytic agent

A

medication that degrades polymers in secretions

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7
Q

KT: mucoregulatory agent

A

drug that reduces the volume of airway mucus secretion

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8
Q

KT: mucospissic agent

A

medication that increases viscocity of secretions and may be effective in the therapy of bronchorrhea

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9
Q

N-Acetylcysteine (NAC)

A
  • Mucolytic, Mucoactive
  • MucoMyst (10%, 20%)
  • Breaks disulfide bonds
  • Used for viscous secretions (plugs) or acetaminophen overdose
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10
Q

Dornase alfa

A
  • Mucolytic, Mucoactive
  • Pulmozyme
  • Used to treat CF patients
  • Breaks apart DNA and F-actin
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11
Q

Properties of mucus (4)

A
  • Protective
  • Lubricative
  • Waterproofing
  • Entraps microorganisms
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12
Q

General Indication for Mucoactive Therapy

A

reduce the accumulation of airway secretions, improve pulmonary function/gas exchange, reduce infection/damage

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13
Q

Disease/States for Mucoactive Indication

A
  • CF
  • CB (COBP)
  • Pneumonia (viral/bacteria)
  • Diffuse panbronchiolitis (DPB-emphysema)
  • Primary cilia dyskinesia
  • Asthma
  • Bronchiectasis (over-production)
  • Dehydration
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14
Q

Optimal mucus would be…

A

thin enough to be able to cough out mucus, and thick enough to not slide deeper into alveoli.

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15
Q

Physiology: two layers

A
  • Gel - stickier/drier
  • Periciliary layer - wet
  • functional surfactant layer sepeartes periciliary fluid from mucus gel
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16
Q

Physiology: surface epithelial cells

A
  • pseudostratified, columnar, ciliated epithelial cells
  • surface goblet cells (no direct innervation, 600 goblet cells/mm2 of a normal airway)
  • clara cells
17
Q

Physiology: submucosal glands

A
  • innervated by the parasympathetic system
  • provides airway surface mucin, the chemical that makes up sputum
  • serous and mucous cells pump out more fluids
18
Q

4 things to look for when diagnosing sputum

A
  • size
  • color
  • tenaciousness
  • smell
19
Q

Physiology: ciliary system

A
  • 200 cilia per cell
  • effective power stroke
  • recovery stroke
20
Q

4 factors affecting mucociliary system

A
  • COPD
  • airway drying
  • narcotics
  • endotracheal suctioning
21
Q

Healthy mucus is:

A

clear, viscoelastic, sticky

22
Q

A healthy person secretes…

A

100 mL/day, most of which s reabsorbed in the bronchial mucosa or swallowed w/ saliva

23
Q

Two major classes or mucin are…

A

secreted and membrane-tethered mucins (mucus plugs)

24
Q

5 mucoactive CF drugs

A
  • Dornase alfa (MucoMyst)
  • Kalydeco (Ivacaftor)
  • Bronchitol (d-mannitol)
  • Gelsolin
  • Thymosin B4
25
Q

Therapeutic options for controlling hypersecretion (3)

A
  • Remove causative factors
  • Optimize threacheobronchial clearance
  • Use mucoactive agents when indicated
26
Q

Hazards/Precautions of NAC

A
  • bronchospasm (less common in 10%)
  • mechanical obstruction of airway
  • sticky film on patients face/mask
  • incompatible w/ certain antibiotics
27
Q

Dose and administration of Dornase Alfa

A
  • A single use ampoule (2.5 mg in 2.5 mL)
  • Refrigerated and protected from light
  • Delivered by the Hudson RCI, Acorn II, and PARI LC PLus
28
Q

Adverse Effects of Dornase Alfa

A

Common: voice alteration, pharyngitis, laryngitis, rash, chest pain, and conjunctivitis

29
Q

Kalydeco

A

Ivacaftor

facilitates chloride transfer channels (lack of sodium channels in CF, only used w/ certain genetic markers)

30
Q

Bronchitol

A

D-mannitol
Increases mucociliary clearance, reduces sputum viscosity, increases hydration of fluid layer, enhances airway clearance
avg. FEV1, improvement of 7%, DPI
cannot be used w/ asthmatics

31
Q

Gelsolin and Thymosin B4

A

Used for CF and reduces viscosity of sputum.
Gelsolin is dose-dependent
Thymosin B4 is dose and time dependent

32
Q

3 Expectorants

A
  • Iodide-containing agent
  • Sodium bicarbonate
  • Guaifenesin (Mucinex)
33
Q

Iodide-containing agents

A

Thought to stimulate the secretion of airway fluid

34
Q

Sodium-bicarbonate

A

Increases the local bronchiol pH, and weakens the bond.

Does not liquefy the sputum, so easier to clear mucus out

35
Q

Guaifenesin-may stimulate the cholinergic pathway and induce increased secretion from submucosal glads

A

-may stimulate the cholinergic pathway and induce increased secretion from submucosal glands

36
Q

General Contraindications of Mucoactive Therapy

A

-FEV1

RT104A-Pharmacology (5 decks)

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