Ch 9 Mucus controlling drugs
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| Abhesive | Substance that reduces adhesion.
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| Elasticity | Rheologic property characteristic of solids; it is represented by the storage modules G'.
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| Expectorant | Medication meant to increase the volume or hydration of AW secretions.
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| Gel | Macromolecular description of pseudoplastic material having both viscosity and elasticity.
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| Glycoprotein | Protein with attached oligosaccharide units.
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| Mucin | The principal constituent and high molecular weight glycoprotein, it gives mucous its physical/chemical properties such as viscoelasticity.
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| Mucoactive agent | 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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| Mucokinetic agent | Medication that increases cough ciliary clearance of respiratory secretions.
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| Mucolytic agent | Medication that degrades polymers in secretions. Classic mucolytics have free thiol groups to degrade mucin, and peptide mucolytics break pathologic filaments of neutrophil-derived DNA or actin in sputum.
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| Mucoregulatory Agent | Drug that reduces the volume of AW mucus secretion and appears to be especially effective in hyper secretory states, such as brochorrhea, diffuse panbron, chiolitis (DPB), CF, and some forms of asthma.
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| Mucospissic Agent | medication that increases viscosity of secretions and may be effective in therapy of bronchorrhea.
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| Mucus | Secretion, from surface goblet cells and submucosal glands, composed of water, proteins, and glycosylated mucins. The glycoprotein portion of the secretion is termed mucin. Mucus (noun) is the secretion; mucous (adjective) is the cell or gland type.
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| Oligosaccharide | Sugar that is the individual carbohydrate unit of glycoproteins.
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| Phlegm | Purulent material in the AW. From the greek word from inflammation. When expectorated, phlegm is called sputum.
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| Rheology | Study of the deformation and flow of matter.
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| Sol | Macromolecular description of the respiratory secretion in true solution, with the physical property of viscosity (usually referred to as the periciliary layer)
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| Sputum | Expetorated Phlegm that contains respiratory tract, oropharyngeal, and nasopharyngeal secretions and bacteria and products of inflammation including polymeric DNA and actin.
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| Viscosity | Resistance of liquid to sheer forces. A rheologic property characteristic of liquids and represented by the loss of modulus G'.
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| Mucoactive therapy should be considered when? | After therapy to decreased infection and inflammation.
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| What does Mucus do? | Lubricates, waterproofs and protects against osmotic or inflammatory changes.
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| What can a normal mucus barrier do? | Entrap microorganisms, inhibiting chronic bacterial infection and biofilm formation.
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| Name 4 Mucoactive agents? | N-acetylcysteine (NAC)
Dornase Alpha
Aqueous aerosols: Water, Saline
Hyperosmolar (7%) saline
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| Indications for N-acetylcysteine (NAC) | Bronchitis, efficacy not proven for any dose of NAC for an lung disease
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| Indications for Dornase alpha | CF
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| Indications for Aqueous aerosols: Water, Saline | Sputum induction, secretion, mobilization
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| Indications for Hyperosmolar (7%) saline | AW clearance (Mucokinetics) for therapy of CF
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| Dosages for N-acetylcysteine (NAC) | SVN: 3-5mL of 10% or 20%
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| Dosages for Dornase alpha | SVN: 2.5mg/2.5mL ampoule, 1 ampoule Q day
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| Dosages for Aqueous aerosols: Water, Saline | SVN: 3-5mL, as ordered
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| Dosages for Hyperosmolar (7%) saline | SVN: 4mL
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| Brand Names for N-acetylcysteine (NAC) | Mucomyst
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| Brand Names for Dornase alpha | Pulmozyne
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| Brand Names for Aqueous aerosols: Water, Saline | Doesn't have one
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| Brand Names for Hyperosmolar (7%) saline | Hyper-Sal
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| The AW secretion consists of? | Mucous Layer - Where mucin glycoprotein is located,
and
a watery, periciliary layer
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| Drugs that effect Mucociliary clearance? | Surfactants
Beta agonist agents
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| What do Epithelial ion do in the AW? | Exchange in the AW surface liquid maintains normal periciliary fluid depth.
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| CF AW secretions contain how much Mucin? | Very little intact mucin.
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| What does a CF AW consist of? | Filled with Pus derived from neutrophil degregation.
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| What are the physical properties of mucus? | Viscosity
elasticity
cohesivity
and adhesivity.
Normal ranges of these properties are needed for adequate mucus transport to occur.
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| What 3 drugs are approved by aerosol to modify AW secretions? | NAC (Mucomyst), Dornase alpha, and hypertonic saline.
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| Classic mucolytics | Reduce mucins by serving disulfide bonds or charge sheilding.
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| What drug does not improve mucus clearance when given as an aerosol and should not be used as a mucoactive agent? | NAC (Mucomyst)
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| What antibiotics is NAC (Mucomyst) incompatible with? | Sodium Ampicillin
Amphotericin
Erythromycin lactobionate
Tetracyclines (tetracycline oxytatracycline)
Aminoglycosides
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| What are Potassium iodide and glycerol guaiacolate considered? | Expectorants or mucokinetic agents.
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| Other agents that modify AW secretions: | inhaled anticholinergics such as atropine
Ttricyclic nucleotides
Phospholipids
Antiproteases
gene therapy
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| What do studies show about long term use of ipratropium bromide are associated with? | Reduction in the volume of mucus secretion in patients with CB.
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| AD technique incorporates what? | Staged breathing with small tidal breaths from expiratory reserve volume, repeated until secretions collect in central AWs.
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| With IPV | The PT breathes through a mouth piece that delivers high-flow mini bursts at rates exceeding 200 cycles/min.
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| Chest wall systems consist of | large volume variable frequency are pulse delivery system attached to an inflatable vest worn by PT.
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| Pts with long-term problems of secretion management should? | be taught as many mucus controlling therapy techniques possible to control their condition.
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