Respiratory Care Pharmacology Chapter 9: Mucus-Controlling Drug Therapy

mucociliary system

the conducting airways in the lung, nasal cavity, and oropharynx are lined by a...

transporting and removing trapped inhaled particles, cellular debris, and dead cells

what is the main function of respiratory tract mucus?

mucociliary escalator

what is the major defense system of the respiratory tract?

mechanical obstruction (i.e. mucus plug)

failure of the mucociliary clearance system may result in...

-goblet cells

-submucosal glands

what 2 structures produce/secrete mucus ?

-gel

-sol

what are the two layers of mucus on top of the epithelial lining?

FALSE: the gel layers sits on top of the sol layer

True or False: The watery sol layer sits on top of the viscous gel layer

Cilia

hair-like structures that trap microbes and debris and move them up and out of the airways

100 mL/day

how much mucus do healthy individuals produce a day?

True

True or False: Most of our secreted mucus is reabsorbed in the bronchial mucosa or swallowed with saliva

-volume

-hydration

-composition

name three factors that can alter the clearance of airway mucus

yes

can thickened, slow moving, adhesive mucus cause airway obstruction?

mucus

sticky, slippery gel with viscoelastic properties

Elasticity

property of solid by which the solid changes shape (deforms) when a force is applied then resuming shape

viscosity

resistance of liquid to shear forces; resistance to movement when force is applied

increased resistance to flow

how would increased viscosity affect the resistance to flow?

Cohesivity

forces between similar (mucus) molecules

Adhesivity

attractive forces between the mucus and airway surfaces

Tenacity

the product of cohesive and adhesives forces together

FALSE: the more tenacious the sputum, the harder it is to clear

True or False: The greater the tenacity of sputum, the easier it is to clear the sputum.

bacterial infection

hypersecretion of mucus predisposes the patient to...

-reducing accumulation of airway secretions

-improve pulmonary function/gas exchange

-prevent repeated infection and airway damage

name 3 indications for mucoactive agents

True

True or False: mucoactive agents can decrease infection and inflammation

Mucoactive agents

any agent that has an effect on mucus secretions

Mucokinetic agents

drugs that increase ciliary clearance of respiratory mucus secretions

Mucoregulatory agents

agents that reduce the volume of airway mucus secretions

Mucolytic agents

medications thought to mobilize secretions by mechanisms other than direct thinning of mucus such as reducing sputum viscosity while preserving elasticity, or decreasing adhesivity

N-Acetylcysteine (NAC)

what is the generic name for Mucomyst?

10%, 20% (600-1000mg)

what are the percent strengths and dosage for Mucomyst?

Dornase alfa

what is the generic name for Pulmozyme?

2.5mg/2.5mL

what is the dosage for Pulmozyme?

cystic fibrosis

Pulmozyme is used exclusively to treat what patients?

Small Volume Nebulizer

what delivery device is used to administer Mucomyst and Pulmozyme?

-water

-saline (0.9%)

-hypotonic saline (<0.9%)

-hypertonic saline (>0.9%)

Name the 4 aqueous aerosols used to mobilize mucus

-COPD

-Cystic Fibrosis

-Airway drying (i.e. mechanical ventilation)

-Narcotics

-Endotracheal suctioning

name 4 factors that can slow mucociliary transport

naw

Does drinking dairy milk really increase mucus production and congestion?

gel

mucolytic agents decrease elasticity and viscosity of mucus by breaking down which layer of the mucus blanket?

directed cough

what is the most important part of conventional chest physiotherapy?

FALSE: if patient is unable to cough up sputum, they are at risk for getting a mucus plug lodged in their airway

True or False: You can add postural drainage to chest physiotherapy on patients with a nonproductive cough.

viscosity

N-Acetylcysteine works by reducing...

causes bronchospasm

what is the main hazard of N-Acetylcysteine?

a bronchodilator

Mucomyst must always be administered with...

suction catheter

if the patient cannot produce a productive cough, what should the respiratory therapist have on hand before administering Mucomyst?

cystic fibrosis

DNA-rich pus from neutrophil degradation is seen in...

digests extracellular DNA to reduce the viscosity and adhesivity

What is Pulmozyme's mode of action?

Insufflation--Exsufflation

inflates lungs with positive pressure followed by negative pressure to simulate a cough (cough assistance)

Airway Oscillation

technique in which the airway is vibrated to loosen mucus from the airway walls

before and after treatment

when should the patient be instructed to cough?