Mucus-Controlling Drug Therapy Flashcards

Flashcards about Mucus-Controlling Drug Therapy

Mucociliary escalator

The major defense system in the airways.

Properties of Mucus

Protective, lubricating, waterproofing, and entraps microorganisms

Diseases indicated for mucus controlling drug therapy

Cystic fibrosis (CF), Chronic bronchitis, Pneumonia, Diffuse panbronchiolitis (DPB), Primary ciliary dyskinesia, Asthma, Bronchiectasis

Agents for Mucus-Controlling Drug Therapy

N-Acetylcysteine (NAC), Dornase alfa, Aqueous aerosols, Water, Saline, Hyperosmolar saline

Mucus

Secretion from surface goblet cells and submucosal glands composed of water, proteins, and glycosylated mucins

Phlegm

Secretions in the airways

Sputum

Expectorated phlegm that contains respiratory tract, oropharyngeal, and nasopharyngeal secretions, bacteria, and products of inflammation, including polymeric DNA and actin

Mucoactive agent

Has an effect on mucus secretion

Mucokinetic agent

Increase cough or ciliary clearance of respiratory secretions

Mucoregulatory agent

Reduce the volume of airway mucus secretion

Mucospissic agent

Increase viscosity of secretions

Mucolytic agent

Degrades polymers in secretions

Submucosal glands

Provide airway surface mucin and are under parasympathetic control.

Pulmonary diseases where mucus or mucociliary clearance can be abnormal

Chronic bronchitis, Asthma, Cystic fibrosis

Mucolytic agents

Decrease elasticity and viscosity of mucus; gel structure is broken down

Indications for N-Acetyl-L-Cysteine (NAC)

Treatment of conditions associated with viscous secretions; Acetaminophen overdose

Mode of action for N-Acetyl-L-Cysteine (NAC)

NAC disrupts the structure of the mucus polymer by substituting free thiol (sulfhydryl) groups for disulfide bonds connecting mucin proteins

Hazards of N-Acetyl-L-Cysteine (NAC)

Bronchospasm and Mechanical obstruction of airway

Indications and use of Dornase Alfa in CF

For clearance of purulent secretions, to reduce frequency of respiratory infections requiring parenteral antibiotics, to improve or preserve pulmonary function in these subjects

Mode of action of Dornase Alfa

Reduces viscosity and adhesivity by breaking down DNA

Mucokinetic Agents

Increase cough clearance by increasing expiratory airflow or by reducing sputum adhesivity and tenacity

Surface-Active Phospholipids

Thin surfactant layer between the periciliary fluid and mucus gel; prevents airway dehydration, permits mucus spreading on extrusion from glands, allows efficient ciliary coupling with mucus, allows ciliary release from mucus once kinetic energy is transmitted

Mucoregulatory Medications

Steroids, Anticholinergics (Atropine, Ipratropium bromide, Tiotropium), Macrolide antibiotics

Hyperosmolar saline (7%) and mannitol

May increase FEV1 in patients; alternate effect is an acute decrease in FEV1; unpleasant taste; coughing may make it unsuitable for long-term use

Insufflation-Exsufflation

Inflates lungs with positive pressure followed by negative pressure to simulate cough

Active cycle of breathing (ACB) and forced expiratory technique (FET) maneuver

Combination of breathing control, thoracic expansion control, and forced expiration technique from progressively increasing lung volumes

Autogenic drainage

Aims to “optimize” airflow in various generations of bronchi to move secretions

Exercise

Causes increased sputum production compared with rest; appears to augment bronchial hygiene

Positive airway pressure

Can be effective alternatives to chest physical therapy in expanding lungs and mobilizing secretions. Cough, FET, Pursed-lipped breathing

Oscillation of airway

The FLUTTER(R) and The Percussionator(R)

Chest wall compression

Reported to be effective for secretion clearance in patients with CF. Conjecture is that this device has a role in lung expansion for patients other than those with cystic fibrosis in acute care settings