question

When should Mucoactive therapy be considered?

answer

after the therapy to decrease infection and inflammation

question

Failure of the self-renewing, self-cleansing mucociliary escalator may result in what?

answer

mechanical obstruction of the airway, often with thickened, adhesive secretions

question

Where in the body is mucus found?

answer

airways, GI tract, and genital tract

question

What is the purpose of mucus?

answer

protection (against osmotic or inflammatory changes), lubrication, waterproofing it also entraps microorganisms

question

What is the term used for liquefying thick mucus to a watery state?

answer

Mucolysis

question

Because mucus is a ____ with physical properties of viscosity and elasticity, drug therapy for mucus clearance disorders should optimize the ___________ ___________of the mucus gel for __________ clearance

answer

gel; physical state; efficient

question

The terms mucolytic agent and mucoactive agent indicate what?

answer

the breakdown of mucus

question

Why use mucoactive therapy?

answer

to reduce accumulation of airway secretions, with concomitant improvement in pulmonary function and gas exchange and to prevent repeated infection and airway damage

question

Which diseases indicate use for mucoactive therapy?

answer

those with hypersecretion or poor clearance of airway secretions * cystic fibrosis, acute and chronic bronchitis, pneumonia, asthma, bronchiectasis, etc

question

Patient's with adequately preserved expiratory airflow and cough usually have a (better/worse) response to mucoactive drug therapy

answer

Better

question

What is the name of the secretion that lines the surface of the airway?

answer

mucus

question

What are the 2 phases of mucus?

answer

A gel layer and a watery periciliary layer

question

Describe the gel layer of mucus

answer

it is propelled toward the larynx by the cilia and floats on top of the periciliary layer

question

Which cells are responsible for airway secretions and are the source of components found in respiratory mucus?

answer

surface epithelial cells and submucosal glands, with serous and mucus cells

question

Mucus secreted by surface epithelial cells and glands in the airway provide for basic ...?

answer

protection of the respiratory tract, including humidification and warming inspired gas, mucociliary transport of debris, waterproofing and insulation, and antibacterial activity

question

Define mucoactive agent

answer

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

question

Define mucolytic agent

answer

medication that degrades polymers in secretions

question

Define mucus

answer

secretions from goblet cells and submucosal glands made of water, proteins, and glycosylated mucins

question

Mucus vs. Mucous

answer

mucus is the secretion mucous is the cell or gland type

question

What may cause a slower mucociliary transport rate?

answer

COPD or CF Airway Drying Narcotics Cigarette smoke Atmospheric pollutants and Allergens Hyperoxia and Hypoxia Endotracheal suctioning, Airway trauma, and Tracheostoy

question

Does milk make mucus, does it increase respiratory tract congestion?

answer

No data supports milk and dairy products as causing symptoms of congestion

question

A healthy person produces how much mucus secretion and typically how will it look?

answer

100mL of mucus every 24 hours; the mucus should be clear, viscoelastic, and sticky

question

Where is most mucus secretions reabsorbed

answer

in the bronchial mucosa or swallowed in saliva

question

During disease, what happens to mucus secretions

answer

the volume increases dramatically and it is usually expectorated or swallowed

question

Primary function of respiratory tract mucus

answer

transport and remove trapped inhaled particles, cellular debris, or dead and aging cells

question

What is the purpose of mucins

answer

to protect and clear properties of mucus

question

Define sputum

answer

expectorated phlegm

question

How is mucus usually cleared through airway? How is sputum usually cleared through airway?

answer

by airflow and ciliary movement by cough

question

Define phlegm

answer

purulent material in the airways, can be considered pus

question

Define chronic bronchitis

answer

daily sputum expectoration for 3 months of the year for at least 2 consecutive years, usually in a tobacco smoker or ex-smoker

question

What is the most important predisposing factor to airway irritation and mucus hypersecretion

answer

tobacco smoke *other factors can include viral infections, pollutants, and genetic predisposition

question

In acute severe and fatal asthma, there is profound _____ of highly viscous and rigid mucus leading to _____ _____ _____

answer

hypersecretion complete airway obstruction

question

In asthma, aggressive use of B agonists may contribute to what and why?

answer

they may contribute to airway obstruction because B receptors are likely fully saturated, which may induce the secretion of viscous mucus

question

Define bronchorrhea

answer

production of watery sputum of 100mL or more per day *occurs in about 9% of pts with chronic asthma

question

Which medications are most effective when bronchorrhea is associated with airway inflammation

answer

mucoregulatory medications

question

What is a mucospissic agent

answer

medication that increases viscosity of secretions and may be effective in the therapy of brochorrhea

question

What form of bronchorrhea does not respond well to mucoregulatory therapy

answer

congenital fucosidosis

question

Define mucoregulatory agent

answer

drug that reduces volume of airway mucus secretion and appears to be especially effective in hypersecretory states like bronchorrhea, CF, panbronchiolitis (DPB), and some asthma

question

Define plastic bronchitis

answer

Rare disease characaterized by the formation of large gelatinous or rigid branching airway casts The casts can be spontaneously expectorated and occasionally pts cough up large impressions of their tracheobronchial tree Casts are often described as "pudding-like" or "toothpaste" Casts are too thick for suctioning and too friable to be removed with forceps

question

Define cystic fibrosis (CF)

answer

chronic hereditary disease characterized by an impaired CFTR protein; CF includes chronic airway infection and inflammation leading to bronchiectasis, progressive pulmonary function decline, and eventually death

question

What are the airways in CF almost entirely filled with

answer

pus from neutrophil degredation

question

In the airway, what do adhesion forces refer to

answer

the attractive forces between the mucus and airway surface -adhesion severely reduces the ability to clear secretions by airflow (cough)

question

What are the physical properties of mucus

answer

adhesion cohesion viscosity elasticity

question

Define mucokinetic agent

answer

medication that increases cough or ciliary clearance of respiratory secretions

question

In the airway, what does cohesion refer to

answer

forces between like molecules

question

What is a potential negative effect of mucolytics

answer

they may reduce mucus gel to a more liquid state which may lead to aspiration with use of suction catheters

question

How to control mucus hypersecretions

answer

remove causative agents (infections, smoking, allergens, pollution) optimize tracheobronchial clearance (cough, deep breathing, bronchodilators, postural drainage) use mucoactive agents when needed

question

The mucolytic acetlycysteine (NAC) ___________ improve mucus clearance when given as an aerosol and _________ be used as a mucoactive medication

answer

does not should not

question

What is the dosage of 10% Mucomyst (NAC) and 20% Mucomyst (NAC)?

answer

6-10mL tid/qid 3-5mL tid/qid

question

When does NAC reduce viscosity immediately

answer

when in physical contact with mucus (not sputum)

question

When is the mucolytic activity of NAC increased and when is it optimal

answer

increased with higher pH and optimal at local pH of 7.0-9.0

question

What is the most serious complication of NAC

answer

bronchospasm due to its acidity of pH 2.2 *more likely in asmatics *more common when using 10% than 20% solution *use rapid onset bronchodilator as pretreatment to limit risk

question

Why can NAC provoke nausea and vomiting

answer

the bad smell

question

NAC is incompatible with certain antibiotics, what changes take place during incompatibility

answer

form of a precipitate, clarity, color, odor

question

Dornase Alfa (Pulmozyme) is used for

answer

clearance of purulent secretions in cystic fibrosis

question

When given by aerosol, Dornase Alfa

answer

reduces viscosity and adhesivity of infected respiratory secretions

question

Usual dose of Dornase Alfa

answer

2.5mg daily *keep refrigerated and away from light

question

Adverse effects of Dornase Alfa include

answer

voice alteration pharyngitis laryngitis rash chest pain conjunctivitis

question

Iodide-containing agents are generally considered

answer

expectorants

question

What is an expectorant

answer

medication meant to increase the volume or hydration of airway secretions

question

Mucoregulatory agents are

answer

medicines used to decrease mucus hyper secretion *atropine

question

Mucoactive therapy is sometimes ________ with CPT

answer

combined

question

An alternative to CPT can be

answer

PAP techniques, which is generally more effective than IS and IPPB

Pharmacology Ch 9: Mucus-Controlling Drug Therapy – Flashcards

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