Respiratory Pharmacology
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| Three Layers of the Muccociliary Escalator | Mucosa-Psuedostratified Columnar Cells
Submucosa-Bronchial Glands,Goblet Cells, Smooth Muscle
Adventitia-Connective Tissue
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| Functions of the Muccociliary escalator. | Warm and humidify inspired gases
Prevent excessive heat and moisture loss
Protects the lungs from inhaled debris.
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| Clara Cells | Increase degree of metabolic activity and contain lots of enzymes.
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| Bronchial Glands | Produce most of the mucus
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| Goblet Cells | Produce a small amount of mucous to lubricate the airways
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| Serous Cells | Less viscuous mucus (sol layer) to allow cilia to beat freely
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| How much mucous is produced per day? | 100 CC of Mucous
90 CC reabsorbed by the airway
10 CC expectorated
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| How far does the mucous blanket go? | Terminal Bronchioles
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| How thick are the layers to the mucous blanket? | gel-1-2 microns thick
Sol-4-8 microns thick
5-10microns total
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| What are the stats for the psuedostratified columnar cells? | 200 cilia per psuedostratified cell.
6 microns in length
Beat 1000 times per minute
move mucus 2 cm per minute in healthy lungs.
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| What are the components of sputum? | 95 % water
Highly complex macromolecule,glycoprotein, muccopolysaccharide.
Held together by disulfide/hydrogen bonds
DNA-from infection;give viscosity/color.
Cell Debris.
Electrolytes
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| What are the functions of mucus? | Prevent H20 from moving in and out of epithelial cells.
Shield epithelium from toxic cells.
Lubricate the airway
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| What are some diseases that increase the volume or thickness of mucus? | Chronic bronchitis
Acute bronchitis
Asthma
Cystic fibrosis
Pneumonia
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| What are factors that impair ciliary activity? | ET tubes
Extremes of temperature
High concentration of oxygen
Dust, fumes, and smoke
Dehydration
Infection
Thick mucus
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| What are factors that lead to thick mucus? | Increased respiratory rate
Increased depth of breathing
Systemic fluid loss
Infections
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| What are components of bland aerosols? | Liquids that contain no drugs
Do not affect mucus molecule directly
Alter the water content
Sometimes called wetting agents
All bland aerosols are irritating.
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| Sterile Water | Mostly found in nebulizers/humidifiers.
Free of microorganisms.
May containt additives to make bacteriostatic.
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| Distilled Water | Sterile and Pure
More irritating to the airway and rarely used
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| normal Saline | .9% NaCL (isotonic)
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| Hypertonic Saline | 5%/10% strength
Very irritating.
Sputum induction.
Given with Beta 2 agonist
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| Hypotonic Saline | .45% strength
Less irrritating
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| Deliver methods of aerosols | Humidifier- Provides molecular water to inspired air.
Nebulizer-Creates and aerosol
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| What are mucolytics? | Drugs that control mucous by altering the structure of the mucous molecule
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| Why would you take a mucolytic? | Because it liquifies mucus and makes it easier to expectorate.
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| How does a mucolytic work? | It breaks down the mucus molecule
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| What is N-acetylcysteine trade names? | Mucomyst
Mucosol
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| How does N-acetylcystein work? | It breaks down disulfide bonds and reduces the viscosity of secretions.
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| What is the dosage of N-acetylcysteine for a 20% solution? | 3-5ml TID/QID
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| What is the dosage of Mucomyst for a 10% solution? | 6-10 ml TID/QID
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| What is the dosage of Mucosol for direct instillation? | 1-2 ml (either strength) directly into the ET tube.
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| What are side effects to N-acetylsisteine? | Bronchospasm, Nausea (due to foul odor), Rhinorrea, Bronchorrea, Stomatitis.
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| What are some special considerations about Mucosol? | It may turn purple but it does not change its effectiveness.
It must be refridgerated and discarded after 96 hours.
It may react with some substances.
Must be given with a bronchodilator before or with treatment.
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| What is another use for Mucosol? | It can be used as an antidote to protect the liver from damage in acetominophine overdose.
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| What is the trade name of Dornase Alfa? | Pulmozyme
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| What are some basic facts about Pulmozyme? | It is a clone of natural human enzyme that digests extracellular DNA.
FDA approved in 1994.
Maintenance therapy for CF patients.
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| What is the dosage of Pulmozyme? | 2.5mg/2.5ml solution QD
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| What are some considerations to Pulmozyme? | Must be refridgerated and protect from light.
Should not remain at room temperature for greater than 24 hours.
PPE should be used when administering.
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| What are the adverse reactions to Pulmozyme | Voice Alteration, Pharyngitis, Laryngitis, Rash, Chest pain, Conjunctivitis
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| How does sodium bicarbonate work? | It is a weak base that makes mucus less adhesive by increasing pH to weaken bonds. Osmosis increases respiratory tract secretions on proteases digest protein molecules.
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| What are some adverse reactions to sodium bicarbonate? | It is irritating.
Large amounts can result in systemic absorption and increase pH.
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| What is a common expectorant? | guafenesin
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| How do expectorants work? | They increase the amount of fluid in the respiratory tract and stimulate cough. They work by increasing vagal gastric reflex stimulation or by absorption into the respiratory glands
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| What are common antitussive agents? | Codeine, Dextromethorphan
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| How do antitussives work? | Depress the cough center located in the medulla
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| Which patients should not be given an antitussive? | Patients with thick retained secretions.
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| What is Ethanol? | Ethyl alcohol
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| What is ethanol? | Surface-Acting agent which decreases surface tension.
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| What does Ethanol treat? | pulmonary edema secondary to CHF
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| What are some side effects to Ethanbol? | It can be harmful to pulmonary tissues.
Can cause intoxication.
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| What physiology is located in the respiratory zone? | respiratory bronchioles, alveolar ducts, alveoli, pulmonary capillaries
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| What does the respiratory zone lack? | Smooth muscle and mucus producing cells
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| What do the alveolar ducts end with? | a cluster of alveoli
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| What are the two types of alveolar cells? | Type I Pneumocytes
Type II Pneumocytes
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| Describe Type I pnuemocytes | Very large, thin, and flat
Constitute 8% of alveolar cells but cover 93% of the alveolar surface
Allow for diffusion of gases
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| Describe type II pneumocytes | Very small and comprise only 7% of the alveolar surface.
Manufacture surfactant
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| What does surfactant do? | Maintain the condition of alveolar surface
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| What are the three functions of surfactant? | Prevent alveolar collapse
Enable lung to expand easily
Prevents leakage of fluid from the alveolar capillary membrane
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| What is surfactant made up of? | 80% phospholipids
10% Neutral lipids
10% surface proteins
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| What is surface tension? | The force of contraction at the surface of liquid that pulls the molecules at the surface inward and down.
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| What is the Law of Laplace? | The smaller the radius the greater the surface tension.
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| Which cells produce surfactant | Type II cells (constantly produce them)
Has a short half-life
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| What are the effects of Surfactant? | Prevents alveolar collapse.
Prevents overdistension.
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| What is the trade name of beractant? | Survanta
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| Tell some facts of Survanta | Approved in 1991.
Is an extract of minced cow lung supplimented with DPPC and proteins
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| After administration what is reccommended to spread the surfactant? | Place infant in 4 positions.
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| Is Survanta(beractant)approved for the adult population? | No
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| What is the trade name of calfactant? | Inasurf
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| What are the side effects of Survanta/Inasurf? | Infection
Increased incidence of apnea (early extubation)
Overventilation, hypocarbia, hyperoxia, pulmonary hemorrhage.
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| How is Survanta/Inasurf administered? | Intratracheally
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| What are the indications for Surfactant? | Meconium Aspiration Syndrome
Infant with RDS
Pulmonary Hemmhorage
Congenital Diaphramatic Hernia
Severe pneumonia
Pulmonary infections
Any condition where there is loss of surfactant and low lung volume.
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