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Muckokinetics and Su
Respiratory Pharmacology
| Question | Answer |
|---|---|
| Three Layers of the Muccociliary Escalator | Mucosa-Psuedostratified Columnar Cells Submucosa-Bronchial Glands,Goblet Cells, Smooth Muscle Adventitia-Connective Tissue |
| Functions of the Muccociliary escalator. | Warm and humidify inspired gases Prevent excessive heat and moisture loss Protects the lungs from inhaled debris. |
| Clara Cells | Increase degree of metabolic activity and contain lots of enzymes. |
| Bronchial Glands | Produce most of the mucus |
| Goblet Cells | Produce a small amount of mucous to lubricate the airways |
| Serous Cells | Less viscuous mucus (sol layer) to allow cilia to beat freely |
| How much mucous is produced per day? | 100 CC of Mucous 90 CC reabsorbed by the airway 10 CC expectorated |
| How far does the mucous blanket go? | Terminal Bronchioles |
| How thick are the layers to the mucous blanket? | gel-1-2 microns thick Sol-4-8 microns thick 5-10microns total |
| 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. |
| 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 |
| What are the functions of mucus? | Prevent H20 from moving in and out of epithelial cells. Shield epithelium from toxic cells. Lubricate the airway |
| What are some diseases that increase the volume or thickness of mucus? | Chronic bronchitis Acute bronchitis Asthma Cystic fibrosis Pneumonia |
| What are factors that impair ciliary activity? | ET tubes Extremes of temperature High concentration of oxygen Dust, fumes, and smoke Dehydration Infection Thick mucus |
| What are factors that lead to thick mucus? | Increased respiratory rate Increased depth of breathing Systemic fluid loss Infections |
| 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. |
| Sterile Water | Mostly found in nebulizers/humidifiers. Free of microorganisms. May containt additives to make bacteriostatic. |
| Distilled Water | Sterile and Pure More irritating to the airway and rarely used |
| normal Saline | .9% NaCL (isotonic) |
| Hypertonic Saline | 5%/10% strength Very irritating. Sputum induction. Given with Beta 2 agonist |
| Hypotonic Saline | .45% strength Less irrritating |
| Deliver methods of aerosols | Humidifier- Provides molecular water to inspired air. Nebulizer-Creates and aerosol |
| What are mucolytics? | Drugs that control mucous by altering the structure of the mucous molecule |
| Why would you take a mucolytic? | Because it liquifies mucus and makes it easier to expectorate. |
| How does a mucolytic work? | It breaks down the mucus molecule |
| What is N-acetylcysteine trade names? | Mucomyst Mucosol |
| How does N-acetylcystein work? | It breaks down disulfide bonds and reduces the viscosity of secretions. |
| What is the dosage of N-acetylcysteine for a 20% solution? | 3-5ml TID/QID |
| What is the dosage of Mucomyst for a 10% solution? | 6-10 ml TID/QID |
| What is the dosage of Mucosol for direct instillation? | 1-2 ml (either strength) directly into the ET tube. |
| What are side effects to N-acetylsisteine? | Bronchospasm, Nausea (due to foul odor), Rhinorrea, Bronchorrea, Stomatitis. |
| 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. |
| What is another use for Mucosol? | It can be used as an antidote to protect the liver from damage in acetominophine overdose. |
| What is the trade name of Dornase Alfa? | Pulmozyme |
| 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. |
| What is the dosage of Pulmozyme? | 2.5mg/2.5ml solution QD |
| 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. |
| What are the adverse reactions to Pulmozyme | Voice Alteration, Pharyngitis, Laryngitis, Rash, Chest pain, Conjunctivitis |
| 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. |
| What are some adverse reactions to sodium bicarbonate? | It is irritating. Large amounts can result in systemic absorption and increase pH. |
| What is a common expectorant? | guafenesin |
| 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 |
| What are common antitussive agents? | Codeine, Dextromethorphan |
| How do antitussives work? | Depress the cough center located in the medulla |
| Which patients should not be given an antitussive? | Patients with thick retained secretions. |
| What is Ethanol? | Ethyl alcohol |
| What is ethanol? | Surface-Acting agent which decreases surface tension. |
| What does Ethanol treat? | pulmonary edema secondary to CHF |
| What are some side effects to Ethanbol? | It can be harmful to pulmonary tissues. Can cause intoxication. |
| What physiology is located in the respiratory zone? | respiratory bronchioles, alveolar ducts, alveoli, pulmonary capillaries |
| What does the respiratory zone lack? | Smooth muscle and mucus producing cells |
| What do the alveolar ducts end with? | a cluster of alveoli |
| What are the two types of alveolar cells? | Type I Pneumocytes Type II Pneumocytes |
| 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 |
| Describe type II pneumocytes | Very small and comprise only 7% of the alveolar surface. Manufacture surfactant |
| What does surfactant do? | Maintain the condition of alveolar surface |
| What are the three functions of surfactant? | Prevent alveolar collapse Enable lung to expand easily Prevents leakage of fluid from the alveolar capillary membrane |
| What is surfactant made up of? | 80% phospholipids 10% Neutral lipids 10% surface proteins |
| What is surface tension? | The force of contraction at the surface of liquid that pulls the molecules at the surface inward and down. |
| What is the Law of Laplace? | The smaller the radius the greater the surface tension. |
| Which cells produce surfactant | Type II cells (constantly produce them) Has a short half-life |
| What are the effects of Surfactant? | Prevents alveolar collapse. Prevents overdistension. |
| What is the trade name of beractant? | Survanta |
| Tell some facts of Survanta | Approved in 1991. Is an extract of minced cow lung supplimented with DPPC and proteins |
| After administration what is reccommended to spread the surfactant? | Place infant in 4 positions. |
| Is Survanta(beractant)approved for the adult population? | No |
| What is the trade name of calfactant? | Inasurf |
| What are the side effects of Survanta/Inasurf? | Infection Increased incidence of apnea (early extubation) Overventilation, hypocarbia, hyperoxia, pulmonary hemorrhage. |
| How is Survanta/Inasurf administered? | Intratracheally |
| 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. |
Created by:
kparkerlehman
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