Question Answer
Three Layers of the Mucociliary Escalator Mucosa-Pseudostratified Columnar Cells Submucosa-Bronchial Glands, Goblet Cells, Smooth Muscle Adventitia-Connective Tissue
Functions of the Mucociliary 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 viscous 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 pseudostratified columnar cells? 200 cilia per pseudostratified 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, mucopolysaccharide. 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.
Question Answer
mucous is a macromolecule
mucus strands R crossed linked w/ disulfide bonds= gel w/consists mostly of H2O around the structure
gel w/mostly water surrounding the structure is known as hydrophilic
normal mucous production= low viscosity & high elasticity (jello)
enough water is necessary 4 mucous formation but once formed mucous don’t readily incorporate _ _ _ topically applied water
admin. by aerosol or direct instillation 20% 2-3 mL TID or QID 10% 2-3 mL TID or QID acetylcysteine (mucomyst)
breaks disulfide bonds & substitutes its own HS groups 4 disulfide bonds; when theses physical contact w/ moucos it begins 2 < __ viscosity immediatly
Bronchospasms/ N/V / runny nose / airway obstructions are r/t mucomyst hazard
don’t use mucomyst for > _ hrs its caustic to airways 72hrs
mucomyst can also be TX 4 _ _ & can be given up 2 10-12hrs pc 2 prevent liver damage acetaminophen overdose
Pulmozyme is a mucolytic
reduces the viscosity secretion that occur w/lung infection by breaking down DNA accumulated in the secretions; mostly used w/ CF Pt rhDNAse {pulmozyme}
there is no evidence that bland aerosols _ mucus to a less _ state reduce/ viscous
using sterile water for; Stridor, croup like cough, hoarseness following extubation, upper airway irritation. Pt discomfort w/airway inst. BYPASSED ^airway large volume aerosol
4 DX of pneumocystis carinii pneumonia & TB sputum culture/ induction
provide a medium in which secretions can travel through th T-B tree when a PT coughs Saline bullets
increase the amount of fluid in respiratory track the best 1 is water, medullary stimulation/ or bronchial mucus glands expectorants
Question Answer
Acetylcystine NAC Mucomyst
Dornase Alfa Pulmozyme
Mucomyst 1-2 ml with Bronchodilator
Plumozyme 2.5ml/2.5ml
MOA for Acetylcystine (NAC) Breaks dloulfid bonds to make more viscus
MOA for Dornase Alfa Digests DNA debris to make less sticky
Indications for Mucomyst Bronchitis, non-productive cough
Indications for Pulmozyme Cystic Fibrosis
Pulmozyme side effects voice alterations, pharyngitis, laryngitis, rash, chest pain, conjunctivitis
Mucomyst side effects nausea and vomiting
Mucomyst hazards bronchospasm
pulmozyme hazards none
Special precautions for Mucomyst do not mix with antibiotics always give with beta agonist
Special precautions for dornase alfa keep refrigerated must be used with approved neb.