Mucous Controlling Drugs Surfactants

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Mucous Controlling Drugs Surfactants

• By Jim Clarke

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Mucus-Secreting Apparatus
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Mucus Composition

• 95 is water
• 3 is protein

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Factors Affecting Mucociliary Transport

• The following factors slow mucus movement
• Age-related factors (56 years old)
• Presence of COPD
• General Anesthetics
• Use of Atropine

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More Factors Slowing Mucus Movement

• Presence of tracheostomy
• Use of endotracheal suctioning techniques
• Cigarette Smoke
• Atmospheric pollutants
• Hyperoxia and hypoxia

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Diseases Prone to Mucus Hypersecretion

• Chronic Bronchitis
• hyperplasia of submucosal glands goblet cells
• Asthma
• mucus plugging
• Cystic Fibrosis
• mucoviscidosis

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Mucus Controlling Agents

• Mucolytics - actually break down mucus
• Expectorants - increase the volume of bronchial
  secretions and increase cough volume

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Mucolytic Agents

• Acetylcysteine (Mucomist) - for aerosol
  administration or direct instillation into the
  bronchial tree
• Available as
• 20 solution or
• 10 solution
• Usual dose is 3 - 5 ml via SVN tid or qid

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Mode of Action of Mucomist

• Breaks down the disulfide bonds that keep mucus
  strands bonded

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Side Effects of Mucomist
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Actual Side Effects of MM

• Bronchospasm
• Never give acetylcysteine by itself to
  asthmatics!!
• Best given with a bronchodilator like albuterol
• Stomatitis
• Nausea
• Rhinorrhea

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Dornase Alpha (Pulmozyme)

• Developed for use in tx of pulmonary
  complications of cystic fibrosis
• Pulmozyme is more effective than Mucomist in
  reducing mucus viscosity in these patients
• Additionally, Pulmozyme
• improves airway clearance of secretions
• decreases frequency and severity of respiratory
  infections

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Mode of Action

• Works by breaking down DNA of mucus using
  enzymatic action

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Dose Administration

• Usual dose is 2.5 mg/day - given via aerosol
• Solution should be refrigerated and protected
  from light

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Side Effects

• Common
• Voice changes laryngitis
• rash, conjunctivitis, chest pain
• Less common
• dyspnea hypoxia increased cough
• pneumothorax weight loss

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Other Agents

• Amiloride - used via aerosol to reverse water
  loss from mucus in cystic fibrosis
• Uridine triphosphate (UTI) can be given with
  Amiloride to improve mucociliary clearance
• Gelsolin
• Antiproteases

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More Others

• Gene therapy
• Sodium bicarbonate
• Propylene glycol
• Glycerol guaiacolate
• Water
• is the best expectorant

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Effect of Bland Aerosols on Mucus

• No evidence that bland aerosols reduce mucous
  viscosity by adding water to the gel or sol
  layers
• Sputum induction techniques can increase sputum
  production and cough activity

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Surfactants
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What is Surface Tension?
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LaPlaces Law
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Surfactants in Tx of Pulmonary Edema

• Surfactants can be administered via aerosol in
  order to cause bubbles seen in edema fluid to
  collapse
• The collapse of the frothy edema fluid improves
  ventilation and decreases the work of breathing

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How Surface-active Agents Work
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Ethyl Alcohol (EtOH)

• Has been used via aerosol to treat severe frothy
  pulmonary edema
• There is a lack of evidence that this actually
  works
• It can also be toxic to mucus membranes!

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Mucus Wetting Agents

• Previously used to decrease surface tension of
  mucus thereby making it flow more easily
• Never actually showed clinical efficacy

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Artificial Surfactants

• Used to prevent lung complications in infants 1350 grams
• Used to prevent Respiratory Distress Syndrome in
  low birth weight babies with evidence of immature
  lungs
• Used as a rescue therapy in infants with RDS

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Exogenous Surfactants

• Used to replace the normally found surfactants
  absent in the lungs of premature newborns
• Instilled directly into the lungs of newborns
  through an endotracheal tube

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How Exogenous Surfactant Works
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Natural Surfactants

• Survanta (Beractant)- made from extract of
  minced cow lung
• Other surfactant extracts made from pig lungs

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Synthetic Surfactants

• Made from combinations of laboratory chemicals
• Exosurf (Colfosceril Palmitate) -

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End of Session