![Page 1: Mucokinetics RC 195. Mucokinetics – drugs that increase and aid clearance of respiratory tract secretions Hypoviscosity agents (Wetting agents) Mucolytics](https://reader036.vdocument.in/reader036/viewer/2022062518/56649e9e5503460f94b9f99f/html5/thumbnails/1.jpg)
Mucokinetics
RC 195
![Page 2: Mucokinetics RC 195. Mucokinetics – drugs that increase and aid clearance of respiratory tract secretions Hypoviscosity agents (Wetting agents) Mucolytics](https://reader036.vdocument.in/reader036/viewer/2022062518/56649e9e5503460f94b9f99f/html5/thumbnails/2.jpg)
Mucokinetics – drugs that increase and aid clearance of respiratory tract secretions
• Hypoviscosity agents (Wetting agents)• Mucolytics• Expectorants (Bronchomucotropics)
![Page 3: Mucokinetics RC 195. Mucokinetics – drugs that increase and aid clearance of respiratory tract secretions Hypoviscosity agents (Wetting agents) Mucolytics](https://reader036.vdocument.in/reader036/viewer/2022062518/56649e9e5503460f94b9f99f/html5/thumbnails/3.jpg)
Muco-ciliary Blanket
95% water, 2% glycoproteins
Gel layer-high viscosity from goblet cells
Sol layer – low viscosity from submucosal bronchial glands
![Page 4: Mucokinetics RC 195. Mucokinetics – drugs that increase and aid clearance of respiratory tract secretions Hypoviscosity agents (Wetting agents) Mucolytics](https://reader036.vdocument.in/reader036/viewer/2022062518/56649e9e5503460f94b9f99f/html5/thumbnails/4.jpg)
Both goblet cells and bronchial sub-mucosal glands increase secretion when irritated. Vagal stimulation will also increase bronchial sub-mucosal gland secretion.
Increased goblet cell secretion = increased sputum viscosity.Increased bronchial sub-mucosal gland secretion = decreased sputum viscosity
![Page 5: Mucokinetics RC 195. Mucokinetics – drugs that increase and aid clearance of respiratory tract secretions Hypoviscosity agents (Wetting agents) Mucolytics](https://reader036.vdocument.in/reader036/viewer/2022062518/56649e9e5503460f94b9f99f/html5/thumbnails/5.jpg)
Mucokinetics are needed when secretions
increase in amount and/or viscosity
![Page 6: Mucokinetics RC 195. Mucokinetics – drugs that increase and aid clearance of respiratory tract secretions Hypoviscosity agents (Wetting agents) Mucolytics](https://reader036.vdocument.in/reader036/viewer/2022062518/56649e9e5503460f94b9f99f/html5/thumbnails/6.jpg)
Hypoviscosity/Wetting Agents: Water
• Systemic administration, eg P.O. or IV, decreases viscosity by increasing the sol layer
• Aerosol may decrease viscosity by diluting the gel layer– Limitations of aerosol
• Nebulizer output• Bronchospasm• Hypotonicity and mucosal swelling
![Page 7: Mucokinetics RC 195. Mucokinetics – drugs that increase and aid clearance of respiratory tract secretions Hypoviscosity agents (Wetting agents) Mucolytics](https://reader036.vdocument.in/reader036/viewer/2022062518/56649e9e5503460f94b9f99f/html5/thumbnails/7.jpg)
Hypoviscosity/Wetting Agents:Saline solutions
• Normal Saline (.9%)– Isotonic and good diluent for drugs
• Half-normal Saline (.45%)– Hypotonic, good diluent, and can be administered via
USN• Aerosol solutions tend to increase in tonicity
as they go deeper into the lung because of evaporation!
![Page 8: Mucokinetics RC 195. Mucokinetics – drugs that increase and aid clearance of respiratory tract secretions Hypoviscosity agents (Wetting agents) Mucolytics](https://reader036.vdocument.in/reader036/viewer/2022062518/56649e9e5503460f94b9f99f/html5/thumbnails/8.jpg)
Hypoviscosity/Wetting Agents:Saline solutions (cont.)
• Hypertonic Saline (usually 10%)– Wetting agent– Bronchorrhea (draws fluid from mucosa to dilute gel)– May also help break up mucoprotein-DNA bonds in
mucus (mucolytic effect!)• Limitations:
– Bronchospasm– Hypernatremia
![Page 9: Mucokinetics RC 195. Mucokinetics – drugs that increase and aid clearance of respiratory tract secretions Hypoviscosity agents (Wetting agents) Mucolytics](https://reader036.vdocument.in/reader036/viewer/2022062518/56649e9e5503460f94b9f99f/html5/thumbnails/9.jpg)
![Page 10: Mucokinetics RC 195. Mucokinetics – drugs that increase and aid clearance of respiratory tract secretions Hypoviscosity agents (Wetting agents) Mucolytics](https://reader036.vdocument.in/reader036/viewer/2022062518/56649e9e5503460f94b9f99f/html5/thumbnails/10.jpg)
Hypoviscosity/Wetting Agents:Sodium Bicarb
• Usually 2 – 7.5% solution• Wetting agent and bronchorrhea• Also alkaline pH breaks up hydrogen bonds• Also breaks up calcium bonds• Like hypertonic saline, it is both a wetting agent and a
mucolytic• Can usually NOT be used as a diluent for drugs• Has same side effects as hypertonic saline
![Page 11: Mucokinetics RC 195. Mucokinetics – drugs that increase and aid clearance of respiratory tract secretions Hypoviscosity agents (Wetting agents) Mucolytics](https://reader036.vdocument.in/reader036/viewer/2022062518/56649e9e5503460f94b9f99f/html5/thumbnails/11.jpg)
Mucolytics
Aid mucokinesis by breaking up bonds in mucus
![Page 12: Mucokinetics RC 195. Mucokinetics – drugs that increase and aid clearance of respiratory tract secretions Hypoviscosity agents (Wetting agents) Mucolytics](https://reader036.vdocument.in/reader036/viewer/2022062518/56649e9e5503460f94b9f99f/html5/thumbnails/12.jpg)
Mucolytics:Mucomyst (N-Acetylcysteine)
• 10 or 20% solution (hypertonic and alkaline pH)
• Breaks disulfide bonds (most effective form of mucolysis)
• Also breaks mucoprotein bonds and hydrogen bonds
• Bronchorrhea
![Page 13: Mucokinetics RC 195. Mucokinetics – drugs that increase and aid clearance of respiratory tract secretions Hypoviscosity agents (Wetting agents) Mucolytics](https://reader036.vdocument.in/reader036/viewer/2022062518/56649e9e5503460f94b9f99f/html5/thumbnails/13.jpg)
Mucolytics:Mucomyst (N-Acetylcysteine) cont.
• Aerosol dose is 2-5ml of 10%– 10% is as effective as 20%
when aerosolized and is not as irritating
• Side effects/Pre-cautions:– Bronchospasm
• May need a concurrent bronchodilator
– Decreased ciliary activity• Patient may need to be
suctioned if he can’t cough effectively
– Nausea/rhinorrhea
• Reacts with metal and rubber• Shelf life is 96 hours after
opening– Should be refrigerated– Purple streaks when too old
• Inactivates some antibiotics if they are aerosolized with Mucomyst
![Page 14: Mucokinetics RC 195. Mucokinetics – drugs that increase and aid clearance of respiratory tract secretions Hypoviscosity agents (Wetting agents) Mucolytics](https://reader036.vdocument.in/reader036/viewer/2022062518/56649e9e5503460f94b9f99f/html5/thumbnails/14.jpg)
Mucolytics:Pulmozyme (Dornase Alpha or
DNAse)• Excellent aerosol mucolytic for cystic fibrosis
patients• Lyses the DNA bonds in the sputum of cystic
fibrosis patients– These patients have a lot of these bonds!
![Page 15: Mucokinetics RC 195. Mucokinetics – drugs that increase and aid clearance of respiratory tract secretions Hypoviscosity agents (Wetting agents) Mucolytics](https://reader036.vdocument.in/reader036/viewer/2022062518/56649e9e5503460f94b9f99f/html5/thumbnails/15.jpg)
Expectorants (Bronchomucotropics)
• Usually stimulate sol layer production by direct irritation or indirect through vagal stimulation– Remember, increased sol means decreased viscosity!
• Smoke is a bronchomucotropic!– Unfortunately, it’s irritation stimulates the bronchial submcosal
glands AND the goblet cells so mucus production increases as well as viscosity
• Spicy food causes increased sol due to vagal stimulation!
![Page 16: Mucokinetics RC 195. Mucokinetics – drugs that increase and aid clearance of respiratory tract secretions Hypoviscosity agents (Wetting agents) Mucolytics](https://reader036.vdocument.in/reader036/viewer/2022062518/56649e9e5503460f94b9f99f/html5/thumbnails/16.jpg)
Vagal Stimulation and Mucokinesis
![Page 17: Mucokinetics RC 195. Mucokinetics – drugs that increase and aid clearance of respiratory tract secretions Hypoviscosity agents (Wetting agents) Mucolytics](https://reader036.vdocument.in/reader036/viewer/2022062518/56649e9e5503460f94b9f99f/html5/thumbnails/17.jpg)
Expectorants (Bronchomucotropics):SSKI
• Vagal stimulation and irritation when administered orally• Also stimulates proteolytic enzymes for a slight
mucolytic effect• Side effects/Precautions:
– Tastes like hell!– Excess vagal stimulation
• N &V, diarrhea, bradycardia
– Anaphylaxis
![Page 18: Mucokinetics RC 195. Mucokinetics – drugs that increase and aid clearance of respiratory tract secretions Hypoviscosity agents (Wetting agents) Mucolytics](https://reader036.vdocument.in/reader036/viewer/2022062518/56649e9e5503460f94b9f99f/html5/thumbnails/18.jpg)
Expectorants (Bronchomucotropics):Guaifenesin
• Vagal stimulation like SSKI but not as foul tasting or severe side effects– Active ingredient in many “cough” medicines, eg
Robitussin– Prescription version is Humibid (pills)
• Guaifenesin is a very effective expectorant for chronic bronchitis
![Page 19: Mucokinetics RC 195. Mucokinetics – drugs that increase and aid clearance of respiratory tract secretions Hypoviscosity agents (Wetting agents) Mucolytics](https://reader036.vdocument.in/reader036/viewer/2022062518/56649e9e5503460f94b9f99f/html5/thumbnails/19.jpg)
Expectorants (Bronchomucotropics):Ammonium Chloride
• Vagal stimulation only• Found in many children’s “cough” syrups
because it is easy to flavor• Side effects are like SSKI and Guaifenesin
– Also may cause metabolic acidosis
![Page 20: Mucokinetics RC 195. Mucokinetics – drugs that increase and aid clearance of respiratory tract secretions Hypoviscosity agents (Wetting agents) Mucolytics](https://reader036.vdocument.in/reader036/viewer/2022062518/56649e9e5503460f94b9f99f/html5/thumbnails/20.jpg)
One more case study!
![Page 21: Mucokinetics RC 195. Mucokinetics – drugs that increase and aid clearance of respiratory tract secretions Hypoviscosity agents (Wetting agents) Mucolytics](https://reader036.vdocument.in/reader036/viewer/2022062518/56649e9e5503460f94b9f99f/html5/thumbnails/21.jpg)
This is the end of this course. But….
![Page 22: Mucokinetics RC 195. Mucokinetics – drugs that increase and aid clearance of respiratory tract secretions Hypoviscosity agents (Wetting agents) Mucolytics](https://reader036.vdocument.in/reader036/viewer/2022062518/56649e9e5503460f94b9f99f/html5/thumbnails/22.jpg)