Pharm Unit 9 & 10

Front 1

What is the Mucociliary Escalator?

Back 1

Its Cilia that constantly propels the mucous layers towards the oropharnyx

Front 2

What disease processes slow the function of the Mucociliary escalator

Back 2

1-Bronchitis (inflammatory)

2-Asthma (inflammatory)

3-Cystic Fibrosis (plugs airway)

Front 3

What is the histology of the of the Mucociliary escalator made up from?

Back 3

1-Ciliated columnar epithelium
2-Basement membrane
3- Mucous layers

Front 4

What does the basement membrane of the Mucociliary escalator contain?

Back 4

1-Contains the sub-mucosal glands

2-Innervated via the parasympathetic never

Front 5

What are the mucous layer of the Mucociliary escalator?

Back 5

Gel: more viscous upper layer

Sol: less viscous lower layer

Front 6

what is the mucous source for the Mucociliary escalator?

Back 6

1-Surface goblet cells

2-Submucosal glands

Front 7

Where are the surface goblet cells and submucosal glands found?

Back 7

terminal bronchioles

Front 8

What is ratio of columnar epithelium to goblet cells?

Back 8

5:1

Front 9

There are about ________ goblet cells per ______

Back 9

6800 / mm2

Front 10

What are the drug effects of mucolytic agents?

Back 10

Break up the thick molecular structure
hydration

Front 11

What is the primary source of mucous for "subepithelial calls"?

Back 11

1-Submucosal glands

40x the volume of the goblet cells

Front 12

submucosal glands are innervated by_________ and have what kind of stimulation?

Back 12

innervated via Vagus nerve

Has cholinergic stimulaton

Front 13

Subepithelial cells produce what two fluids that get excreted into the airways when mixed?

Back 13

1-serous

2-mucous

Front 14

The cilliary system proples secreations towards the?

Back 14

Pharynx

Front 15

the cilliary system beats at about

Back 15

11-18Hz

Front 16

What are the factors affecting transport of the cilliary system?

Back 16

1-age
2-COPD
3-General anestesia
4-Anticholinergics
5-Nacotics
6-smoking
7-air pollution
8-milk intake

Front 17

How much mucous do we produce / day?

Back 17

100mL/day

Front 18

How much mucous reaches our glottis?

Back 18

~ 10% or 10mL

Front 19

What is the molecular structure of mucous?

Very complex

Back 19

1-Long polypeptide chains, held with disulfide bonds
2-has a side carbohydrate chain
phospholipids and serum proteins are also present.

Front 20

What disease state alters the mechanism of Ion transport?

Back 20

Cystic Fibrosis

Front 21

How does the change in mucous affect Chronic bronchitis?

Back 21

1-Increase mucous production, airways get plugged up
2-Hypertrophy of mucous secreting cells
3-chronic airway inflammation do primarily from smoking

Front 22

How does mucous affect Asthma?

Back 22

1-inflammation
2-increased airway secretion
3-reactive smooth muscle a distinguishing factor

Front 23

How does mucous affect Cystic Fibrosis?

Back 23

1-Hereditary disease
2-Increase mucous viscosity / quantity
3-increase inflammatory process
4-lead to chronic bronchiectasis

Front 24

What are the physical properties of mucous?

Back 24

1-adhesive forces (sticky)
2-Cohesive forces (between mucous)
3-Visoelastic (fluid & solid properties)
4-Spinability (drawn into threads Droop test)

Front 25

What is the idea behind mucous controlling agents?

Back 25

1-liquefy the mucous
2-thin its viscosity
3-mucolytic agents break up the thick molecular structure

Front 26

What are mucolytics?

Back 26

they break down mucous

Front 27

What are expectorants?

Back 27

Stimulate production of secretions

Front 28

What are the general goals for mucolytic agents?

Back 28

1-Improve mucocilliary action
2-remove causative factors "smoking"
3-optimize tracheobronchial clearance via: cough, hydration, deep breathing
4-reduce inflammation-steroids
5-antibiotics -bacterial nfections

Front 29

What is the trade name for Acetylcysteine

Back 29

Mucomyst

Front 30

What are the indications for Mucomyst?

Back 30

Thick viscous secretions
Antidote for tylenol -drink it

Front 31

What is the dosage for Mucomyst?

Back 31

20% = 3-5 mL tid/qid
10% = 6-10mL tod/qid

Front 32

What is the mode of action for Mucomyst (acetylcysteine)

Back 32

1-Breaks disulfide bond
2-decreases viscosity via shortening the poloypeptide chain

Front 33

What are the hazards from taking Mucomyst (acetylcysteine)?

Back 33

1-Bronchospasm: give with a bronchodilator
Albuterol or Metaproterenaol
2-Nausea
3-smells like rotten eggs
4-Bad taste

Front 34

What antibiotics dont mix with Mucomyst (acetylcysteine)

Back 34

1-Ampicillin
2-Amphotericin
3-Erythromycin
4-tetracylines

Front 35

What is the trade name for Dornase Alfa

Back 35

Pulmozyme

Front 36

What does Pulmozyme (Dornase Alfa) clone?

Back 36

Clone of pancreatic DNase

Front 37

what is disease is pulmozyme (Dornase Alfa) used for?

Back 37

Cystic Fibrosis

Reduces infection by reducing mucous viscosity

Front 38

What is the mode of action for Pulmozyme? (Dornase Alfa)

Back 38

protoypic action that Specifically breaks down the DNA in protiens

Front 39

What is the dosage for Pulmozyme? (Dornase Alfa)

Back 39

1-Daily dose of 2.3 mg in 2.5 mL
2-Refrigerate / protect from sun

Front 40

What kind for nebulizer what you use to administer Pulmozyme? (Dornase Alfa)

Back 40

Perijet:
good for small particles and good outputs

Front 41

What are expectorants?

Back 41

they stimulate secretion production

Front 42

What drugs are used as an expectorants?

Back 42

1-Potassium Iodine (SSKI)
2-Sodium bicarbonate
3-Guaifenesin (Mucinex)
4-Oligosaccharides
5-Triphospahate nucleotide (ATP / UTP)
6-Surface active agents

Front 43

What is Potassium Iodine (SSKI) used for ?

Back 43

Pre-sputum sample
stimulates mucous production

Front 44

what is Sodium bicarbonate used for?

Back 44

increase pH, more alkolatic weakening the bonds in mucous

Front 45

What is Mucinex (Guaifenesin) used for?

Back 45

Stimulate mucous production

Front 46

What is Oligosaccharides used for?

Back 46

improve hydration and clearence

Front 47

what is Triphospahate nucleotide (ATP / UTP) used for?

Back 47

stimulate Cl excretion

Front 48

What is surface active agents used for?

Back 48

there phosphlipids to reduce surface tention

Front 49

How does surfactant work?

Back 49

agent that lowers surface tension in alveolar structures

Front 50

Surface tension is cause how?

Back 50

by cohesive forces between like molecules

Front 51

How does LaPlace laws apply too surface tension?

Back 51

Equates pressure to the surface tensionand the radius of a bubble (alveolus)

Front 52

What role does the alveolus play with surface tension?

Back 52

1-Liquid lining structure
2-As surface tension increases, the alveolar want to collapse

Front 53

What is surfactant?

Back 53

A natural lipoprotien that reduces the effects of surface tension

Prevents the alveoli from collapsing

Front 54

Why would we use Ethyl Alcohol
ETHOH...Vodka has a surface agent?

Back 54

b/c it reduces the surface tension

reducing bubbles back to a liquid

Front 55

What kinds of patients would benifit from Vodka?

Back 55

Acute pulomonary edema pts
For foamy pink secreations
may occuled airway

Front 56

What are the disadvantages of ETOH...Vodka?

Back 56

Lack of scientific evidence!!!

Front 57

What is the action of a "Wetting" agent?

Back 57

breaks down the hydrophopic bonds in mucous
Thought to break the mucous into smaller particles

Front 58

what are two wetting agent?

Back 58

1-Alevaire
2-Tergemist

Front 59

What is the idea of using phospholipids as a surface active agent?

Back 59

to be used as a lubricant for mucous transport

Front 60

What does exogenous mean?

Back 60

1-from outside the body
2-Not produced by the patient

Front 61

What is the clinical use for Exogenous surfactants?

Back 61

used for Premi neonates <32-33 wks
They dont produce there surfactant so we deliver them via an ET tube

Front 62

What are the two types of availabe exogenous surfactent agents?

Back 62

1-Exosurf

2-Survanta

Front 63

How is surfactant produce?

Back 63

By the tpye II alveolar cells

Magic lipoprotiens

Front 64

Surfactants have ________ lipids inside the molecule

Back 64

85-90 % by weight

Front 65

What is the role of the phospolipids that are carried inside the surfactant?

Back 65

responsible for the reduction in surface tension

Front 66

How does your body normally "naturally" produces surfactant

Back 66

1-inflation of lungs trigger the release of surfactent from the lamellar bodies
2-SP-A breaks the layer ip resulting in a quick dispersal of surfactant trought the alveolar surface

Front 67

How much surfactant is recycled / reabsorbed?

Back 67

90-95%

Front 68

What is the key to replacement therapy with surfactent?

Back 68

RECYCLING, taken into the type II cell and resued!

Front 69

What agent is a natural surfactent?

Back 69

Survanta

Front 70

Where does Survanta come from?

Back 70

Bovine lungs

Front 71

How was Survants modified of human use?

Back 71

by adding
DPPC
palmitic acid
tripalmitin

Front 72

What is a medical hazard from Survanta?

Back 72

Contaminating infectious agents

Front 73

What agent is a Artificial (synthetic) agent?

Back 73

Exosurf

Front 74

How was Exosurf formed?

Back 74

By combining:
DPPC
cetyl alcohol
tyloxapol

Front 75

What are the advantages of Exosurf?

Back 75

Free from Infectious agents

Front 76

What is the disadvantage of Exosurf?

Back 76

May not have the same proformance as the natural product

Front 77

What are the clinical indication for exogenous surfactent?

Back 77

1-to prevent ARDS
2-Rescue treatment for ARDS

Front 78

What is the clinical effect from exogenous surfactant?

Back 78

1-reduces surface tension by replacing alveolar surfactant
2-Increases FRC
3-decreased peak pressures on mechanical ventilation b/c compliance improves

Front 79

What is the trade name for Colfosceril Palmitate?

Back 79

Exosurf

Synthetic Drug

Front 80

How do you prepare Exosurf (Clofoscril Palmitate)

Back 80

1-Store as a dry powder
2-reconstitute w/ 8mL of sterile water
3-Forms a milky white fluid

Front 81

What are the clinical indication to give Exosurf?

Back 81

1-prophylactic therapy for weights <1350gm
2-prophylactic for wt > 1350 gm w/evidence of RDS
3-Rescue drug for RDS infants

Front 82

What is the dose for Exosurf? (Colfosceril Palmitate)

Back 82

Give 5mL in two divided does via direct ET administration

Front 83

How do administer Exosurf?

Back 83

1-instilled first 1/2 directly into ET tube
2-give in mideline position, rotate right and is bagged in
3-2nd dose given midline rotate Left and bagged in

Front 84

How do administer Survanta?

Back 84

1-Instilled via 5 Fr catheter in ET tube
2-Dose given in quarters (25% or 1/4 per dose)
3-pt bagged / retured to CMV for 30 sec between doses
4-Ok to repeat dose after 6hrs use CMV between dose
5-make sure to check PEEk pressures

Front 85

What is the trade name for Beractant?

Back 85

Survanta

Front 86

What are the clinical indication to give Survanta? (Beractant)

Back 86

1-Prophylactic for wt< less1250 gm w/evidence of RDS

2-Rescue treatment for RDS

Front 87

What is the dose for Survanta? (Beractant)

Back 87

100mg/kg or (4mL/kg)

Front 88

Is Survanta (Beractant)synthetic or natural?

Back 88

Natural

Front 89

Is Exosurf (Colfosceril Palmitate) natural or synthetic?

Back 89

Synthetic

Front 90

What are the hazards of exogenous surfactants?

Back 90

1-Airway occulsion
2-desaturation (hypoxia)
3-Bradycardia

Front 91

Why is occlusion a hazard with surfactant administration?

Back 91

given via ET tube kids will desat very quikley lowering there SpO2 like in the 80's

Front 92

Why will the pt PaO2 values increase with surfactant admin.?

Back 92

You need to lower there FIO2 to keep PaO2 low to prevent RLF

Front 93

Why is over ventilation a hazard with surfactant admin.?

Back 93

Can pop a lung b/c of the change in compliance
Watch PIP during bagging / CMV

Front 94

Why is pulmonary hemorrhage a hazard with premies and the administration of surfactant?

Back 94

b/c of low birth weight -- 700gm