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Lower Respiratory:
Class of drugs:
- •Mucolytics
- •Bronchodilators
- •Anti-Inflammatory Agents
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Mucolytics
•Prototype: Acetylcysteine (mucomyst)
•Indications: Mucolytics adjuvant therapy for abnormal or viscous mucous secretions in acute and chronic bronchopulmonary disease
•Treatment of: cystic fibrosis, pneumonia, tuberculosis, COPD
•Other uses: bronchoscopy, postoperatively, tracheostomies, acetaminophen overdose
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Mucolytics continued:
Pharmacokinetics:
- •Onset:
- -Inhalation: 1 minute
- -Instillation: 1 minute
- •Duration: 2-3º
- •Peak:5-10 minutes
- •Metabolized: liver
- •Excreted: kidneys
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Mucolytics cont.:
Pharmacodynamics
Pharmacodynamics: acetylcysteine affects the mucoproteins in the respiratory secretions. It splits disulfide bonds that are responsible for holding the mucous material together. The result is a decrease in the tenacity of viscosity of the secretions.
Notes: Sometimes patients need to have suctioning done to help pull out the secretions.
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Mucolytics:
Contraindications/precautions:
- • Hypersensitivity
- • History of respiratory compromise: increased secretions can compromise the airway if it is not cleared.
- • History of asthma: bronchospasm can occur
- • Pregnancy category B
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Mucolytics:
Adverse effects
• Nausea and Vomiting*
• Rhinorrhea*
• Bronchospasm
• Bronchoconstriction
- • Chest tightness
- “burning” feeling in upper airway
* (most common)
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Mucolytics
Nursing (indications):
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- Assessment:
- -Respiratory baseline including ability to cough
- -Abdominal assessment for hepatomegaly
- -Temperature, skin evaluation
• Environment-usually given under the direct supervision of respiratory therapist or RN
- Notes: Temperature, skin evaluation might be because they have an infection.
- Usually given in the hospital (if under supervision)
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Mucolytics:
Nursing Diagnosis
- Ineffective Airway Clearance related to:
- (Thick mucus, bronchospasm, inhaled drug)
Desired outcome: the patient’s airway will be maintained without increased difficulty breathing
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Mucolytics:
Intervention and Planning
- •Patient and family education
- -Instruct patients to report all adverse effects, including difficulty breathing, severe nausea and dizziness
- -Inform patients that the drug is administered with the assistance of Respiratory therapist or RN
- -Medication has an odor-but transient
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Mucolytics:
Ongoing assessment and evaluation
secretions are loosening and the patient is having success coughing and moving secretions.
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Mucolytics: Critically thinking Nurse Know...
- • Used to liquefy thick, tenacious secretions
- • Major contraindication: hypersensitivity
- • Most common adverse effects: N/V, rhinorrhea
- • Most serious adverse effects: bronchospasm and bronchoconstriction
- • Minimizing adverse effects: keep suction equipment close by
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Acetylcysteine (Mucomyst) is the drug of choice in treatment of:
- a. Allergic rhinitis
- b. Cystic fibrosis
- c. Sinusitis
- d. Viral upper respiratory disease
Answer=B.
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The action of acetylcysteine (Mucomyst) is to:
- A. Break down mucoproteins in the airways that block airflow
- B. Decrease inflammation in the bronchioles
- C. Dilate the bronchioles
- D. Stop the breakdown of the mast cells
Answer=A.
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Bronchodilators-Beta agonists:
- •Indications: Sympathomimetic action:
- -Dilate airways
- -increased rate and depth of respirations
- •Treatment of: asthma & COPD
- Notes:Beta 2 agonists work on bronchodilation, but will also cause some side effects, I.e. jittery.
- Release bronchospasm, reduce airway resistance, facilitates mucus drainage, and increases vital capacity of the lungs.
- Causes glycogenolysis.
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