MANAGEMENT IN CASE (RHINOSINUSITIS) | Tutorial B-1 RS

130110110177|Gabriella Chafrina| 06/11/13

Mucolytic
Mucus
- Composition: 95% water (need for water intake to replenish
and mucus doesnt easily absorb water once created) , 3%
protein and carbohydrates, 1% lipids, less than 0.3% DNA
- Glycoproteins:
o Large (macro) molecules
o Strands of polypeptides (protein) that make up the
backbone of the molecule string of amino acid
o Carbohydrate side chains
o Chemical bonds hold mucus together
Intramolecular: dipeptide links to connect amino acids
Intermolecular: disulfide and hydrogen bonds to connect adjacent macromolecules
Different with expectorant works by signaling the body to increase the amount or hydration of secretions,
resulting in more yet clearer secretions and as a byproduct lubricating the irritated respiratory tract. One
expectorant guaifenesin is commonly available in many cough syrups. Often the term "expectorant" is
incorrectly extended to any cough medicine, since it is a universal component
Function:
- Weakening of intermolecular forces binding adjacent
glycoprotein chains by disruption of disulphide bonds
Acetylcysteine breaks the bonds by substituting a
sulfhydril radical (SH)






- Alteration of pH to weaken sugar side chains of glycoprotein
o 2% of NaHCO
3
solutions are used to increased the pH of mucus by weakening carbohydrates side chains
o Can be injected directly into the trachea or aerosolized (2-5 mL)
- Destruction of protein (proteolysis) contain in the glycoprotein core of proteolytic enzymes by breaking
down of DNA in mucus
o By attacks the protein component of the mucus using Dornase Alpha (Pulmozyme)

Ambroxol 3 x 30 mg
MoA: hydrolysis disulphide chain in mucous polymer mucous become thinner and less viscous secretions
mucous more easily to drainage and clearance
Contraindication: hypersensitivity
Side Effect: GI symptom, runny nose, allergic reactions
Pregnancy Category: C
Dosage:
- Adults: daily dose of 30 mg (1 Ambroxol tablet) to 120 mg (4 Ambroxol tablets) taken in 2-3 divided doses
- Children <2 years: half a tsp Ambroxol syrup 2x daily
- Children 2-5 years: half a tsp Ambroxol syrup 3x daily
- Children >5 years: 1 tsp Ambroxol syrup 2-3x daily
Have a fast onset (<30 minutes) and long duration of effect (at least 3 hours)
MANAGEMENT IN CASE (RHINOSINUSITIS) | Tutorial B-1 RS

130110110177|Gabriella Chafrina| 06/11/13
Analgetic

Ibuprofen 3 x 200 mg
Indication
For symptomatic treatment of rheumatoid arthritis, juvenile rheumatoid arthritis and
osteoarthritis. May be used to treat mild to moderate pain and for the management of
dysmenorrhea. May be used to reduce fever. Has been used with some success for treating
ankylosing spondylitis, gout and psoriatic arthritis. May reduce pain, fever and inflammation of
pericarditis. May be used IV with opiates to relieve moderate to severe pain. Ibuprofen lysine
may be used IV to treat patent ductus arteriosus (PDA) in premature neonates.
Pharmacodynamics
Ibuprofen is a nonsteroidal anti-inflammatory agent (NSAIA) or nonsteroidal anti-inflammatory
drug (NSAID), with analgesic and antipyretic properties. Ibuprofen has pharmacologic actions
similar to those of other prototypical NSAIAs, which are thought to act through inhibition of
prostaglandin synthesis.
Mechanism of
action
The exact mechanism of action of ibuprofen is
unknown. Ibuprofen is a non-selective inhibitor of
cyclooxygenase, an enzyme invovled in prostaglandin
synthesis via the arachidonic acid pathway. Its
pharmacological effects are believed to be due to
inhibition cylooxygenase-2 (COX-2) which decreases
the synthesis of prostaglandins involved in mediating
inflammation, pain, fever and swelling. Antipyretic
effects may be due to action on the hypothalamus,
resulting in an increased peripheral blood flow,
vasodilation, and subsequent heat dissipation.
Inhibition of COX-1 is thought to cause some of the side effects of ibuprofen including GI
ulceration. Ibuprofen is administered as a racemic mixture. The R-enantiomer undergoes
extensive interconversion to the S-enantiomer in vivo. The S-enantiomer is believed to be the
more pharmacologically active enantiomer.
Absorption
~ 80% absorbed from GI tract
Time to reach peak plasma concentration = 47 minutes (suspension), 62 minutes (chewable
tablets), 120 minutes (conventional tablets)
Side Effects
May cause peripheral edema and fluid retention. Use caution in patients with congestive heart
failure or severe uncontrolled hypertension. May cause dyspepsia, heartburn, nausea, vomiting,
anorexia, diarrhea, constipation, stomatitis, flatulence, bloating, epigastric pain, and abdominal
pain. Peptic ulcer and GI bleeding have been reported. May also cause dizziness, headache and
nervousness. Acute renal failure accompanied by acute tubular necrosis has been reported.
Most common symptoms of overdose are abdominal pain, nausea, vomiting, lethargy, vertigo,
drowsiness (somnolence), dizziness and insomnia. Other symptoms of overdose include
headache, loss of consciousness, tinnitus, CNS depression, convulsions and seizures. May rarely
cause metabolic acidosis, abnormal hepatic function, hyperkalemia, renal failure, dyspnea,
respiratory depression, coma, acute renal failure, and apnea (primarily in very young pediatric
patients).
Protein binding
90-99% to whole human plasma and site II of purified albumin, binding appears to be saturable
and becomes non-linear at concentrations exceeding 20 mcg/ml.
MANAGEMENT IN CASE (RHINOSINUSITIS) | Tutorial B-1 RS

130110110177|Gabriella Chafrina| 06/11/13

Saline Irrigation
Mechanical irrigation with buffered,
physiologic, or hypertonic saline may reduce
need for pain medication and improve
overall patient comfort, particularly in
patients with frequent sinus infections.
Frequent rinsing prevents the accumulation
of nasal crusts and promotes mucociliary
clearance. Hypertonic saline (1/2 tsp salt in
8 oz water) may increase the rate of
clearance in certain cases and osmotically
decreases mucosal congestion. Antibiotic
irrigations such as gentamicin (80 mg/L)
may be considered in refractory cases of
chronic rhinosinusitis.

Nasal irrigation with nasal saline 0.9%
In mucous membrane, cilia pass bacteria
and other debris to the throat where they
can be harmlessly swallowed. When
membranes swell, cilia cant do their job.
With nasal irrigation, you use the saline
solution to rinse out your nasal passages.
The salt water also restores moisture and
eases inflammation of the mucous
membranes. Swelling is reduced, making it
easier to breathe.