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INTRODUCTION

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dornase alfa (dor-nase al-fa)

Pulmozyme

Classification

Therapeutic: cystic fibrosis therapy adjuncts

Pharmacologic: pulmonary enzymes

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Indications
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Adjunct management (with standard therapy) of cystic fibrosis.

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Action
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Breaks down excessive amounts of DNA found in the respiratory tract of patients with cystic fibrosis. Excessive DNA contributes to increased sputum viscosity and risk of infection. Therapeutic Effects: Decreased infection rates and requirement for parenteral anti-infectives. Improved pulmonary function.

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Adverse Reactions/Side Effects
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EENT: sore throat, voice alteration, conjunctivitis, hoarseness, rhinitis. Resp: cough, dyspnea. CV: chest pain. Derm: rash. Misc: fever.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Assess the quantity and consistency of sputum to help document whether this drug is successful in reducing the viscosity of respiratory secretions.

  • Monitor any chest pain and attempt to determine if pain is drug-induced or caused by cardiovascular dysfunction (e.g., angina that occurs during exercise).

  • Assess any breathing problems, and report severe or persistent cough or difficult, labored breathing.

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Interventions
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  • When implementing airway clearance techniques or other pulmonary interventions, attempt to intervene when the drug has produced mucolytic effects. Effects typically begin 15 min after inhalation.

  • Design and implement breathing exercises to maximize ventilation and help prevent infections caused by pulmonary congestion.

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Patient/Client-Related Instruction
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  • Counsel patient and family/caregivers on proper inhalation techniques. Emphasize the need to adhere to the recommended dose and frequency of inhalations.

  • Instruct patient and family/caregivers to report other troublesome side effects such as severe or prolonged headache, skin rash, fever, nasal inflammation, eye irritation, sore throat, hoarseness, or voice changes.

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Pharmacokinetics
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Absorption: Negligible absorption following inhalation.

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Distribution: Action is primarily local.

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Metabolism and Excretion: Unknown.

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Half-life: Unknown.

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TIME/ACTION PROFILE (effect on noted parameters)

ROUTE ONSET PEAK DURATION
Inhalation within 15 min* 3 days-1 wk weeks-months 48 hr

*Significant concentrations in sputum.

Improvement in respiratory function.

Decreased incidence of respiratory tract infections.

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Contraindications/Precautions
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Contraindicated in: Hypersensitivity to dornase alfa or Chinese Hamster Ovary cell products.

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Use Cautiously in: Children (incidence of cough, rhinitis, and rash is increased); Pregnancy or lactation (safety not established).

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Interactions
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Drug-Drug: None significant.

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Route/Dosage
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Inhaln (Adults and Children): 2.5 mg 1–2 times daily.

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Availability
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Solution for inhalation: 1 mg/mL in 2.5-mL single-use ampules.

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