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Cystic fibrosis is an autosomal recessive multisystem progressive disorder that results in mucus in various organs becoming thick and sticky. The disease primarily affects patients' upper and lower airways, causes long-lasting lung infections, and limits the ability to breathe over time. Dornase alfa is an inhaled medication that thins mucus, used to manage and treat cystic fibrosis. It has been shown to decrease respiratory tract infections in selected patients with forced vital capacity (FVC) greater than 40% of predicted. This activity outlines the indications, action, and contraindications for dornase alfa as a valuable agent in the therapy for cystic fibrosis, pleural effusion, and emphysema. Objectives: Describe the mechanism of action of dornase alfa. Identify the potential adverse effects of dornase alfa. Summarize the monitoring needs for patients on dornase alfa. Outline the importance of improving collaboration and communication amongst the interprofessional team to improve outcomes for patients receiving dornase alfa. Access free multiple choice questions on this topic.

The likelihood of Dornase alfa related to systematic toxicity is rare due to its short half-life and poor systemic absorption. In isolated incidences of overdose where patients used 16 times the maximum daily dose tolerated the medication well. Animal data suggests no evidence of maternal toxicity, embryotoxicity, or teratogenicity was observed. Dornase alfa has been tested negative in genotoxicity assays: the in vitro Ames assay, in vitro mouse lymphoma assay, and in vivo mouse bone marrow micronucleus assay.

Even though dornase alfa is safe due to its short half-life and poor systemic absorption, the interprofessional healthcare team, including physicians (MDs and DOs), mid-level practitioners (nurse practitioners and physician assistants, pharmacists), nursing staff, and pharmacists, must follow up with the patients to ensure the correct use of the drug. Since dornase alfa is used with a nebulizer compression system, it is crucial to assist patients in understanding how to use the medication to properly achieve its fullest effects. Clinicians need to ensure that the patient is using a nebulizer with a mouthpiece to ensure the maximum drug delivery to the lungs. A patient that is unable to breathe in and out properly should not be using a mouthpiece. Instead, the recommendation should be to use a device that utilizes a face mask. Nurses and home aid healthcare personnel also need to educate the patients not to combine dornase alfa with any other cystic fibrosis medications in the nebulizer since it will decrease the drug's efficacy. Pharmacists can also play a direct role in patient education and follow-up, reinforce proper administration, and reach out to the nurse or prescriber if they suspect any issues with the patient's therapy regimen. Interprofessional communication is essential in the care of CF patients with dornase alfa to ensure that the patient receives the most significant therapeutic benefit with the least amount of side effects, leading to optimal patient outcomes. [Level 5]