15. Inhalation pharmacotherapy

Question 1

What are the advantages of giving drugs in inhaled form?

Answer 1

Effective, rapid effect, safety.

Question 2

What are the disadvantages of giving drugs in inhaled form?

Answer 2

Need for a device, depends on patients’ compliance, depends on inhalation technique, oral candidiasis can occur.

Question 3

What are the inhaled agents used in pharmacotherapy?

Answer 3

Corticosteroids, Beta-2 agonists (SABA/LABA), Muscarinic antagonists, Antibiotics.

Question 4

What are the influencing factors of deposition in the respiratory system?

Answer 4

• Agent size,
• inhalation flow + PIF,
• inhalation and breath-hold timing,
• respiratory anatomy,
• inhaler characteristics.

Question 5

What are the indications for inhaled pharmacotherapy?

Answer 5

COPD or asthma +/- acute exacerbations, respiratory disease + expiratory wheezing.

Question 6

What are the types of inhalers?

Answer 6

• Metered dose inhalers (MDI)
• Dry powder inhalers (DPI)
• Soft mist inhalers (SMI)
• Nebulizers

Question 7

What is the propellant used in MDIs?

Answer 7

HFA (hydrofluoroalkane).

Question 8

What percentage of the drug reaches the lower airways when using an MDI?

Answer 8

10%.

Question 9

What is the advantage of using an MDI?

Answer 9

Small particle size, effective deposition, and cheap.

Question 10

What is the disadvantage of using an MDI?

Answer 10

Need for accurate coordination and high particle velocity.

Question 11

What is the drug formulation used in DPIs?

Answer 11

Dry powder.

Question 12

What is required for proper effectiveness when using a DPI?

Answer 12

Sufficiently strong inhalation.

Question 13

What determines the particle size in DPIs?

Answer 13

Peak inspiratory flow (PIF).

the faster the inhalation, the smaller the particles

Question 14

What is the disadvantage of using a Soft mist inhaler (SMI)?

Answer 14

Expensive.

Question 15

What is the name of the device that uses LABA or LAMA in SMI?

Answer 15

Respimat.

Question 16

What is a nebulizer?

Answer 16

A device that turns liquid medicine into a mist for inhalation through a mouthpiece or mask.

Question 17

What are the advantages of using a nebulizer?

Answer 17

No need for coordination, applicable in emergency situations, and can be used with SABA + saline.

Question 18

What are the disadvantages of using a nebulizer?

Answer 18

Inaccurate dosing, expensive, and requires maintenance.

Question 19

What is the difference between a metered dose inhaler and a dry powder inhaler?

Answer 19

A metered dose inhaler requires coordination, while a dry powder inhaler does not require coordination but requires deep inspiration.

Question 20

Who is a nebulizer suitable for?

Answer 20

Elderly, children, and unconscious patients who can use a mask.

Question 21

What are the factors that influence the effectiveness of inhalation devices?

Answer 21

• Age,
• education,
• socio-economic status,
• physical condition,
• comorbidities,
• lifestyle,
• family support,
• psychological status,
• dosage,
• ease of use,
• patient education,
• appearance,
• size
• taste.

Question 22

What are some determinants of poor inhaler techniques?

Answer 22

Older age, use of multiple devices, co-morbidities (arthritis, stroke, neuropathy), lack of previous education on inhaler techniques.

Question 23

What is considered good education on inhaler techniques?

Answer 23

Minimum 6 months, combined with practice, repeated education.

Question 24

What is the importance of educating patients on inhaler techniques?

Answer 24

The therapeutic successfulness of the patients depends on the efficient molecules and the correct use of the inhaler.