2.5.1 Treatment of Pulmonary Disorders

Question 1

When should supplemental O₂ be prescribed

Answer 1

PaO2 under 55 mmHg or SaO2 < 88%

Question 2

What are some disadvantages of inhalation delivery?

Answer 2

• Airway hypersensitivity (cough/bronchospasm)
• Delivery impaired by underlying lung dz (COPD, asthma, CF)

Question 3

The transactivation of glucocorticoids leads to undesired stimulation of what metabolic pathway?

Answer 3

increased gluconeogenesis along with other negative side effects

Question 4

Why is insulin no longer administered via inhalation?

Answer 4

It was discontinued b/c it led to cases of airway hypersensitivity resulting in bronchospasm

Question 5

What are some of the advantages on inhalation delivery?

Answer 5

• Higher [] of drug at site of action
• Limits systemic side effects

Question 6

What are some contraindications for non-invasive positive pressure ventilation?

Answer 6

Hemodynamic instability, Decreased LOC, Copious secretions

Question 7

Give an example of a pharmacologic intervention that is delivered via inhalation

Answer 7

Nebulizer - tobramycin, an antibiotic

Metered dose inhaler

Question 8

What is the density of helium?

Answer 8

0.179 g/L

Question 10

What is the golden number for positive pressure ventilation? What occurs if pressure exceeds this number?

Answer 10

P_plat <30 cm H₂0; if this pressure is exceeded, permanent damage to the alveoli can occur

Question 11

What are some indications for invasive positive pressure ventilation?

Answer 11

Respiratory Failure, Hemodynamic instability, Paralysis, Decreased LOC

Question 12

Where is venacava filter placed? What is its purpose?

Answer 12

Venacava filters are placed in the IVC. They are used to catch emboli from conditions live DVT before they can become pulmonary emboli

Question 13

What are some of the different modalities for non-pharmacologic treatment of respiratory disorders?

Answer 13

Pressure (positive and negative)

Gases

Surgical

Alveolar lavage/Bronchoscopy/Vena cava filter

Question 14

How is prednisone administered? What type of drug is it and what are its effects?

Answer 14

Orally; glucocorticoid suppresses inflammation systemically (asthma, COPD, autoimmune dz)

Question 15

How do negative pressure ventilators work?

Answer 15

Devices for negative pressure ventilation work by producing an intermittent negative pressure around the thorax and abdomen. The transpulmonary pressure increases, thereby assisting inhalation and inflating the lungs. Passive elastic recoil then deflates the lungs.

Question 16

What are some pertinent side effects of glucocorticoids?

Answer 16

Thin arms and legs, muscle wasting

Impaired wound healing

Osteoporosis

Tendency to be hyperglycemic

Question 17

What is nebulized delivery?

Answer 17

Air passes through a liquid (ie antibiotic) to turn it into an aerosol, which is then inhaled

Question 18

What are some of the different modalities used in pharmacologically treating patients with lung disorders?

Answer 18

Inhalation, Oral, Intravenous, Intramuscular, Transdermal

Question 19

What are some indications for non-invasive positive pressure ventilation?

Answer 19

Hypoxia, Hypercapnia, Obstructive Sleep Apnea (OSA)