2.5.1 Treatment of Pulmonary Disorders

Question 1

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

Answer 1

Inhalation, Oral, Intravenous, Intramuscular, Transdermal

Question 2

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

Answer 2

Pressure (positive and negative)

Gases

Surgical

Alveolar lavage/Bronchoscopy/Vena cava filter

Question 3

What are some of the advantages on inhalation delivery?

Answer 3

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

Question 4

What are some disadvantages of inhalation delivery?

Answer 4

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

Question 5

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

Answer 5

Nebulizer - tobramycin, an antibiotic

Metered dose inhaler

Question 6

What is nebulized delivery?

Answer 6

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

Question 7

Why is insulin no longer administered via inhalation?

Answer 7

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

Question 8

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

Answer 8

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

Question 9

What are some pertinent side effects of glucocorticoids?

Answer 9

Thin arms and legs, muscle wasting

Impaired wound healing

Osteoporosis

Tendency to be hyperglycemic

Question 10

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

Answer 10

increased gluconeogenesis along with other negative side effects

Question 11

How do negative pressure ventilators work?

Answer 11

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 12

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

Answer 12

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

Question 13

What are some indications for invasive positive pressure ventilation?

Answer 13

Respiratory Failure, Hemodynamic instability, Paralysis, Decreased LOC

Question 14

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

Answer 14

Hypoxia, Hypercapnia, Obstructive Sleep Apnea (OSA)

Question 15

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

Answer 15

Hemodynamic instability, Decreased LOC, Copious secretions

Question 16

When should supplemental O₂ be prescribed

Answer 16

PaO2 under 55 mmHg or SaO2 < 88%

Question 17

What is the density of helium?

Answer 17

0.179 g/L

Question 18

Where is venacava filter placed? What is its purpose?

Answer 18

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