Aerosol Drug Therapy

Question 1

What is an Aerosol?

Answer 1

suspension of solid or liquid particles in gas generated with devises that physically disperse matter into small particles and suspend them into gas

Question 2

What is the goal of Aerosol therapy?

Answer 2

Deliver a therapeutic dose of the selected pharmacological agent to the desire site of action

Question 3

Particle sizes

Answer 3

measured by particle suspension in a lab

Question 4

Heterodisperse

Answer 4

Aerosols with different particle sizes (most common)

Question 5

Monodisperse

Answer 5

Aerosols with particles of similar size

Question 6

Particle size depends on…

Answer 6

substance, method used to generate, environment

Question 7

Inhaled Mass

Answer 7

Only fraction of emitted aerosols will be inhaled

Question 8

Respirable Mass

Answer 8

Only fraction of inhaled is deposited into the lungs

Question 9

MMAD

Answer 9

mass median aerodynamic diameter which is a method to measure aerosols

Question 10

What influences particle mass

Answer 10

inspiratory flow rate, flow pattern, respiratory rate, inhaled volume, I:E ratio, breath-holding

Question 11

Types of aerosols

Answer 11

atomizes, nebulizers, inhalers

Question 12

Adding medication to aerosols

Answer 12

provides higher therapeutic index

Question 13

Types of deposition

Answer 13

inertial impaction, sedimentation, brownian diffusion

Question 14

Inertial Impaction

Answer 14

particle size >5 - impacts upper airway; nose, larynx, and trachea - mainly oropharynx

Question 15

Sedementation

Answer 15

particle size 1-5 - central airways (2-5 lower airways) (1-3 parenchyma, alveolar region)

Question 16

Breath Holding

Answer 16

after inhalation of aerosol increases sedimentation and distribution across lungs

Question 17

Brownian

Answer 17

particle size <3 - parenchyma (respiratory region)

Question 18

particle size between 0.5 and 1

Answer 18

very low mass and can be exhaled back out

Question 19

particle sizes <0.5

Answer 19

greater lung retention rate

Question 20

Hazard of aerosol therapy

Answer 20

adverse reaction to medication, airway reactivity leading to bronchospasm

Question 21

Types of aerosol therapy

Answer 21

MDI, DPI, pneumatic nebulizers, large volume nebulizers

Question 22

MDI (pressurized Metered Dose Inhaler)

Answer 22

portable, compact, easy to use, most commonly prescribed, rescue inhaler, drug = HFA (hydrofluoroalkane)

Question 23

Priming

Answer 23

shaking device and releasing one or more sprays into air when pMDI is new or hasn’t been used in awhile

Question 24

pMDI particle size

Answer 24

2-6 (about 80% deposits in oropharynx and 10-20% is deposited pulmonary)

Question 25

Open-mouth concerns

Answer 25

steroid in pMDI can increase the risk of thrush and difficulty speaking (dysphonia) (EDUCATE PATIENT TO RINSE MOUTH)

Question 26

Spacer and Holding chambers

Answer 26

must be used with MDI

Question 27

spacer

Answer 27

extension to device that is valveless and adds distance between pMDI and patients mouth, this reduces oropharynx deposition and need for hand breath deposition

Question 28

Holding chamber

Answer 28

extension to MDI that has valves to prevent aerosol in chamber from being cleared on exhalation, higher respirable drug dosage into the lungs with less oropharyngeal deposition. better than the spacer for for hand breath cordination

Question 29

DPI ( Dry Powder Inhalers )

Answer 29

a breath-actuated dosing system that an aerosol is created when the patient draws air through dose of finely milled drug powder

Question 30

DPI flow

Answer 30

dispersion depends on creation of turbulent flow in inhaler, flow should be at least 40-60 L/Min. Low inspiratory flow decreased dose to lungs and increases particle size

Question 31

who shouldn’t use DPI

Answer 31

no infants, small children, those who cannot follow instructions, and patients with severe airway obstruction

Question 32

pneumatic jet nebulizers

Answer 32

powered by high-pressure oxygen on air by a portable compressor, compressed gas cylinder, 50 psi wall outlet

Question 33

nebulizer performance depends on

Answer 33

baffles, flow, and gas source

Question 34

baffles

Answer 34

surface in which particles impact and fall out of suspension and smaller particles stay in suspension

Question 35

small-volume nebulizers

Answer 35

slow inspiratory flow optimizes SVN, delivery method is by mask and mouthpiece, 10mL of meds, 7-10 minute treatments

Question 36

large-volume nebulizers

Answer 36

useful for severe bronchospam, 30mL of meds, treatment lasts up to 2 hours

Question 37

types of large-volume nebulizers

Answer 37

small particle aerosol generator (SPAG), vibrating mesh nebulizers, smart nebulizers, Akita (activaero)

Question 38

issues with administering aerosol to infants and children

Answer 38

smaller airway diameter, breathing rate is faster, nose breathing (filters out large particles), lower minute volumes, patient cooperation, NEVER give to crying children.

Question 39

Blow-By technique

Answer 39

when patient cannot tolerate mask treatment, the treatment is given toward a patients nose / mouth several inches away

Question 40

Assessing a patient receiving aerosol treatment

Answer 40

patient interview, observation, measure vital signs, asuculation (before/after), ABG, oximetry

Question 41

Aerosol treatment to mechanical ventilated patients

Answer 41

measure changes in peak/ plateau pressure; a drop in peak pressure and if PEEP decreases means treatment is working

Question 42

nasal oxygen

Answer 42

flows >30 L/Min have higher deposition