Aerosolized agents, Cold and Cough Agents, and Nervous System Flashcards
1
Q
definition of aerosol therapy
A
delivery of either solid or liquid aerosol into the respiratory tract for therapeutic purposes
2
Q
definition of medicated aerosol
A
a suspension of a liquid or solid drug in a carrier gas
3
Q
What are the goals of aerosol therapy
A
to humidify dry gases, to improve mobilization and clearance of respiratory secretions and to deliver aerosolized drugs to the respiratory tract
4
Q
Advantages of the aerosol delivery of drugs
A
meds are delivered very quickly, painless and convient, and they have smaller effective dosages of the drug
5
Q
advantages of the aerosol route
A
delivers meds locally, reduces systemic effects, and lungs provide a portal of entry for inhaled aerosol agents intended for the systemic effect
6
Q
disadvantages of the aerosol route
A
difficult to get precise dosages each time, dose reproducibility is inconsistent, clinicians lack proper knowledge of device use and protocols, patients usually self administers which requires good patient education and compliance, numerous device types and variability, standardized technical info on aerosol producing devices is lacking
7
Q
definition of aerosol
A
suspension of solid or liquid in a carrier gas
8
Q
What are some factors that influence drug delivery within the lungs?
A
stability, penetration, deposition, and aerosol
9
Q
stability definition
A
the tendency of an aerosol to remain in suspension.
10
Q
Because of stability it is important for the patient to do what?
A
hold their breath
11
Q
penetration definition
A
refers to how deep into the lungs the aerosol particles travel
12
Q
deposition definition
A
refers to the aerosolized agents particles falling out of suspension to remain in the lung
13
Q
What influences deposition?
A
patients breathing pattern, particle size, and the patients disease
14
Q
aerosol generating devices for oral inhalation have what efficiency percentage?
A
10-15%
15
Q
What is one of the most important factors in determining whether an aerosol will get into the lung?
A
size of particle
16
Q
10-15 microns deposit where?
A
stuck in upper airways (nose and mouth) Example nasal spray
17
Q
5-10 microns deposit where?
A
penetrate to upper airways. Large bronchi
18
Q
1-5 microns deposit where?
A
penetrate lower respiratory tract from the trachea to lung periphery
19
Q
<0.5 microns deposit where?
A
penetrate alveoli; may be breathed right back out
20
Q
inertial impaction definition
A
impacting of aerosol particles upon airway walls. Increases with larger sizes and higher velocities.
21
Q
settling is greater for large particles with slow velocities under the influence of what?
A
gravity
22
Q
What increases time needed to maximize sedimentation?
A
inspiratory breath holds
23
Q
Diffusion
A
also called brownian motion. Affects particles less than 1 um and is a function of time and random molecular motioin
24
Q
Nasal decongestants
A
OTC metered spray pumps, which produce large particles that settle in the nasal region.
25
nasal decongestants are what referred to as what?
vasoconstrictors
26
Bronchodilators
enlarge the diameter of the airway, including relaxing the smooth muscle that surrounds the airways.
27
Example of a nasal decongestant?
neo-synephrine
28
Example of a bronchodilator?
Proventil and Atrovent
29
Antiasthmatics or mast cell stabilizers
desensitize the allergic response; which prevents or decreases the incidence of asthma.
30
Examples of antiasthmatics
Cromolyn sodium and Nedocromil sodium
31
Corticosteroids
used in moderate and severe asthma attacks to reduce the inflammatory response within the lung. Can prevent or lessen late phase asthma.
32
Examples of corticorsteroids
QVAR, Vanceril, Flovent, Azmacort
33
Mucolytics
break down secretions within the lungs to make it easier to expectorate and clear the lungs. Can be given via nebulization or directly instilled into the lungs in liquid form. Good for CF patients
34
Example of mucolytic
Mucomyst
35
Antimicrobials
aerosolized antibiotics and antiviral agents.
36
Examples of antimicrobials
Gentamicin, Amphotericin B, Ribavirin
37
SVN
mediciated aerosol delivery device that uses a gas powered source to continuously aerosolize a liquid medication
38
How long do SVN treatments last?
8-12 minutes
39
What is the most common type of SVN
small volume jet neb
40
Advantages to SVN
ability to aerosol many drug solutions, able to aerosolize drug mixtures, minimal cooperation or coordination required, useful in very young or very old, effective with low inspiratory flows, normal breathing pattern can be used, drug concentrations/doses can be modified
41
Disadvantages to SVN
equipment required is expensive, treatments are somewhat lenghty, contamination is possible, assembly and cleaning are required, wet/cold spray occurs, variability in performance characteristics among different types of brands, power source is needed, dead volume
42
Breath Actuated Nebulizer (BAN)
newer, nebulizes only on inspiration and has a low dead volume. Treatment time is around 3-5 minutes
43
Ultrasonic Nebulizer (USN)
electrically powered, capable of high output, particle sizes vary by brand. small portable unit that requires DC voltage
44
Advantages to USN
small, rapid nebulization with shorter treatment times, smaller drug amounts, can be used during travel
45
Disadvantages to USN
expensive, fragile, requires electrical source, possible degradation of drug
46
Mesh nebulizers
use a plate or mesh with multiple apertures to move liquid formulations through a fine mesh to generate aerosol. Have no baffle.
47
Advantages to mesh nebs
does not require gas source, powered electrically, leave little dead volume, efficient, small size, shorter treatment times
48
Disadvantages to mesh nebs
expensive, fragile, requires electrical source, possible degrading effect on drug yet to be determined
49
LVN
aerosolized bronchodilators administered continuously
50
Examples of LVN?
HEART and HOPE nebs
51
LVN are used for?
status asthmaticus
52
LVN are effective treatment for what type of patients?
ones with severe pulmonary disease
53
Metered Dose Inhaler (MDI) Advantages
small, portable, efficient, short treatment time, easy to use, self administered, more than 100 doses are available, no drug prep needed, difficult to contaminate
54
Disadvantages to MDI's
complex hand breathing coodination, proper inhalation pattern, drug concentration/doses are fixed, foreign body aspirations can occur, high oropharyngeal impaction and loss occur if extension device is not used, canister depletion is difficult to determine
55
Factors affecting MDI performance
loss of dose, shaking canister, timing of actuation intervals, open mouth vs closed mouth use, loss of prime, storage temp
56
What are the two categories of MDI's
Conventional pMDI and Breath-actuated pMDI
57
Spacer devices
reservoir devices are used with aerosol delivery devices such as MDIs to optimize drug delivery
58
Reservoir definition
extension tube with a mouthpiece added to the MDI
59
What are the 2 types of reservoir devices?
spacers, and valved holding chambers
60
Spacer definition
simple extensions with no one way valves to contain the aerosol cloud; placed b/w MDI and patient
61
Valved holding chamber definition
spacers with one way valves that hold aerosol until the patient inhales
62
Spacer device advantages
allows patient to slow down, better lung deposition, allows patient to have something stable in their mouth. if patient lags behind when breathing in it is unimportant because the aerosol is formed in chamber
63
Disadvantages to spacer devices
large, additional expense, some assembly required, possible source of baterial contamination, patient errors
64
What percentage of patients do not use their MDIs correctly
60-70%
65
MDI instructions
Assemble inhaler (hold upright and take off cap), Shake MDI well, exhale normally, hold MDI about 1 inch in front of open mouth, begin to take a slow deep breath; pressing down on the canister as you continue to inhale, breathe in until lungs are full and then hold breath for up to 10 seconds, wait 1 minute before taking next puff, reassemble and store.
66
What should you always do after taking an inhaled steroid?
rinse mouth with mouthwash or water to prevent oportunistic oral infections
67
Dry powder inhaler (DPI)
devices that deliver the drug in powder form to the lungs for absorption, breath actuated, small/self generating, now external power sources
68
Patient must generate what LPM for the device to properly aerosolize the dry powder
30-90 LPM
69
DPI instructions
ensure mouthpiece is clear, exhale normally away from DPI, inhale from the mouthpiece fast to total lung capicity, hold breath for up to 10 seconds, remove mouthpiece from mouth and exhale away
70
Example of DPI
Advair Serevent
71
A DPI is difficult to take for who?
small children and someone is acute respiratory distress
72
Advantages to DPI
small, portable, no CFC propellants, no cold freon effect, simple to determine remaining drug doses, built in dose counter, no head tilt needed
73
DPI disadvantages
only a limited range of drugs are available to date, patient are not as aware of the dose inhaled as with an MDI and many distrust delivery, moderate to high inpiratory flow rates are needed, high oropharyngeal impaction, some devices may require patients to reload before each use, vulnerable to ambient humidity
74
When to choose an MDI for a patient?
patient can follow instructions and has a stable breathing pattern
75
When to choose a SVN for a patient?
patient is unable to follow instructions, has an unstable breathing pattern, or is in respiratory distress
76
When to choose a DPI for a patient?
for adults and children who have adequate inspiratory flow rates; works well in cold weather conditions (unlike MDI's)
77
What devices can be used on mechanically ventilated patients?
SVNs and MDIs but special considerations are used for SVNs because the additional flow used to power the SVN can add additional ventilatory volume
78
What are some recommended ventilator parameters for optimal deposition
patient-triggered breath is better, tidal volume >500 mL for adults, slow RR, slow inspiratory flow rate (30LPM or less) , longer inspiratory times
79
Factors that affect aerosol deposition in intubated patients are?
ventilator settings, ventilator circuit, type or aerosol device, and patient breathing patterns
80
Central nervous systems contains what?
brain and spinal cord
81
Peripheral nervous system contains what?
somatic and autonomic/ compromised of all the nerves outside the brain and spinal cord
82
Afferent nerves
carry sensory info from parts of the body to the brain for processing
83
Efferent nerves
carry impulses away from the brain and spinal cord; also known as motor nerves, voluntary control, Causes you to DO AN ACTION
84
Autonomic nervous system
involuntary, unconscious control (digestion). Contain the parasympathetic and sympathetic branches
85
Somatic nervous system
voluntary, conscious motor control
86
Sensory branch
made of afferent neurons from heat, light, pressure, and pain receptors, Stimulation is sent from receptors to CNS
87
Somatic nervous system is manipulated by what?
neuromuscular blocking agents to induce paralysis
88
Autonomic nervous system regulates the activity of what?
HR, pupillary dilation/contraction, glandular secretions, smooth muscles, exocrine glands, cardiac tissue, and certain metabolic activites
89
Parasympathetic branch
Rest and Digest, day to day bodily functions, essential to life.
90
SLUDGE
salvation, lacrimation, urination, defecation/digestion, gastronintestinal motility, emesis (vomiting)
91
Sympathetic branch
Fight or Flight, heart rate and blood pressure increase, blood sugar rises, blow flow shifts from periphery to heart and muscles, bronchodialtion, not essential to life
92
Steps of nervous system conduction
a resting nerve receives a stimulatioin, an electrical impulse carries the signal along the nerve fiber or axon, the synapse connects to either another nerve, muscle or gland, a chemical neurotransmitter substance must now travel across the synapse, passes out of presynaptic knob to post synaptic cleft, this is where the neurotransmitter is picked up and continues to effector site
93
Chemical are manufactured and stored where?
at the end of axons and released upon stimulation by the electrical impulse
94
What two main neurochemical substances are stored or manufactured at the ends of the nerve fibers?
Acetylcholine (ACh) and Norepinephrine (NE)
95
ACh
neurotransmitters for all autonomic ganglia, parasympathetic neuroeffector junctions, and somatic neuromuscular junctions
96
NE
neurotransmitter at sympathetic terminal nerve sites
97
Cholinergic receptors
receptors that bind with ACh, can be either muscarinic or nicotinic
98
Nicotinic receptors
skeletal muscles of the somatic system at the site of action, preganglionic sites in the parasympathetic and sympathetic nervous system, faster response time
99
Muscarinic receptors
postganglionic site of the parasympathetic nervous system, slower response time
100
Adrenergic receptors
bind with NE for in the sympathetic nervous system, includes alpha and beta receptors
101
Alpha 1 affects what tissues?
Vascular SM, Pilomotor SM, pupil
102
Action of Alpha 1
contracts, dilation, "goose bumps"
103
Beta 1 affects what tissues?
heart
104
Beta 1 action
stimulates rate and force
105
Beta 2 affects what tissues?
Respiratory SM vasculature, autonomic motor (involuntary musc. stimulation)
106
Beta 2 action
bronchodilates, tremors, relaxes vascular beds
107
Dopamine affects what tissue?
renal
108
Dopamine action
relaxes arteries
109
Beta 2 are used for treatment of what?
bronchospasm (asthma)
110
One junction system
somatic NS, brain ------> effector site
111
Two junction system
autonomic NS, brain ----> junction ----> effector site
112
Somatic nervous system transmission
controls skeletal muscles, the synapse is the neuromuscular junction, a single nerve axon carries the signal to the brain for sensory input
113
Autonomic NS transmission
two junctions to pass thru. Presynaptic and postsynaptic neuron.
114
Ganglion definition
nerve that lies outside the CNS
115
cholinergic nerve transmission
mediated by neurotransmitter ACh
116
ACh is broken down by what?
acetylcholinesterase (AChE)
117
Adrenergic nerve transmission is mediated by what?
NE
118
Drugs that affects the ANS
cholinergics/parasympathomimetics, anticholinergics/parasympatholytics, adrenergics/sympathomimetics, antidrenergics/sympathoytics
119
Cholinergics direct acting
mimic ACh, bind and activate muscarinic or nicotinic receptors directly
120
Cholinergics indirect acting
inhibit AChE causing building of endogenous ACh at neuroeffector junction of parasympathetic nerve ending or the neuromuscular junction so more ACh is availalbe to receptor sites
121
Adverse reactions to cholinergics
SLUDGE, blurred vision, SOB, dec HR and BP
122
Anticholinergics
block ACh receptors, blocks salivary secretion, decreases mucous gland secretion, bronchodilation, inc HR, mydriasis, decreases GI acid secretion, relaxes bladder, inhibits motion sickness
123
Adrenergics sympathetic activation effects
heart stimulation, inc CO, inc BP, mental stimulation, accelerated metabolism, bronchodilation
124
What are some Catecholamies
epinephrine, norepinephrine, dopamine, dobutamine, isoproterenol
125
Antiadrenergics
adrenergic blockers block or slow the effects of the sympathetic system
126
Examples of Alpha blockers
Doxazosin, Terazosin
127
Examples of Beta blockers
Propranolol, Metoprolol, Atenolol
128
Adverse effects of antiadrenergics
bradycardia, atrioventricular blockade, exacerbation of asthma
129
common cold definition
viral upper respiratory tract infection, usually characterized by mild/general malaise and a runny/stuffy nose
130
Colds last about how long?
7-10 days
131
Epidemiolgy of colds
average adult has 2-4 colds per year. Americans suffer one billion colds annually
132
Pathophysiology of colds
more than 200 viruses cause the common cold. Rhinovirus 20-40%, Coronavirus 20%, RSV 10%
133
Cold symptoms
sneezing, sore throat, cough, chest discomfort
134
Treatment for cold
rest, fluids, liquids, supportive care, symptom management
135
Flu definition
influenza, caused by a viral infection, onset is generally rapid, systemic symptoms
136
Flu symptoms
fever, headache, general muscle ache, extreme fatigue/weakness
137
Treatment of flu
Anti-virals and flu vaccine
138
Sympathomimetics are what?
decongestants
139
Anti histamines do what?
dry secretions
140
Expectorants do what?
Inc. mucus clearance
141
Anti tussives are what?
suppress cough reflex
142
Sympathomimetics
included in cold remedies, cause vasoconstriction, many are included in topical sprays,
143
Mechanisms of action for sympathomimetics
causes vasoconstriction which leads to reduced blood flow, reduces swelling of nasal passages, decreases inflammatory process
144
Topical vs Oral sympathomimetics
a lower dose is needed for topical faster onset and less systemic side effects, both have rebound nasal congestion, more extensive decongestant effects involving deeper blood vessels when taking oral
145
Pseudoephedrine
Sudafed and Dimetap, use with caution with diabetes, heart disease, hyperthyroidism or glaucoma. duration varies on dosage form,
146
Pseudoephedrine is now behind the counter due to what?
U.S Patriot Act because of its use to make meth
147
Phenylephrine
Neo-Synephrine limited proof of effectiveness orally. 10mg dose of this is not much better than placebo
148
Examples of nasal decongestants
Afrin, Pretz-D, Privine, Tyzine, Neo-Synephrine
149
Side effects to decongestants
rebound congestion, tremor, tachycardia, inc. BP
150
Intranasal corticosteroids (nasal sprays) examples
Rhinocort, Nasalide, Flonase, Nasacort, Nasonex, Vancenase, Beconase
151
Mechanisms of action for nasal sprays
anti inflammatory effects by inhibiting cytokine release from nasal epithelial cells, inhibits leukotriene production, and decreases nasal congestion
152
How long can it take corticosteroids to work?
2-4 weeks. Max effects can take up to 6 months
153
Side effects to nasal sprays
burning/stinging, irritation, dry nose
154
Antihistamines
usually cause drowsiness. Benedryl is one example.
155
What receptors are blocked when using antihistamines
H-1 and H-2
156
H-1 histamine receptor
anti histamines. Smooth muscle contraction. Results in increased vagal activity
157
H-2 histamine receptor
H-2 blockers, mediate actions of histamine on gastric secretions
158
H-3 receptors
located primarily in CNS, autoreceptors for cholinergic neurotransmission in the airway. Involved with CNS functions and feedback control of histamine release
159
production of histamine is influenced by what factors?
chemicals, physical injury, allergens, drugs, dust, and cigarette smoke
160
Where is histamine stored?
tissue mast cells, found in connective tissue
161
airway obstruction results from what?
mucosal edema
162
Effects of histamine in pulmonary system
inc. airway resistance, dec. expiratory flow rate, dec. diffusion capacity, inc. total lung capacity, inc. mucus production, and promotes mucosal edema
163
Effects of histamine systemically
vasodilation, stimulates adenyl cyclase in mast cells, releases catecholamines from adrenal medulla, and inc. vascular permeability
164
place in therapy for histamines
useful for allergic rhinitis, better at preventing the onset of symptoms. NOT useful for acute asthma
165
mechanism of action for histamines
blocks the action of the H-1 receptors.
166
1st generation antihistamine
when given with a decongestant it is recommended by guidelines. Early generations are more proven and have more rapid results
167
2nd generation antihistamines
no as effective because they are less sedating due to the fact that they don't penetrate the CNS
168
examples of first generation antihistamines
Benadryl, Dimetane, Chlor-Timeton
169
examples of second generation antihistamines
Zyrtec, Allergra, and Claritan
170
side effects to anithistamines
sedation (first > second), dry mouth/throat, altered coordination, some patients experience exictation, can induce their own metabolism.
171
What is sometimes added to antihistamines
decongestants
172
definition of expectorants
agents that facilitate removal of mucus from the lower respiratory tract
173
Mucolytic expectorants
facilitate removal via lysing action
174
Stimulant expectorants
increase the production and clearance of mucus
175
Composition of mucus
95% water, and 5% long/flexible strands of protein and lipid molecules
176
Functions of mucus are what?
shields epithelia from direct contact with toxic materials, irritants, allergens, and microorganisms, prevents infecton, prevent water from moving into and out of epithelia and lubrication of airway
177
what is the best expectorant?
Water
178
airway obstruction results in what?
increased mucus thickness, impaired ciliary activity, dehydration, and thick retained secretions in airways
179
increased mucus thickness can be caused by what?
chronic bronchitis, asthma, CF, acute bronchitis, and pneumonia
180
impaired ciliary activity cause be cause by what factors?
ET tubes, extreme temps, high 02 concentration, dust/fumes/smoke, dehydration, thick mucus, and infections
181
dehydration can be cause by what?
inc. RR, inc. depth of breathing, systemic fluid loss, and infections
182
what agents can enhance diuresis
caffeine, tea/cola, beer, and alcohol mixtures
183
what is an example of an expectorant?
Guaifenesin
184
gauifenesin does what?
irritates the gastric mucosa, and stimulates respiratory tract secretions leading to inc. respiratory fluid voluje and dec. mucus viscosity
185
use of expectorants in bronchitis?
improved cough symptoms, chest discomfort, ease in bringing up sputum, duration of acute exacerbations dec. , symptoms and airflow improve, further infection reduced.
186
Mechanism of action for expectorants?
inc. vagal gastic relfex stimulation. Absorption into the respiratory glands to stimulate mucus production directly
187
Antitussives are what?
cough suppressants
188
The cough center is located where?
medulla
189
What type of cough do you want to try and surpress?
dry, hacking, non productive cough
190
anti tussive action range for codeine
10-20mg
191
above 30mg of codeine produces what?
analgesia
192
examples of antitussives
codeine sulfate, hydrocodone, Robitussin, Benadryl, and Tessalon Perles
193
cough suppressants should NOT be give to who?
patients with thick retained secretions
