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PHAR253 > Delivery of Resp Meds > Flashcards

Delivery of Resp Meds Flashcards

1
Q

Why is inhaled therapy preferred for respiratory medications?

A

maximizes delivery of drugs to lungs
minimizes systemic side effects

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2
Q

What is essential with respiratory medications?

A

proper technique

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3
Q

What are the three main categories of respiratory devices?

A

metered-dose inhalers (MDIs)
dry powder inhalers (DPIs)
-Turbuhaler, Twisthaler, Respiclick, Diskus, Handihaler, Breezhaler, Aerolizer, Ellipta, Genuiar
respimat soft mist inhaler (SMI)

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4
Q

What is an MDI?

A

pressurized inhaler that delivers medication by using a propellant spray

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5
Q

What are some important points regarding the use of MDIs?

A

breath holding important for deposition
coordination essential
emphasize slow, deep breath
priming

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6
Q

True or false: MDIs have dose counters

A

false

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7
Q

Explain how to use an MDI.

A
  1. shake the inhaler well (3-4 shakes)
  2. remove cap
  3. breathe out, away from inhaler
  4. bring inhaler to mouth, place between teeth and close your mouth around it
  5. start to breathe in slowly, press the top of your inhaler once and keep breathing until you have taken a full breath
  6. remove the inhaler from mouth, hold breath for 10 seconds, then breathe out
  7. if you need a 2nd puff, wait 30 seconds
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8
Q

What is a spacer?

A

a tube-like chamber added on to a MDI
allows the patient to inhale the med slowly & deeply over multiple breaths

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9
Q

Which population are spacers good for?

A

children
elderly
debilitated
recommended for all

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10
Q

What can be attached to a spacer?

A

a mask

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11
Q

True or false: the efficacy of spacer+MDI is not equal to the efficacy of a nebulizer

A

false
MDI+spacer=nebulizer

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12
Q

How should an MDI+spacer be cleaned?

A

mild detergent to reduce static
-no boiling water or alcohol
do not dry

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13
Q

Explain how to use an MDI+spacer.

A
  1. shake the inhaler well (3-4 shakes)
  2. remove the cap from your, and from the spacer (if it has one)
  3. put the inhaler into the spacer
  4. breathe out, away from the spacer
  5. bring the spacer to mouth, put the mouthpiece between your teeth and close your lips
  6. press the top of the inhaler once
  7. breathe in very slowly until you have taken a full breath, if you hear a whistle sound, you are breathing too fast
  8. hold your breath for 10 seconds, breath out
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14
Q

What are the common errors for MDIs?

A

failure to shake before use
holding inhaler in wrong position
failing to exhale prior to inhalation
actuating inhaler too early during exhalation
actuating inhaler too late while inhaling
inhaling too rapidly
multiple actuating without shaking MDI between doses

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15
Q

Differentiate between the different inspiratory resistance devices of DPIs.

A

low resistance devices
-Breezhaler
medium resistance devices
-Ellipta/Genuiar/Diskus
high resistance devices
-Turbuhaler/Handihaler

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16
Q

What are turbuhalers?

A

breath actuated device
-require minimal inspiratory flow rate for optimal delivery
cant taste or feel the drug
emphasize a fast breath
rattling noise=desiccant

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17
Q

True or false: tubuhalers have a dose counter

A

false
they have an empty indicator (although some do have a counter)

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18
Q

What is the minimum age for the use of turbuhalers?

A

5 years of age or greater

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19
Q

Explain how to use a turbuhaler.

A
  1. unscrew cap and take it off, hold the inhaler upright
  2. twist the coloured grip as far as it will go, then twist it all the way back (should hear a click)
  3. breathe out away from the device
  4. put mouthpiece between teeth, close lips and breathe in forcefully+deep
  5. remove from mouth before breathing out
  6. always check the dose counter or for a red mark (indicates empty)
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20
Q

Which devices are similar to turbuhalers?

A

twisthaler
respiclick

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21
Q

What is a diskus? Describe it.

A

breath activated device
can feel the drug
maintain parallel to ground once activated
has a dose counter

22
Q

True or false: a diskus has a relatively long expiry date

A

false
typically have shorter expiry dates

23
Q

Does drug delivery vary with different ranges of air flow rates for a diskus?

A

fairly consistent across a range of drug delivery rates

24
Q

Explain how to use a diskus.

A
  1. open diskus, hold in palm, put thumb of other hand on the thumb grip and push the thumb grip until it clicks into place
  2. slide the lever away from you as far as it will go to get your med ready
  3. breathe out away from the device
  4. place mouthpiece in mouth and close lips
  5. breathe in deeply until you have taken a full breath
  6. remove the diskus from your mouth
  7. hold breath for 10s and then breathe out
  8. check the number of doses
25
Q

What is a handihaler? Describe it.

A

breath activated device
uses capsules (light+moisture sensitive)
technique requires multistep process

26
Q

Do handihalers have a dose counter?

A

no
1 capsule=1 dose (thus no dose counter)

27
Q

True or false: if you wanted to clean a handihaler, it would be appropriate to use detergent or cleaning agents

A

false

28
Q

Does drug delivery vary with different ranges of air flow rates for a handihaler?

A

drug delivery consistent across range of air flow rates

29
Q

Describe how to use a handihaler.

A
  1. remove capsule from package (dont take it out any sooner than needed)
  2. flip off the lid of the handihaler
  3. flip open the mouthpiece
  4. put the capsule in the hole
  5. flip the mouthpiece closed, make sure you hear a click
  6. hold the handihaler upright, with the mouthpiece facing up
  7. sit up with your back straight
  8. press the button on the side (pokes hole in capsule)
  9. exhale all of your air
  10. seal lips around the mouthpiece
  11. breathe in slowly and deeply until lungs are full
  12. as you breathe in you should notice the handihaler is vibrating (shows its taken properly)
  13. take handihaler out of mouth and hold breath for as long as you can
  14. breathe out normally
  15. take another breath from handihaler (ensuring you take all the med)
  16. take handihaler out of mouth
  17. hold breath for as long as you can
  18. breathe out normally
  19. discard capsule
30
Q

Which devices are similar to the handihaler?

A

breezhaler
aerolizer

31
Q

What are the common errors for dry powder inhalers?

A

not keeping the device in correct position while loading dose
not keeping device in correct position when inhaling
failing to exhale fully before use
failing to inhale completely
inhaling too slowly or weakly
using past expiry date or when empty

31
Q

What are the newer devices that are pre-loaded, offering more choice and convenience for patients?

A

ellipta and genuair

32
Q

Describe the Ellipta.

A

simply open cap to prepare dose
make sure the air intake vent is not covered during inhalation
short expiration date after removing protective coating

33
Q

Describe the Genuair.

A

simply press down loading button to prepare dose
the loading button will lock to signal empty
make sure the button is completely released prior to inhalation

34
Q

What must be immediately discarded after opening the Ellipta?

A

desiccant and foil packaging

35
Q

What must be done before inhaling a dose from an Ellipta?

A

open the colored cap, there is a “click” when the dose is ready to be inhaled

36
Q

How can a dose of an Ellipta be lost?

A

opening and closing the cover without inhalation of the loaded dose

37
Q

When will the Ellipta dose counter turn red?

A

when there is less than 10 doses remaining

38
Q

How should an Ellipta be held?

A

just below horizontal
-if the device is tipped past horizontal, the medication will fall out of the mouthpiece

39
Q

How do you prepare a Genuair for inhalation?

A

coloured button should be pressed and released
-coloured control window will change from red to green
-do not hold down the button while inhaling
during dose inhalation there is an audible “click”
-after proper inhalation the window will change back to red
-keep breathing in even after the click to ensure delivery of full dose

40
Q

When should someone on a Genuair obtain a new inhaler?

A

when a red striped band appears in the dose window

41
Q

What are the pros of SMI respimats?

A

slow moving mist gives pt time to inhale
no effort needed to coordinate
improved delivery to lungs
dose indicator

42
Q

What are the cons of SMI respimats?

A

requires reasonable strength to spring load dose
not approved for kids <5 or with spacer
priming if unused for 3d (Combivent) or 7d (Spiriva/Inspiolto)

43
Q

Explain how to use a Respimat.

A
  1. prime inhaler (according to package)
  2. turn clear base 1/2 turn (counter-clockwise)
  3. open the cap until it snaps open
  4. breathe out slowly and close lips around the mouthpiece without covering air vents
  5. while taking in a slow deep breath, press the dose release button and continue to breath for as long as possible, hold breath for 10s
  6. breathe normally
  7. replace cap
  8. if another dose is needed, rpt steps 3-8
44
Q

What are the common errors with Respimat?

A

too deep of a breath may cause irritation at back of throat and coughing
not pressing down on button while breathing
not loading the canister into the device properly

45
Q

What are the 5 steps to help remember a general inhaler technique?

A
  1. prepare the dose
  2. breathe out
  3. breathe medication in
  4. hold breath x 10 seconds
  5. breathe out
    may take 2nd breath from DPI to ensure entire dose is inhaled
    best to wait ~minute between puffs
46
Q

Which devices require priming?

A

MDI
Respimat

47
Q

Compare and contrast MDI vs SMI vs DPI.

A

MDI and SMI require coordination of timing of inhalation with activation of delivery
DPI are breath actuated, timing of inhalation is not an issue and some are pre-loaded

48
Q

What are nebulizers?

A

electric or battery powered machines that turn liquid medication into a fine mist that is inhaled
user breathes in through a mouthpiece or mask

49
Q

What are some factors to consider when choosing the right device for a patient?

A

ability of pt to coordinate
ability to reach peak inspiratory flow
physical limitations
poor medication delivery during acute attacks
advanced disease
does the pt feel the med is working?

50
Q

Which device is an important contributor to greenhouse emissions?

A

pMDIs
-propellant=0.03% of emissions
-if all other factors are equal, consider a DPI or SMI

51
Q

What is the #1 reason for therapy failure of respiratory medications?

A

inhaler technique

PHAR253 (16 decks)

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