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PHAR 395 > Device Review > Flashcards

Device Review Flashcards

1
Q

What type of inhaler is respimat?

A

Soft mist inhaler (SMI)

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2
Q

Should know the different DPI types (9)

A
  1. Turbuhaler®
  2. Twisthaler®
  3. Discus®
  4. Handihaler®
  5. Aerosolizer®
  6. Breezhaler®
  7. Diskhaler®
  8. Ellipta®
  9. Genuair®
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3
Q

Should know 4 important steps for general inhaler technique

A
  1. Prepare dose
  2. Breathe out
  3. Seal lips over mouth piece and breath medication in
  4. Hold breath x 10 seconds
    - May take 2nd breath from DPI ensure entire dose in inhaled
    - Best to wait ~ minute between puffs of the same medication
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4
Q

What to know about MDI usage?
That is;
1. Deposition?
2. Coordination?
3. Breathing?
4. Priming?
5. Counters?

A
  1. Breath holding important for deposition
  2. Coordination essential
  3. Emphasize slow, deep breath
  4. Priming required
  5. Most do not have dose counters
    - Need to Keep track of doses
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5
Q

Go through the steps of using an MDI (7)

A
  1. Shake the inhaler well before use (3 or 4 shakes)
  2. Remove the cap
  3. Breathe out, away from your inhaler
  4. Bring the inhaler to your mouth. Place it in your mouth between your teeth and close you mouth around it.
  5. Start to breathe in slowly. Press the top of your inhaler once and keep breathing in slowly until you have taken a full breath.
  6. Remove the inhaler from your mouth, and hold your breath for about 10 seconds, then breathe out.
  7. If you need to take a second puff, wait 30 seconds.
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6
Q

Who is a spacer good for?

A

Children, elderly, debilitated - recommended for all though

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7
Q

What does a spacer allow for?

A

Allows the patient to inhale the medication slowly & deeply over multiple breaths

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8
Q

What to know about MDI and spacer?
How to clean?

A
  1. MDI + spacer = nebulizer
  2. Time between actuation and inspiration < 5 seconds
  3. Clean with mild detergent to reduce static (no boiling water or alcohol); do not dry
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9
Q

Go through the steps of using an MDI and spacer? (8)

A
  1. Shake the inhaler well before use (3-4 shakes)
  2. Remove the cap from your inhaler, and from your spacer, if it has one
  3. Put the inhaler into the spacer
  4. Breathe out, away from the spacer
  5. Bring the spacer to your mouth, put the mouthpiece between your teeth and close your lips around it
  6. Press the top of your inhaler once
  7. Breathe in very slowly until you have taken a full breath. If you hear a whistle sound, you are breathing in too fast. Slowly breath in.
  8. Hold your breath for about ten seconds, then breath out.
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10
Q

What are some common errors for using pressurized MDIs? (7)

A
  1. Failure to shake before use
  2. Holding inhaler in the wrong position
  3. Failing to exhale prior to inhalation
  4. Actuation inhaler too early or during exhalation
  5. Actuating inhaler too late while inhaling
  6. Inhaling too rapidly
  7. Multiple actuating without shaking MDI between doses
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11
Q

What to know about coordination of inhalation and activation of MDI vs. SMI vs. DPI (3)

A
  1. MDI and SMI require coordination of timing of inhalation with activation of delivery of med
  2. DPI are breath actuated, so timing of inhalation is not an issue and some are pre loaded for easier use.
  3. Some inhalers have numerous steps involved in the delivery of inhaled med and this can lead to missteps in the procedure
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12
Q

What to know about Turbuhaler usage? (4)

A
  1. Breath actuated device - require a minimal inspiratory flow rate for optimal delivery
  2. 5 years of age or greater
  3. Emphasize forceful and deep breath
  4. Can’t taste or feel the drug
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13
Q

Go through the steps of using a turbuhaler (6)

A
  1. Unscrew the cap and take it off. Hold the inhaler upright
  2. Twist the coloured grip of your Turbuhaler® as far as it will go. Then twist it all the way back. You have done it right when you hear a “click”
  3. Breathe out away from the device
  4. Put the mouthpiece between your teeth, and close your lips around it. Breathe in forcefully and deeply through your mouth
  5. Remove the Turbuhaler® from your mouth before breathing out
  6. Always check the number in the side counter window under the mouthpiece to see how many doses are left. For the Turbuhalers® that do not have a dose counter window, check the window for a red mark, which means your medication is running out. When finished, replace the cap.
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14
Q

What to know about diskus usage? (5)

A
  1. Breath activated
  2. Can feel the drug
  3. Maintain parallel to ground once activated
  4. Has a dose counter
  5. Drug delivery consistent across a range of air flow rates
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15
Q

Go through the steps of using a diskus (8)

A
  1. Open your DISKUS®: Hold it in the palm of your hand, put the thumb of your 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 medication ready
  3. Breathe out away from the device
  4. Place the mouthpiece gently in your mouth and close your lips around it
  5. Breathe in deeply until you have taken a full breath
  6. Remove the DISKUS® from your mouth
  7. Hold your breath for about ten seconds, then breathe out
  8. Always check the number in the dose counter window to see how many doses are left.
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16
Q

What to know about handihaler usage? (6)

A
  1. Breath activated
  2. Drug delivery consistent across range of air flow rates
  3. Technique requires multistep process
  4. Capsules are light and moisture sensitive
  5. Each capsule equals 1 dose so no dose counter required
  6. Cleaning – if needed do not use cleaning agents or
    detergents
17
Q

Spiriva is what type of device?

A

Handihaler

18
Q

Go through the steps of using a handihaler (19)

A
  1. Remove a capsule from the blister package of medicine. Take the capsule out of the package right before you’re going to use it.
  2. Flip off the lid of the HandiHaler©.
  3. Flip open the mouthpeice.
  4. Put the capsule in the hole.
  5. Flip the mouthpeice closed. Make sure you hear a click, so you know it’s closed properly.
  6. Hold the HandiHaler© upright, with the mouthpiece facing up.
  7. Sit up with your back straight.
  8. Press the big button on the side of the HandiHaler©. This pokes a hole in the capsule to let the medicine out.
  9. Exhale: blow out all your air.
  10. Seal your lips around the HandiHaler© mouthpeice.
  11. Breathe in slowly and deeply from the HandiHaler© mouthpiece, until your lungs are full.
  12. As you’re breathing in, you should notice that the HandiHaler© is vibrating. This is supposed to happen. It shows that you’re taking it properly.
  13. Take the HandiHaler© out of your mouth and hold your breath for as long as you can (10 seconds or longer, if you can).
  14. Breathe out normally.
  15. Take another breath from the HandiHaler©, to make sure you get all the medicine: Seal your lips around the HandiHaler© and take another deep breath in.
  16. Take the HandiHaler© out of your mouth.
  17. Hold your breath for as long as you can (10 seconds or longer, if you can).
  18. Breathe out normally.
  19. Discard Capsule
19
Q

Breezehalers and Aerolizers are similar to what device?

A

Handihalers

20
Q

What to know about ellipta usage? (3)

A
  1. Simply open the cap to prepare dose
  2. Make sure the air intake vent is not covered during inhalation
  3. Short expiration date after removing protective covering
21
Q

What to know about genuair usage? (3)

A
  1. Simply press down loading button to prepare dose
  2. The loading button will lock to signal empty
  3. Make sure the button is completely released prior to inhalation
22
Q

Go through the steps of using an ellipta (5)

A
  1. Foil packaging and desiccant must be discarded immediately after opening
  2. The colored cap should be opened before inhaling the dose, there is “click” when the dose is ready to be inhaled
  3. If the device cover is opened and then closed without inhalation of the loaded dose, that dose will be lost; if a dose is lost another dose can be loaded by opening the device cover again-double dosing will no occur
  4. If the device is tipped past horizontal, the medication will fall out of the mouthpiece
  5. When there are less than 10 doses remaining the left half of the counter shows red.
23
Q

Go through the steps of using a genuair (3)

A
  1. To prepare for inhalation, the colored button should be pressed and then released
    - The coloured control window will change from red to green when the dose is ready to be inhaled
    - Do not hold down the button while inhaling
  2. During dose inhalation there is an audible “click”
    - After proper inhalation of the dose the coloured control window will change back to red
    - Keep breathing in even after the “click” to ensure delivery of the full dose
  3. When a red striped band appears in the dose window, obtain a new inhaler
    - The device will “lock” when the last dose has been loaded
24
Q

What are some common errors for DPIs? (6)

A
  1. Not keeping the device in correct position while loading dose
  2. Not keeping device in correct position when inhaling
  3. Failing to exhale fully before use
  4. Failing to inhale completely
  5. Inhaling too slowly or weakly
  6. Using past expiry date or when empty
25
Q

The preloaded DPIs include? (7)

A
  1. Turbuhaler
  2. Respclick
  3. Twisthaler
  4. Discus
  5. Inhub
  6. Ellipta
  7. Genuair
26
Q

What DPIs require loading? (3)

A
  1. Handihaler
  2. Aerosolizer
  3. Breezehaler
27
Q

What are the pros of SMIs? (4)

A
  1. Slow moving mist gives patients more time to inhale
  2. Compared to MDIs less effort needed to coordinate (still some)
  3. Improved delivery to lungs
  4. Dose indicator
28
Q

What are the cons of SMIs? (3)

A
  1. Requires reasonable strength to spring load dose
  2. Not approved for kids <5, or for use with a spacer
  3. Priming if unused for 3 (Combivent) or 7 days (Spiriva / Inspiolto)
29
Q

Go through the steps of using a respimat (8)

A
  1. Prime inhaler (according to package instructions)
  2. Turn the clear base ½ turn (counter-clockwise).
  3. Open the cap until it snaps open
  4. Breath out slowly and fully and close the lips around the end of the mouthpiece without covering the air vents
  5. While taking in a slow, deep breath through the mouth, press the dose release button and continue to breath in slowly for as long as possible. Hold the breath for 10 seconds or as long as comfortable
  6. Breathe normally
  7. Replace cap
  8. If another dose is needed repeat steps 3-8
30
Q

What are 3 common errors with respimat?

A
  1. Too deep of a breath may cause irritation at back of throat and coughing
  2. Not pressing down on the button while breathing
  3. Not loading the canister into the device properly
31
Q

What are nebulizers? (2)

A
  1. Nebulizers are electric- or battery-powered machines that turn liquid medicine into a fine mist that’s inhaled into the lungs.
  2. The user breathes in the mist through a mouthpiece or facemask
32
Q

What are some strategies to ensure effective use of device? (4)

A
  1. CHOOSE the right device
    - Consider patient skills and cost
  2. CHECK inhaler technique at every opportunity
    - Occasionally ask patient to show you the technique
  3. CORRECT poor technique
    - Show patient using a placebo device
    - Be patient, repeat demonstrations as needed
  4. CONFIRM your own knowledge
    - Be confident with all the devices
33
Q

What to base device choice on? (7)

A
  1. Ability of pt to coordinate device optimally
  2. Ability to reach peak inspiratory flow for device
  3. Physical Limitations
    - Arthritis
    - Tremor
    - Poor Eyesight
  4. Poor medication delivery during acute “attacks”
  5. Advanced disease
  6. Allowing pts to handle different devices and have a choice
  7. Does the pt feel the med is working?

PHAR 395 (9 decks)

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