Inhalation_Dr. Gray

Question 1

What is the overall error rate?

Answer 1

50-100%

Question 2

Which errors contribute to compromised drug delivery and reduced efficacy?

Answer 2

Handling error -> storing meds in high humidity, or at inappropriate temperature

-Lack of device training
-elder patients: physical and cognitive factors

Question 3

Which errors contribute to compromised drug delivery and reduced efficacy?

Answer 3

Handling error -> storing meds in high humidity, or at an inappropriate temperature

-Lack of device training
-elder patients: physical and cognitive factors

Question 4

What are the 4 types of Inhalers?

Answer 4

1. Metered-dose inhalers (MDI) often in patients with COPD
   * Pressurized (pMDI)
   * Breath-actuated
2. Dry powder inhaler (DPI), multi and single dose
3. Soft mist inhaler (SMI)
4. Nebulizer

Question 5

pMDI Advantages and Disadvantages

Answer 5

Advantages
* Less expensive
* Portable, light, compact
* Multi-dose device
* Some have dose counters
* Difficult to contaminate

Limitations
Fixed dose, Actuation when breathing in, Priming, and shaking required, High oropharyngeal deposition, Propellant reaction (rare)

Question 6

Soft Mist pMDI Pros and Cons

Answer 6

Advantages:
* Fine-slow velocity mist it sprays for 1.5s, facilitates coordination
* Independent of PIF
* Portability

Limitations:
* Requires coordination between
actuation and inhalation - but not as much as with pMDI
* Assembly required

Question 7

Pros and Cons for DPI

Answer 7

Advantages:
* Breath-actuated
* High portability
* Some multidose

Limitations:
* Dependent on peak inspiratory flow (PIF) rate -> if the patient cant inhale sharply this device is not appropriate

• Must protect from humidity - makes the drug clumpy and it gets at the back of the throat bc of increased particle size
• Dose preparation required for single-dose

Question 8

Small Volume Nebulizers (SVN)
when other therapies fail, patients will use those

Answer 8

called small volume bc 2-3ml are delivered in approximately 10 minutes

*Normal breathing patterns can be used
* Fine-mist aerosol is eligible for many medications
* Eliminates cooperation issues
* Eliminates coordination issues
* Eliminates PIF issues
* Useful for the young/older adult
* Brand performance variability
* Medicare B coverage

Question 9

Small Volume Nebulizers (SVN) - Cons

Answer 9

Limitations:
* Requires power source
* Delivery time 5-20 minutes (pneumatic devices)
* Low portability, heavy wt, Noisy, (pneumatic devices), costly
* Atmospheric loss/risk
* Cleaning required

Question 10

Why is the dose different between MDI/DPI and Nebulizer?

Answer 10

-In Nebulizers, we are breathing in and out and while we are exhaling the machine runs and we lose a lot of drugs

Variables:
-Particle size, Actuating speed, patient training

Question 11

What can happen upon delivering active drugs inappropriately to the throat?

Answer 11

Higher risk of thrush
-> use spacer

Question 12

Patients Selection Considerations for Inhaler devices:

Answer 12

-Patient with poor coordination actuation/inhalation
-short or very shallow breath
-debilitating arthritis
-Cognitively impaired patient
-Cost factors

Question 13

Common errors

Answer 13

-pMDI: Actuation timing

-DPi: Not inhaling deeply or forcefully enough, inserting capsules, wrong positioning

-SMI: Not rotating base to activate the drug, wrong position upon using, Not maintaining inhalation with drug spray