Inhalers Flashcards
What are the different types of breathing devices?
- Inhalers
- Nebulisers
- Parenteral (IV/IM)
- Spacers
- Peak flow meters
What are some keywords to learn for inhalers?
SABA - short acting beta agonist
ICS - Inhaled corticosteroid
LABA - Long acting beta agonist
MART - Maintenance and reliver therapy (ICS & LABA)
LTRA - Leukotriene receptor antagonist
LAMA - Long acting muscarinic antagonist
Summarise PMDI? Give examples?
PMDI = Pressurised metered dose inhalers.
And they are used for mild to moderate asthma.
They involve removing the cap, pressing the top of the inhaler and breathing in at the same time.
Examples:
- Salbutamol (SABA) for quick relief of asthma symptoms
- Salmeterol (LABA) to stop asthma from happening
Summarise Breath actuated inhalers? Give examples?
Also a PMDI.
For mild to moderate asthma.
Suitable for children 12 years and above.
This involves pulling cap down and breathing in, and medicine is automatically released.
Examples:
- Salbutamol (quick relief of symptoms)
- Beclomethasone (stop asthma from happening)
What needs to be considered for breath actuated inhalers?
The top of the inhaler had vents, which are vital for the inhaler to work.
If you block with fingers, the inhalers won’t work.
So hold the inhalers from the side and breathe strong, powerful breaths to release medicine from the inhaler.
What needs to be considered for PDMI?
- Young children may find it hard to hold due to small hands
- Elderly might find it hard to hold and press button.
- Might have to consider giving spacer devices to under 5 year olds and people who struggle.
Give examples of dry powder inhalers (DPIs)?
- Accuhaler
- Turbohaler
Summarise accuhalers?
Usually used by adults and children 4 years and above.
It’s considered for people who struggle with PMDIs.
- Twist to open the inhaler, dose counter will go down to show inhaler is ready.
Put the inhaler in a horizontal position. Then take deep powerful breath to inhale medicine.
What’s a benefit for patients when using DPIs?
Has a dose counter and will tell patients how many doses is left in inhaler.
What needs to be considered for DPIs?
Patients may feel a difference of feeling in mouth when switched from PMDI to DPI.
Patients can have a lack of feeling in the mouth when changed from a spray (PMDI) to a dry power (DPI).
What’s a side effect of DPI?
Patients can develop a cough
Summarise Turbohalers? Give examples?
Dry power inhaler used for adults and children 6 years and above.
To use: Take the lid off, twist cap (brown/red at the bottom), hold horizontal, mouthpiece inside your mouth, then big breath to inhale medicine.
Examples:
-Pulmicort (Budesonide)
- Symbicort (Budesonide/Formeterol)
What’s a benefit of Turbohaler?
Has a dose counter, when twisted the dose will reduce by one.
What are nebulisers used for and what do they do?
Used for severe cute asthma.
It converts solution of drug into aerosol (spray) to breathe in.
It uses higher doses compared to inhalers.
Give examples of Nebulisers?
Saline
What are Saline steri-neb?
Used to dilute nebuliser solution.
Saline is put into the machine. Then mixed with one of the following:
- Ipratropium
- Budesonide
What are Parenteral devices used? Give examples of drugs used as Parenteral?
Used for severe acute asthma.
Usually given when nebulisers can’t be used or isn’t enough.
Drugs include:
- Beta 2 agonists
- Corticosteroids
- Aminophylline
What are examples of beta agonist drugs for asthma?
- SABA - Salbutamol
- LABA - Salmetarol
What are contraindications for Beta agonists?
Severe pre-eclampsia (complications in pregnancy)
What are some cautions with Beta agonist?
Arrythmias and Hypokalaemia
What are side effects of Beta agonists?
- Fine tremor in hands.
- Hypokalaemia
- Palpitations
What is ICS and what are examples?
ICS = Inhaled corticosteroid
Examples include:
- Beclomethasone = Clenil Modulite & Qvar
- Budesonide = Pulmicort
What are the contraindications and cautions for ICS?
There’s not really any.
Corticosteroids cautions and contraindications only apply to oral/IV use.
What are the side effects of ICS?
- Oral candidiasis
- Voice is altered (low raspy sound)
What can be used to treat oral candidiasis?
Anti-fungal oral suspension or gel can treat oral candidiasis without stopping steroid.
What can be used to reduce the risk of ICS?
Use spacer
What must be done after every use of ICS?
Rinse mouth with water after inhalation.
When is SAMA used?
Short acting antimuscarinic antagonist is used for COPD ONLY!
What’s an example of SAMA?
Ipratropium bromide
What is LAMA and what are examples of it?
Long acting antimuscarinic antagonists.
Examples include:
- Aclidinium bromide (Eklira)
- Glycopyrronium bromide (Seebri)
- Tiotropium (Spiriva respimat)
- Umeclidinium (Anoro Ellipta)
Which LAMA drugs are used in asthma and which are used in COPD?
Asthma - Tiotropium
COPD only - Aclidinium bromide, Glycopyrronium bromide, Umeclidinium
What are the cautions for both Antimuscarinic Antagonists?
Prostatic hyperplasia (enlarged prostate)
What are the side effects for both Antimuscarinic Antagonists?
- Dry mouth
- Cough
- Headache
What kind of drug is Montelukast?
A Leukotriene receptor antagonists.
Used for asthma.
What are the cautions for Leukotriene receptor antagonists?
Elderly
What are the side effects of Montelukast?
- Abdominal pain
- Churg Strauss syndrome (blood vessel inflammation)
- Hepatoxicity (liver damage)
What is Theophylline?
A xanthine - a bronchodilator for asthma and STABLE copd.
It is not effective in worsening copd.
What’s a side effect of Theophylline?
Can cause hypokalaemia
Can cause nausea and vomiting.
Can cause palpitations (feels like the heart is racing)
Name two important interactions of Theophylline?
+ beta 2 agonist = increases risk of hypokalaemia
+ smoking = Theophylline is removed from the body quicker, so a higher dose will be needed.
What are the cautions of Theophylline?
- Arrhythmia
- Hypokalaemia
Explain how spacers are used?
The inhaler is inserted into the spacer device.
Press the dose on the inhaler and dose will go into the chamber.
Breathe in ASAP to inhale medicine.
Single breath is recommended.
But can breathe in multiple times - it’s just as effective.
Which inhalers can use a spacer?
Only PMDI inhalers.
Not suitable for DPI.
Which patients use spacers?
- Pts with poor inhalation technique
- Young children
- Nocturnal (night time) asthma
- Patients at risk of candidiasis with inhaled corticosteroid.
- High dose of inhaled corticosteroids
What are the different aerochamber plus?
- 0-18 months = infant, with mask and orange.
- 1-5 years = with mask and child and yellow.
- 5 years and above = can get with or without mask.
What are the different aerochamber plus flow-vu?
- 0-18 months = with mask and orange.
- 1-5 years = with mask and child and yellow.
- 5 years and above = can get with or without mask.
What is the difference between Aerochamber plus & Aerochamber plus flow vu?
AeroChamber plus flow-vu has a flap which moves to show patient is breathing medicine in.
Flow-Vu is dishwasher safe, whilst Aerochamber plus is not.
Flow-Vu is prescription only, whilst AeroChamber plus can be bought without a prescription.
How do you take care of a spacer?
- Clean once a month
With AeroChamber plus + Volumatic:
- Clean with mild detergent
- Rinse
- Allow to air dry (don’t use towels)
Get a new spacer every 6-12 months
What needs to be known about Volumatic and Volumatic paeiatric?
Volumatic - above 3 years old.
Volumatic with paediatric face mask - from birth to 3 years.
The larger the spacer device, the more effective it will be.
More of the medicine from the inhaler will go into the patient’s lungs.
Which device is more effective, Volumatic or AeroChamber?
Volumatic
What is peak flow meter?
A device used to test how quickly you can blow air out of your lungs.
Used to diagnose asthma.
How is a peak flow meter used?
Blow into peak flow meter to get PEF (peak expiratory flow)
Then your get your score, depending on age, height and gender.
Explain the ranges of a peak flow meter?
Low range - small children and adults with low reading
Standard range - for older children and adults with a normal reading
