medications and oxygen therapy

Question 1

how does an inhaler administer drugs?

Answer 1

-direct deposit of medication of particles into airways/ lung tissues

Question 2

how does a nebuliser administer medication?

Answer 2

-delivers medication directly into airways by using a device that converts medication into a fine mist

Question 3

what are different examples of inhalers?

Answer 3

-soft mist inhaler
-dry powder inhalers
-breath - actuated pMDI
-pressurised metered dose inhaler
-pMDI plus spacer

Question 4

what are the 2 most prominent symptoms of resp patients?

Answer 4

-cough
-SOB

Question 5

how often are you supposed to have your inhalers checked?

Answer 5

every 6 months
people are given the devices years ago and they aren’t shown how to use it

Question 6

what are nebulisers used for?

Answer 6

loosening secretions

Question 7

how is bronchodilator achieved with drugs?

Answer 7

-beta 2 agonists - stimulate beta2 adrenoceptors
-anticholinergics - bind to muscarinic receptors and block the action of Ash

Question 8

what are examples of short acting beta 2 agonist drugs?

Answer 8

-salbutamol (Ventolin)

Question 9

what is the action of SABAs?

Answer 9

-relax smooth muscle
-stimulates muco-ciliary clearance
-mild anti-inflam reaction

Question 10

what are examples of short acting muscarinic agonist?

Answer 10

-atrovent / ipratropium bromide

Question 11

what is the action of SAMAs?

Answer 11

-reduces cholinergic bronchial tone
-reduces nocturnal symptoms

Question 12

what inhalers would see with COPD pts?

Answer 12

-SABA
-LABA
-SAMA
-LAMA
-inhaled corticosteroids

Question 13

what are inhaled corticosteroids used for?

Answer 13

reducing inflammation
-‘preventors’
-can only be used in combo with bronchodilators

Question 14

what is a risk of using long term corticosteroid use?

Answer 14

-developing osteoporosis

Question 15

what is a mucoactive drug?

Answer 15

-defined as an agent with the capability of modifying mucus production, secretion, its nature and composition

Question 16

how are mucoactive agents classified?

Answer 16

-by how they act
-mucolytics (thin mucus), -mucokinetics
-mucoegulators (suppress certain mechanisms)

Question 17

what his a mucolytic agent?

Answer 17

an agent that dissolves thick mucus and is usually used to help resp difficulties

Question 18

what are an example of a group of antibiotics that are used to treat chronic and acute infections?

Answer 18

-macrolide antibiotics

Question 19

what are the 5 most commonly used macrocodes?

Answer 19

-azithromycin
-clarithromycin
-erthryomycin
-tobramycin
-roxithromycin

Question 20

what is important to note about chronic infection with pseudomonas aerugionas (PA) and resp function?

Answer 20

-it is proven to be the main perpetrator of lung function decline and ultimate mortality in CF patients

Question 21

what does chronic PA infection lead to physically?

Answer 21

-epithelial surface damage
-airway plugging (mucous blocking airway)

Question 22

what are CTFR modulators for CF patents?

Answer 22

-a class of drugs that act by improving production, intracellular processing and or function of the defective CTFR protein

Question 23

what are the 4 CTFR modulator drugs?

Answer 23

-kalydeco
-orkambi
-symdeko
-trikafta

Question 24

what lung condition could benefit from anti-fibrotic drugs?

Answer 24

-interstitial lung disease (umbrella term for many conditions) eg fibrosis

Question 25

how do anti-fibrolytic medications work?

Answer 25

- they work by reducing the formation of scar tissue on the lungs

Question 26

what is O2 therapy?

Answer 26

admin of oxygen at concentrations greater than that in the air with the intent of treating or preventing hypoxia

Question 27

explain SaO2 vs SpO2

Answer 27

-Sao2- measured directly from an arterial blood sample -Sp02- measured from oximeter

Question 28

what is long term OT?

Answer 28

-defined as oxygen used. by pt with proven hypoxeamia for a minimum of 15 hours per day

Question 29

what is ambulatory oxygen therapy?

Answer 29

-defined as the use of supplemental oxygen during exercise and activities of daily living

Question 30

what is nocturnal OT?

Answer 30

-O2 administered overnight alone without additional O2 treatment during the day

Question 31

what is palliative OT?

Answer 31

-the use of oxygen to relieve the sensation of refractory persistent breathlessness in advanced disease or life limiting illness

Question 32

what is shirt burst oxygen therapy?

Answer 32

-delivering high flow oxygen (15L/min) is a first line effective treatment in medical emergencies

Question 33

when should pts be referred for LTOT?

Answer 33

if they have a resting stable oxygen saturation of less than 92% -they should be referred for a blood gas assessment -pts with peripheral oedema, pulmonary hypertension

Question 34

what does the assessment of LTOT involve?

Answer 34

-ABG sampling on room air for at least 30 mins -assessment of Sp02

Question 35

what should the starting dose for LTOT be?

Answer 35

1L/min

Question 36

how should the titration be carried out for LTOT?

Answer 36

-should be carried out after 30 mins in 1L/min until Sp02 is greater than 90% -needs to be carried out w/ an oxygen concentrator to be more accurate

Question 37

how do we assess for ambulatory oxygen therapy?

Answer 37

6 min walk test or modified test like to and from bathroom, down the ward

Question 38

what are the complications associated with oxygen?

Answer 38

-high concentrations may impair the resp drive -oxygen toxicity -blindness in babies if high conc -drying of mucus membranes, eye irritation - fire hazard - 02 is not explosive but does support combustion

Question 39

how is oxygen delivered?

Answer 39

-nasal cannula -low flow masks -high flow masks -reservoir masks

Question 40

how does nasal cannula / prongs O2 therapy work?

Answer 40

its a low flow system which delivers 02 directly into the nostrils

Question 41

how much % of 02 does 1L-4L of 02 therapy provide?

Answer 41

-1L provides 24% O2 -2L provides 28% O2 -3L provides 32% O2 -4L provides 36% O2

Question 42

for patients who require a higher conc of O2, what other devices should be used to deliver it?

Answer 42

a mask

Question 43

what are reservoir masks used for?

Answer 43

-used for delivery of high levels or 02 -it involves a 1L reservoir bag -vag attached to mask which fills with 02 during expiration so that during aspiration this 02 enriches the inspired gas

Question 44

what are indications for humidification?

Answer 44

-all patients with an artificial airway eg endotracheal tube (as air they are breathing isn't moistened) -to assist clearance of secretions -if patients have thick sticky secretions

Question 45

what are options for humidification treatment?

Answer 45

-systemic hydration -heated humidification -heat moisture exchangers

Question 46

what is heated humidification?

Answer 46

0hot water humidifier -gas is blown over a reservoir of heated sterile water -this absorbs water vapour which is then inhaled by the pt -humifider should be positioned below the level of the pts airway to avoid flooding of the airway

Question 47

what can improve systemic hydration levels in pts?

Answer 47

- increasing oral or IV fluid intake of a patient -during periods of infection and fever, higher fluid intake is needed

Question 48

what are heat moisture exchangers?

Answer 48

-acts as a nose for pts with tracheostomy -less effective