medications and oxygen therapy Flashcards
how does an inhaler administer drugs?
-direct deposit of medication of particles into airways/ lung tissues
how does a nebuliser administer medication?
-delivers medication directly into airways by using a device that converts medication into a fine mist
what are different examples of inhalers?
-soft mist inhaler
-dry powder inhalers
-breath - actuated pMDI
-pressurised metered dose inhaler
-pMDI plus spacer
what are the 2 most prominent symptoms of resp patients?
-cough
-SOB
how often are you supposed to have your inhalers checked?
every 6 months
people are given the devices years ago and they aren’t shown how to use it
what are nebulisers used for?
loosening secretions
how is bronchodilator achieved with drugs?
-beta 2 agonists - stimulate beta2 adrenoceptors
-anticholinergics - bind to muscarinic receptors and block the action of Ash
what are examples of short acting beta 2 agonist drugs?
-salbutamol (Ventolin)
what is the action of SABAs?
-relax smooth muscle
-stimulates muco-ciliary clearance
-mild anti-inflam reaction
what are examples of short acting muscarinic agonist?
-atrovent / ipratropium bromide
what is the action of SAMAs?
-reduces cholinergic bronchial tone
-reduces nocturnal symptoms
what inhalers would see with COPD pts?
-SABA
-LABA
-SAMA
-LAMA
-inhaled corticosteroids
what are inhaled corticosteroids used for?
reducing inflammation
-‘preventors’
-can only be used in combo with bronchodilators
what is a risk of using long term corticosteroid use?
-developing osteoporosis
what is a mucoactive drug?
-defined as an agent with the capability of modifying mucus production, secretion, its nature and composition
how are mucoactive agents classified?
-by how they act
-mucolytics (thin mucus), -mucokinetics
-mucoegulators (suppress certain mechanisms)
what his a mucolytic agent?
an agent that dissolves thick mucus and is usually used to help resp difficulties
what are an example of a group of antibiotics that are used to treat chronic and acute infections?
-macrolide antibiotics
what are the 5 most commonly used macrocodes?
-azithromycin
-clarithromycin
-erthryomycin
-tobramycin
-roxithromycin
what is important to note about chronic infection with pseudomonas aerugionas (PA) and resp function?
-it is proven to be the main perpetrator of lung function decline and ultimate mortality in CF patients
what does chronic PA infection lead to physically?
-epithelial surface damage
-airway plugging (mucous blocking airway)
what are CTFR modulators for CF patents?
-a class of drugs that act by improving production, intracellular processing and or function of the defective CTFR protein
what are the 4 CTFR modulator drugs?
-kalydeco
-orkambi
-symdeko
-trikafta
what lung condition could benefit from anti-fibrotic drugs?
-interstitial lung disease (umbrella term for many conditions) eg fibrosis
how do anti-fibrolytic medications work?
- they work by reducing the formation of scar tissue on the lungs
what is O2 therapy?
admin of oxygen at concentrations greater than that in the air with the intent of treating or preventing hypoxia
explain SaO2 vs SpO2
-Sao2- measured directly from an arterial blood sample
-Sp02- measured from oximeter
what is long term OT?
-defined as oxygen used. by pt with proven hypoxeamia for a minimum of 15 hours per day
what is ambulatory oxygen therapy?
-defined as the use of supplemental oxygen during exercise and activities of daily living
what is nocturnal OT?
-O2 administered overnight alone without additional O2 treatment during the day
what is palliative OT?
-the use of oxygen to relieve the sensation of refractory persistent breathlessness in advanced disease or life limiting illness
what is shirt burst oxygen therapy?
-delivering high flow oxygen (15L/min) is a first line effective treatment in medical emergencies
when should pts be referred for LTOT?
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
what does the assessment of LTOT involve?
-ABG sampling on room air for at least 30 mins
-assessment of Sp02
what should the starting dose for LTOT be?
1L/min
how should the titration be carried out for LTOT?
-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
how do we assess for ambulatory oxygen therapy?
6 min walk test
or
modified test like to and from bathroom, down the ward
what are the complications associated with oxygen?
-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
how is oxygen delivered?
-nasal cannula
-low flow masks
-high flow masks
-reservoir masks
how does nasal cannula / prongs O2 therapy work?
its a low flow system which delivers 02 directly into the nostrils
how much % of 02 does 1L-4L of 02 therapy provide?
-1L provides 24% O2
-2L provides 28% O2
-3L provides 32% O2
-4L provides 36% O2
for patients who require a higher conc of O2, what other devices should be used to deliver it?
a mask
what are reservoir masks used for?
-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
what are indications for humidification?
-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
what are options for humidification treatment?
-systemic hydration
-heated humidification
-heat moisture exchangers
what is heated humidification?
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
what can improve systemic hydration levels in pts?
- increasing oral or IV fluid intake of a patient
-during periods of infection and fever, higher fluid intake is needed
what are heat moisture exchangers?
-acts as a nose for pts with tracheostomy
-less effective
