Overview of Therapeutic Modalities in Pulmonary Medicine Flashcards
Therapeutic modalities include:
Systemic therapy
Inhalational therapy
Oxygen Therapy
respiratory Physical Therapy
Pharmacologic Therapy
Antibiotics
Bronchodilators
Anti-Inflammatory
Oxygen
Non Pharmacologic Therapy
behavior Therapy - Stop Smoking
Occupational therapy
Physical theapy
Routes of Therapies
Oral
parenteral
Inhalational
Systemic side effects
Beta-2-agonists (Cardiovascular, Metabolic)
Methylxanthines (Aminophylline, Theophylline)
Corticosteroids (HPA axis suppression, water and electrolyte imbalance, psychosis, Bone fractures)
Drug that has oral dosage only
Leukotriene receptor agonists
Localized/direct deposition of drugs to the airway
Inhalational therapy
Liquid/solid particles suspended in gas medium, Particles sufficiently small to remain airborne for a considerable period of time
Aerosols
Commonly used methods of inhalational therapy
Nebulization
Metered Dose Inhalers
Dry powder inhalaers
Increasing cross sectional area results in decrease in ______
Air flow velocity
Larger particles deposit in??
Larger airways,
Smaller particles deposit in???
Smaller airways
Beta 2 agonists exert their greatest effect on??
Airway smooth muscles
Optimal particle size for beta 2 agonists:
3 microns
Ideal region for bronchodilators to serve maximal effect
Bronchi and bronchioles
Too small particle size (<1 micron)
Exhaled
maybe detected as foreign body and phagocytized
Increased systemic drug delivery
1-5 microns (OPTIMUM PARTICLE SIZE)
Reach large and small airways. Bronchodialtion action on airway beta 2 smooth muscle
Local anti-inflammatory action via corticosteroid
Too large (>5 microns)
Deposition in posterior oropharynx and swallowed
inertial impaction
Momemtum
At bifurcations in RT
gravitational Sedimentation
Remaining particles move on to the central lung, the air velocity gradually decreaes to much lower values. (1 to 5 microns)
Stoke’s Law
Particles settling under gravity will attain constant terminal setting velocity
NEbulizer
“the machine/the device”
Jet, ultrasonic
Advantages:
- Use of passive breathing
- Good dosage form for pediatric form
Disadvantage
- Time intensive
- Inefficient and cumbersome
- Expensive
- Needs to be cleaned
Pressured Metered Dose Inhaler
Use chemical propellants to deliver medication dose to lungs
Most widely used
Metered: Specific/controlled amount to be aerosolized/released
Optimal conditions for inhaling MDI
Aerosols are actuation of the device at the start of inhalation, inspiratory flow rate of<50 li per min. Followed by 10 seconds breath holding at the end of inspiration
Alternative for CFC
Hydrofluoroalkanes
advantage of MDI
Deliver a reliable/ consistent dose of medications directly yo the site of action
Onset of action is quicker
Side effects fewer
Pirtable
Disadvantage of MDI
Need good coordination of actuation and inhalation
Not very efficient as delivery device-20% or less of the dose
Many have no built in counter
Spacer
decreases the velocity of particles upon release from the device (normally particles ejected at the very rapid velocity, higher chance of impaction of particles in the back of throat)
Aerochamber
Small, regular, large, plus
Azmacort
Built in spacer with device
Which device is for your patient? Good actuation-inhalation coordination
Inspiratory flow <30 l/min - (pMDI , NEBULIZER)
Inspiratory flow >30l/min (pMDI, DPI, NEBULIZER)
Whih device is for your patient? Poor actuation-inhalation coordination
Inspiratory flow < 30l/min
(pMDI + Spacer , Nebulizer)
Inspiratory flow >30 l/min
(pMDI + Spacer, DPI, Nebulizer)
Soft Mist Inhaler
Aerosols with a greater fine particle fraction than most pMDIs DPIs and nebulizer
Aerosol spray produced exits the inhaler more slowly and lasts for a longer time
The most effective device is the one____
which the patient will use
5D’s to consider
Demographics Device Doctor Drug Disease
The fraction or percentage of the inspired air that is made up of O2.
Fraction of inspired oxygen
factors that increase FiO2
Increase oxygen flow
Increase size of reservoir
Factors that decrease FiO2
Decreased RR
Decreased TV
Arterial Blood Gas
pH = 7.35-7.45 pO2 = 80-100 mmHg
pCO2= 35-45 mmHg
HCO3= 22-26 mmol/L
Oxygen saturation of 95% –> pO2
80
Oxygen Concentration
FiO2, Mixture of atmospheric oxygen = 21 % and supplied oxygen = 100%
HOW MUCH FLOW?
16 bpm = 0.5 TV 1
20bpm = 8 TV 16(;i)
25bpm = 12.5 TV 25(li)
35bpm = 17.5 TV 35 (li)
Low face mask
3 L/min air drawn into mask via the holes + 2 L/min Oxygen into mask from the tube
*Of the 5L of mixed air inspired the 2L from your oxygen supply
Face Mask with Reservoir
Partial Rebreathing (has holes -can be compensated by room air)
Non-rebreathing (has valves-increases concentration of oxygen by preventing dilution from exhaled air)
Venturi Mask
High flow: 30L/min into mask, but 25 L/min escapes from mask. So only 5 L/min is inspired
Respiratory Physical Therapy
Muscles strength building exercises
Measure effectiveness of deep breath is by use of
incentive spirometers
flutter device
Breathing Exercises
pursed lip breathing. Exhalation tends to collapse the airway, thus the patient prevents very rapid exhaltion by pursing the lips
Diaphragm should be the main muscle for respiraton
Postural Drainage
instruct the patient to assume different position
MObilization of airway secretions
Chest clapping
Vibration
Ultrasound
