Respiratory Devices Flashcards
Why is inhaled tx preferred?
Maximizes delivery of drugs to lungs
Minimizes systemic side effects
Selecting the best device for a patient depends on:
availability
cost
skills/ability of patient
What should a pharmacist do with pt’s on inhalers?
Review inhaler technique frequently
Patient MUST demonstrate technique (IMPORTANT)
What are the 3 main categories of inahlers?
MDI
Dry Powder Inhalations
Respimat soft mist inhalers
How do MDI’s deliever medication? Disadvantgae?
Pressurized inhaler that delivers medication by using a propellant spray
- MOST do not have dose counters –> need to keep track of doses (pulmo scales)
How to use an MDI?
- PRIME (not actually doses) –> Allow sus to get accurate dose
Shake the inhaler well before use (3 or 4 shakes)
Remove the cap
Breathe out, away from your inhaler
Bring the inhaler to your mouth. Place it in your mouth between your teeth and close you mouth around it.
Start to breathe in slowly. Press the top of your inhaler once and keep breathing in slowly until you have taken a full breath.
Remove the inhaler from your mouth, and hold your breath for about 10 seconds, then breathe out.
If you need to take a second puff, wait 30 seconds.
What is a spacer? Benefits?
A tube-like chamber added on to a metered dose inhaler
Allows the patient to inhale the medication slowly & deeply over multiple breaths
Good for children, elderly, debilitated, recommended for all
Can attach a mask
MDI + spacer =
NEBULIZER
Cleaning a spacer:
Clean with mild detergent to reduce static (no boiling water or alcohol); do not dry
What type of breathing technique should one use with a spacer?
Tidal volume breathing technique vs. 1 slow, deep inspiration
Tidal volume –> Normal breathing –> Small baby or child (will be okay)
If person is old enough to understand, use slow deep breath
How long should one wait between actuation and inspiration with spacer?
Less than 5 seconds
How to use MDI and spacer?
Shake the inhaler well before use (3-4 shakes)
Remove the cap from your inhaler, and from your spacer, if it has one
Put the inhaler into the spacer
Breathe out, away from the spacer
Bring the spacer to your mouth, put the mouthpiece between your teeth and close your lips around it
Press the top of your inhaler once
Breathe in very slowly until you have taken a full breath. If you hear a whistle sound, you are breathing in too fast. Slowly breath in.
Hold your breath for about ten seconds, then breath out.
Can you do 2 doses in a spacer?
NO - Only do one dose then do another
Rate the inspiratory resistance of DPI’s
Low resistance devices (do not need that strong breathe to make it work)
Breezhaler
Medium resistance devices
Ellipta/Genuair/Diskus
High resistance devices
Turbuhaler/Handihaler
Turbhaler:
Breath actuated device
require a minimal inspiratory flow rate for optimal delivery
5 years of age or greater
Emphasize fast breath
Can’t taste or feel the drug
How to use a turbhaler?
Unscrew the cap and take it off. Hold the inhaler upright
Twist the coloured grip of your Turbuhaler® as far as it will go. Then twist it all the way back. You have done it right when you hear a “click”
Breathe out away from the device
Put the mouthpiece between your teeth, and close your lips around it. Breathe in forcefully and deeply through your mouth
Remove the Turbuhaler® from your mouth before breathing out
Always check the number in the side counter window under the mouthpiece to see how many doses are left.
For the Turbuhalers® that do not have a dose counter window, check the window for a red mark, which means your medication is running out.
When finished, replace the cap.
DISKUS FACTS
Breath activated
Can feel the drug
Maintain parallel to ground once activated
Drug delivery consistent across a range of air flow rates
Has a dose counter
- SHort expiry dates
How to use a diskus?
Open your DISKUS®: Hold it in the palm of your hand, put the thumb of your other hand on the thumb grip and push the thumb grip until it “clicks” into place
Slide the lever away from you as far as it will go to get your medication ready
Breathe out away from the device
Place the mouthpiece gently in your mouth and close your lips around it
Breathe in deeply until you have taken a full breath
Remove the DISKUS® from your mouth
Hold your breath for about ten seconds, then breathe out
Always check the number in the dose counter window to see how many doses are left.
Handihaler Facts. How to clean?
Breath activated
Drug delivery consistent across range of air flow rates
Technique requires multistep process
Capsules are light and moisture sensitive
Each capsule equals 1 dose so no dose counter required
Cleaning – if needed do not use cleaning agents or detergents
How to use handihaler? How do you know if its working?
Remove a capsule from the blister package of medicine. Take the capsule out of the package right before you’re going to use it.
Flip off the lid of the HandiHaler©.
Flip open the mouthpeice.
Put the capsule in the hole.
Flip the mouthpeice closed. Make sure you hear a click, so you know it’s closed properly.
Hold the HandiHaler© upright, with the mouthpeice facing up.
Sit up with your back straight.
Press the big button on the side of the HandiHaler©. This pokes a hole in the capsule to let the medicine out.
Exhale: blow out all your air.
Seal your lips around the HandiHaler© mouthpeice.
Breathe in slowly and deeply from the HandiHaler© mouthpeice, until your lungs are full.
As you’re breathing in, you should notice that the HandiHaler© is vibrating. This is supposed to happen. It shows that you’re taking it properly.
Take the HandiHaler© out of your mouth and hold your breath for as long as you can (10 seconds or longer, if you can).
Breathe out normally.
Take another breath from the HandiHaler©, to make sure you get all the medicine: Seal your lips around the HandiHaler© and take another deep breath in.
Take the HandiHaler© out of your mouth.
Hold your breath for as long as you can (10 seconds or longer, if you can).
Breathe out normally.
Discard Capsule
Breezhaler, Aerolizer similar to
HANDIhaler
Ellipta, Genuair
Newer devices that are pre-loaded, offering more choice and convenience to patients
Ellipta Expiry, What not to do?
Simply open the cap to prepare dose
make sure the air intake vent is not covered during inhalation
Short expiration date after removing protective covering
6 weeks after opening
Genuair Facts
Simply press down loading button to prepare dose
The loading button will lock to signal empty
make sure the button is completely released prior to inhalation
How to use ellipta?
Foil packaging and desiccant must be discarded immediately after opening
The colored cap should be opened before inhaling the dose, there is “click” when the dose is ready to be inhaled
If the device cover is opened and then closed without inhalation of the loaded dose, that dose will be lost; if a dose is lost another dose can be loaded by opening the device cover again- double dosing will no occur
If the device is tipped past horizontal, the medication will fall out of the mouthpiece
When there are less than 10 doses remaining the left half of the counter shows red.
How to use Genuair?
To prepare for inhalation, the colored button should be pressed and then released
The coloured control window will change from red to green when the dose is ready to be inhaled
Do not hold down the button while inhaling
During dose inhalation there is an audible “click”
After proper inhalation of the dose the coloured control window will change back to red
Keep breathing in even after the “click” to ensure delivery of the full dose
When a red striped band appears in the dose window, obtain a new inhaler
The device will “lock” when the last dose has been loaded
SMI Pros and CONS
PROs
Slow moving mist gives patients more time to inhale
No effort needed to coordinate
Improved delivery to lungs (higher deposition)
Dose indicator
CONs
Requires reasonable strength to spring load dose
Not approved for kids <5, or for use with a spacer
Priming if unused for 3 (Combivent) or 7 days (Spiriva / Inspiolto)
How to use Respimat?
Prime inhaler (according to package instructions)
Turn the clear base ½ turn (counter-clockwise).
Open the cap until it snaps open
Breath out slowly and fully and close the lips around the end of the mouthpiece without covering the air vents
While taking in a slow, deep breath through the mouth, press the dose release button and continue to breath in slowly for as long as possible. Hold the breath for 10 seconds or as long as comfortable
Breathe normally
Replace cap
If another dose is needed repeat steps 3-8
General Inhaler Technique
Prepare dose
Breathe out
Breathe medication in
Hold breath x 10 seconds
Breathe out
May take 2nd breath from DPI ensure entire dose is inhaled –> Handihaler
Best to wait ~ minute between puffs of the same medication if taking 2 separate doses
General Inhaler Tips
Wait 30 sec to 1 min between doses of the same medication
Inhaler Technique
Proper technique is only used about 10% of the time
#1 reason for therapy failure
Spacers: Use spacers whenever possible, especially in children, elderly
MDI and Respimat: Make sure new devices (or devices that haven’t been used in > 5 days) are primed
What is a nebulizer?
Nebulizers are electric- or battery-powered machines that turn liquid medicine into a fine mist that’s inhaled into the lungs.
The user breathes in the mist through a mouthpiece or facemask
Environmental Impact
pMDIs are an important contributer to greenhouse emissions
Reducing pMDI prescriptions when appropriate could have a meaningful environmental impact
