Respiratory System, Drug Delivery Flashcards
________________ delivers the drug directly to the airways; the dose required is smaller than when given by mouth and side-effects are reduced
Inhalation
Inhaler devices include … (3)
- Pressurized metered-dose inhalers
- Breath-actuated inhalers
- Dry powder inhalers
____________ can help patients, particularly the elderly and children, use pressurized metered-dose inhalers because they remove the need to coordinate actuation with inhalation
Spacer devices
_____________ inhalers may be useful in adults and children over 5 years who are unwilling or unable to use a pressurised metered-dose inhaler.
Dry powder
Alternatively, ______________ inhalers are suitable for adults and older children provided they can use the device effectively
breath-actuated
*Consider the patient’s preference when testing alternative devices to a pressurised metered-dose inhaler; there is no evidence to dictate an order in which devices should be tested
A spacer should always be used if the patient is on a high dose of _____________
inhaled corticosteroid
In adults with mild or moderate acute asthma attacks, a pressurised metered-dose inhaler with a spacer is at least as effective as _____________
nebulisation
On changing from a pressurised metered-dose inhaler to a dry powder inhaler, patients may notice a _______________ previously associated with each actuation. Coughing may also occur
lack of sensation in the mouth and throat
The patient should be instructed carefully on the use of the inhaler. It is important to check that the inhaler continues to be used correctly because inadequate inhalation technique may be mistaken for a ______________
lack of response to the drug
The number and different types of inhalers given to a patient should be _____________
minimised
To avoid accidental aspiration of loose objects when using a pressurized metered dose inhaler, patients should be advised to carry out the following steps… (4)
- Remove mouthpiece cover fully
- Shake device
- Check both the outside and inside of the mouthpiece are clear and undamaged before inhaling dose
- Store the inhaler with the mouthpiece cover on
The spacer device reduces the _____________ of the aerosol and subsequent impaction on the oropharynx and allows more time for evaporation of the __________ so that a larger proportion of the particles can be inhaled and deposited in the lungs
velocity
propellant
Spacer devices are particularly useful for which patients? (5)
- Patients with poor inhalation technique
- Children
- Patients requiring high doses of ICS
- Nocturnal asthma
- Patients prone to candidiasis with ICS
Patients should inhale from the spacer device ________________ after actuation because the drug aerosol is very short-lived
as soon as possible
True or False: when using a spacer, patients should take a single deep breath to maximize absorption of the drug into their lungs
False; tidal breathing is as effective as single breaths
How often should spacers be cleaned?
Once a month by washing in mild detergent; should be allowed to air-dry without rinsing
Why should frequent cleaning of the spacer be avoided?
Electrostatic charge may affect drug delivery
How often should spacer devices be replaced?
Every 6-12 months
Solutions for nebulisation used in severe or life-threatening asthma attacks are administered over _________ minutes from a nebuliser, usually driven by oxygen
5–10
Patients with a severe attack of asthma should preferably have oxygen during nebulisation since beta2 agonists can increase ________________
arterial hypoxaemia
- However, the absence of supplemental oxygen should not delay treatment
A nebuliser converts a ___________ of a drug into an ___________ for inhalation.
solution
aerosol
What are the main drugs delivered by nebulizer? (6)
- Beta 2 agonist
- Ipratropium bromide
- Corticosteroid eg budesonide
- Antibiotic eg colistimethate sodium or pentamidine
- Mucolytic
- Adrenaline
What are the clinical indications of nebulizers? (5)
- Acute exacerbation of asthma or COPD (SABA or ipratropium bromide)
- Regular treatment of severe asthma or reversible airway obstruction when the patient is unable to use other devices (SABA, ipratropium bromide, or steroids)
- CF (colistimethate or mucolytics)
- Severe croup (budesonide or adrenaline)
- Prophylaxis or treatment of PJP (pentamidine)
Before prescribing a nebuliser, a home trial should preferably be undertaken to monitor response for up to ___ weeks on standard treatment and up to ___ weeks on nebulised treatment
2
2