V/Q matching, ABGs, Resp pharmacology, Inhalation & O2 therapy, and Sputum Flashcards
What is the primary function of corticosteroids in respiratory therapy?
Reduce airway inflammation and mucus production
Which conditions are corticosteroids commonly used to treat?
Asthma and COPD
Name the common inhaled corticosteroids.
Beclomethasone (becotide), Fluitcasone (Flixotide), Budesonide (Plumicort), Ciclesonide (Alvesco)
Why should patients rinse their mouths after using inhaled corticosteroids?
To prevent oral infections (candidiasis)
What is a major long-term side effect of systemic corticosteroids?
Osteoporosis
What does the inflammatory reaction in airways trigger?
Brochospams, oedema, mucus hypersecretion
How often are corticosteriods administered to patients?
2x a day
How are corticosteriods administered?
Via tablets/inhaler/nebuliser in conjunction with long acting bronchodilators
What are the common side-effects of corticosteriods?
Hoarseness & oral candidiasis
What are the side-effects of inhaled corticosteriods?
Cataracts, skin bruising & osteoporosis (in high doses)
What are the side-effects of systemic corticosteriods?
Osteoporosis, diabetes, hyperparathyroidism, muscle dysfunction & adrenal insufficiency (if overused)
What is meant by “Corticosteroids don?t alter the course of the disease”?
It doesn?t eliminate/clear the source of the disease; it simply masks the sympyoms
What drugs are used to facilitate airway bronchodilation?
Beta-2 agonist bronchodilators, Anticholinergic bronchodilators, Xanthines
How are ?2 drugs administered?
Via an inhaler/nebuliser
Other than bronchodilation, what’s another function of Beta-2 agonist bronchodilators?
Help to stabilize mast cell activity BUT pt may develop tolerance to drug & mast cell activity, therefore B-2 agonists will still relieve smooth muscle contraction but not combat mast cell activity
How long does it take beta-2 agonistic bronchodilators to activate (what’s their onset time)?
7 minutes
How long does beta-2 agonists provide symptomatic relief for?
4-8 hours
What class of drugs stimulates ?2 receptors in bronchial smooth muscle?
Beta-2 agonists
Name a short-acting beta-2 agonist.
Salbutamol (Others incl: fenoterol, terbutaline)
Name a long-acting beta-2 agonist.
Salmeterol (Others incl: eformoterol, indacaterol)
What are the common side effects of beta-2 agonists?
Tremor, tachycardia & agitation
What is the primary function of anticholinergic bronchodilators?
Block acetylcholine to prevent airway narrowing
What is the onset time for anticholinergic bronchodilators?
30-45 minutes
Name a common anticholinergic bronchodilator.
Ipratropium bromide
What is a common side effect of anticholinergics that affects secretion clearance?
Dry mouth
What class of drugs includes Theophylline and Aminophylline?
Xanthines
What is a major side effect of xanthines that affects the stomach?
Gastric ulcers
What is a cardiovascular side effect of xanthines?
Cardiac arrhythmias
How are Xanthines administered?
Via IV/tablets
What are the functions of Xanthines?
Bronchodilate, decreases inflammation, boost immune system, improve gas exchange & lung function
What are the long-term side-effects of Xanthines?
Gastric ulcer formation & insomnia
What are the immediate side-effects of Xanthines?
Headache, nausea and vomiting, cardiac arrhythmias & tachycardia
Which class of drugs helps clear thick mucus from the airways?
Mucolytics
What type of saline is commonly used to induce sputum in cystic fibrosis patients?
Hypertonic saline
What mucolytic is commonly used in cystic fibrosis patients once daily?
Dornase alpha
What side effect can hypertonic saline cause in sensitive patients?
Bronchospasm
Which mucolytic may cause GI bleeding over time?
Carbocisteine
What is a common use of normal saline in respiratory therapy?
Humidifying the airways and assisting secretion clearance
True or False? Normal saline thins viscous secrettions.
False. It simply enhances clearance of viscous secretions BUT doesn’t thin it out
How are mucolytics administered?
Via nebuliser
What are the implications for physio with regards to mucolytics?
Hypertonic saline can ? bronchospasm in pts prone to bronchospasm & Carbocisteine may cause GI bleeding over time
What are the side effects of normal saline?
There are none
How do corticosteroids affect muscle function with long-term use?
Can cause muscle dysfunction
What condition can long-term corticosteroid use contribute to besides osteoporosis?
Diabetes
Which class of bronchodilators has both short-acting and long-acting variants?
Beta-2 agonists
What is the peak effect time of short-acting beta-2 agonists?
20 minutes
What is the primary way anticholinergic bronchodilators are administered?
Inhaler or nebulizer
How do xanthines improve gas exchange?
By bronchodilating and reducing inflammation
Which xanthine drug is administered via IV or tablets?
Theophylline
What should be monitored in physiotherapy patients using bronchodilators?
Heart rate, tremors, and secretion clearance
Which drug combination includes corticosteroids and long-acting bronchodilators?
Symbicort or Seretide
What is a common side effect of inhaled corticosteroids?
Oral candidiasis (thrush)
How should inhaled corticosteroids be administered to reduce side effects?
With a spacer and mouth rinsing
What class of drugs is often used for acute asthma attacks?
Short-acting beta-2 agonists (SABAs)
Which respiratory drug class has a risk of developing tolerance with frequent use?
Beta-2 agonists
What is the function of mast cell stabilizers?
Prevent release of histamine and inflammatory mediators
How do systemic corticosteroids differ from inhaled corticosteroids?
Systemic corticosteroids have more systemic side effects and are used for severe cases
What is a key concern with long-term use of oral corticosteroids?
Adrenal suppression and withdrawal symptoms
Which drug is used as a rescue inhaler for asthma attacks?
Salbutamol (Ventolin)
What is the primary function of a nebuliser?
Converts liquid medication into aerosol particles for inhalation
When are nebulisers used instead of MDIs?
When simpler inhalers cannot deliver the drug effectively OR the drug can’t be administered in any other way
What is the typical duration of nebuliser treatment?
10-15 minutes
What is the particle size produced by a nebuliser?
Less than 5æm
Describe the mechanism behind how neubisers work
Nebuliser converts solution into aerosol particles which are suspended in a stream of gas
Name two types of nebulisers
Jet nebulisers and Ultrasonic nebulisers
How does a jet nebuliser work?
Uses compressed air/oxygen to create aerosol mist
What is the driving gas flow rate for a jet nebuliser?
5-6 L/min
How does an ultrasonic nebuliser generate aerosol?
Uses high-frequency sound waves
What factor determines particle size in an ultrasonic nebuliser?
The frequency of crystal oscillation
Which type of nebuliser produces a higher gas output?
Ultrasonic nebuliser
What is the standard drug volume delivered by all nebulisers?
4 ml
Name four types of drugs administered via nebulisers
Mucolytics, bronchodilators, corticosteroids, antibiotics
How should a nebuliser be cleaned after use?
Washed and dried thoroughly
Why should nebulisers be serviced regularly?
To prevent malfunction and ensure proper drug delivery
What must be carried when traveling with a portable nebuliser?
An international adaptor
What is the first step when using an MDI?
Shake the inhaler and hold it upright
Why should a patient sit upright when using an MDI?
To allow proper lung expansion and drug delivery
Why is it important to exhale fully before inhaling from an MDI?
To maximize lung capacity for drug intake
When should the canister be pressed in an MDI?
Just after starting to inhale
How long should a patient hold their breath after inhaling an MDI dose?
10 seconds
Why should patients wait one minute between MDI puffs?
To allow the canister to warm up and improve drug delivery
What should be done to an MDI canister in cold weather before use?
Pre-warmed in a pocket
What device improves MDI drug delivery and reduces side effects?
Spacer device
What is the main function of a spacer device?
Acts as a chamber between inhaler and patient to improve drug delivery
How do spacers help reduce side effects of steroid inhalers?
Large particles drop out in the chamber, reducing throat irritation
How does a spacer improve inhaler drug absorption?
Slows aerosol movement, reducing drug loss in the throat
Why do spacers help patients who struggle with inhaler coordination?
They allow for better timing between inhalation and drug release
When are spacers especially useful?
During acute asthma episodes when high doses are needed
Why should all children using steroid inhalers use a spacer?
To reduce side effects and improve medication delivery
What is one key benefit of ultrasonic nebulisers over jet nebulisers?
They produce higher gas output
What type of medication is commonly used in nebulisers for cystic fibrosis patients?
Mucolytics
How do nebulisers help patients with severe airway obstruction?
Deliver medication directly to the lungs in aerosol form
What should be done before exhaling when using an MDI?
Hold the breath for 10 seconds
What is a key precaution to take when using a nebuliser?
Ensure it is cleaned properly to prevent bacterial contamination
Why do MDIs require shaking before use?
To mix the drug evenly within the canister
What component in an ultrasonic nebuliser produces vibrations?
Piezoelectric crystal
Why should an MDI mouthpiece be sealed with lips?
To ensure all medication is inhaled without leakage
What is a common mistake patients make with MDIs?
Inhaling too quickly instead of slowly and deeply
Why do MDIs have a cooling effect when used repeatedly?
The propellant cools down with frequent use
What should be done if an MDI is not used for a long time?
Prime it by releasing a test spray
What happens if a nebuliser is not serviced regularly?
Reduced drug efficiency due to blockages
What type of inhaler requires less patient coordination?
Dry powder inhaler (DPI)
What is the function of a propellant in an MDI?
Helps disperse the drug as an aerosol
Describe the process, from start to end, on how to correctly use a metered dose inhaler (MDI)
Shake inhaler, hold it upright & remove cap. Sit upright. Exhale fully. Seal lips around mouthpiece. Breathe in through mouth, pressing the top of the canister just after initiation of breath, inhale slowly & deeply. Hold the breath for 10 sec before exhaling. If more than one dose is prescribed, wait 1 min between puffs > each puff cools the canister and ? its efficiency. In cold weather, the canister should be pre-warmed in the pocket.
List the advantages of a using a spacer device
Large particles drop out in the chamber, thus reducing local sideeffects of steroids. Aerosol momentum is slowed so that less is lost by action at the back of the throat. Less coordination is required to deliver the aerosol to the airways. High doses of medication can be delivered during an acute episode
What is auscultation?
Process of listening to & interpreting the sounds produced within the thorax
Auscultation is a key diagnostic tool in clinical settings.
What are the components of a stethoscope?
- Bell
- Diaphragm
- Tubing
- 2 earpieces
Each component serves a specific purpose in auscultation.
What is the function of the diaphragm on a stethoscope?
Listen to breath sounds
The diaphragm is designed for high-frequency sounds.
What is the function of the bell on a stethoscope?
Listen to heart sounds (low frequency)
The bell is effective for detecting lower frequency sounds.
In what position should a patient be during auscultation?
Seated/side-lying position
This position helps enhance the quality of the sounds heard.
What should a patient do to reduce turbulence during auscultation?
Breathe in & out through mouth
This technique minimizes noise from nasal breathing.
What is the normal breath sound?
Generated by turbulent airflow in trachea & large airways
Normal breath sounds are typically louder in the apices and softer in lower lobes.
What characterizes bronchial breath sounds?
Normal tracheal sounds heard in lung periphery over consolidated lung areas
These sounds are present throughout inspiration & expiration.
What does diminished breath sound indicate?
- ↓ in initial sound generation
- Globally diminished: pain or muscle weakness
- Locally diminished: obstruction of bronchus or localized fluid/air
Diminished sounds can be a sign of various underlying issues.
What are crackles?
Clicking sounds heard during inspiration due to opening of previously closed alveoli & small airways
They can be coarse (early inspiratory) or fine (late inspiratory).
What is the difference between coarse and fine crackles?
- Coarse: early inspiratory crackles -> sputum retention
- Fine: late inspiratory crackles -> pulmonary oedema or pulmonary fibrosis
The type of crackle can indicate different conditions.
What are wheezes?
Whistling/musical sound produced by turbulent airflow through narrowed airways
Wheezes can be classified as monophonic or polyphonic.
When are wheezes first heard?
On expiration
In cases of severe bronchospasm, wheezes may be heard during both inspiration and expiration.
What does pleural rub sound like?
Rubbing sound with each breath, like boots crunching on snow
It occurs when pleural surfaces are roughened by inflammation, infection, or neoplasm.
What is stridor?
Wheezing sound in upper airways, louder on inspiration than expiration
Stridor indicates upper airway obstruction.
What are adventitious sounds?
Any out of the ordinary breath sounds
Adventitious sounds can indicate various respiratory conditions.
What are vesicular breath sounds?
Normal breath sounds
Vesicular sounds are typically soft and low-pitched.
What does a high-pitched wheeze when aucultating indicate?
Near total obstruction of airways
What does a low-pitched wheeze when auscultating indicate?
Sputum retention
When auscultating, when will you hear wheezing upon inhalation AND exhalation?
When a pt has svere bronchospasms
