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Traditionally, what % of a given dose of aerosolized medication reaches the lower airways, regardless of the delivery device used?
10% - 15%
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If a patient is having issues coordinating actuation of the MDI, what should the RT suggest?
- Tell patient to coordinate inhalation and actuation of the inhaler
- Too slow down their inspiratory flow rate
- Make sure to shake and mix canister contents
- To keep breathing all the way till the end
Breath-actuated MDI: alternative for individuals who find it difficult to coordinate pMDI actuation with inhalation. The device is primed by raising the lever on top. The pMDI canister is triggered by a spring through a triggering mechanism activated when the pt inhales. Improves the delivery of inhaled medication in pts with poor coordination. Maxair was removed from the market for containing CFC propellant.
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What is the purpose of the end-inspiratory breath hold used when an aerosol device delivers medication?
Allows better deposition through gravitational settling
Because the process of sedimentation is time dependent, the end-inspiratory breath hold should maximize deposition in the periphery. It can increase settling of particles; however, depending on particle size, a particle may not fall out of suspension.
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What would be the most appropriate delivery device to use in patients with severe shortness of breath and unable to hold a mouthpiece?
MDI w/ a mask
Use small volume nebulizer (SVN) instead of MDI in emergent acute situations requiring aerosol bronchodilator delivery. A mask is an option with nebulizers for those unable to hold a mouthpiece (avoid mask if possible)
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Define dead volume and what to The flow rate needed to disperse the drug of a DPI sothe patient can effectively inhale the drug ranges from Liters per minute.
Amount of solution that remains in the reservoir of a small volume nebulizer once sputtering begins, causing a decrease in aerosolization. Because of this you should add diluent to add volume and “expand” the solution volume (will not change amount of drug, just expands it). Pg 53
Dead volume: the amt of a drug solution remaining in the reservoir when the device begins to sputter and aerosolization ceases. Because of this you should add diluent to add volume and “expand” the solution volume (will not change amount of drug, just expands it).
30-90 L/min Page 49
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Which aerosol administration devices would you choose for albuterol/ribavirin?
Albuterol (bronchodilator): MDI, SVN, Nebulizer type not specifiedRibavirin: Small particle aerosol generator (SPAG)
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What are the optimal numbers for SVN in terms of volume/dead volume/flow rate/time of nebulization?
- Dead volume: 0.5-1.0ml
- Flow rate/ time of nebulization: 6-8 L/min (ppt states 10 L/min is recommended for flow rate)
- Volume 3-5mL of solution.
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Match aerosol devices with their description.
- SVN (Jet, Mesh, Ultrasonic) Type of aerosol generator that converts liquid drug solutions or suspensions into aerosol. SVNs are powered by compressed gas (air or O2), a compressor, or an electrically powered device. Gas powered (pneumatic)
- Ultrasonic – Converts electric signal to high frequency acoustic vibrations. Uses piezoelectric crystal to produce aerosol.
- pMDI “pressurized Metered Dose Inhalers” (Canisters, propellant/excipient mixture, drug formulary, metering valve, actuator and dose counter
- MDI reservoir devices
- Spacer
- Valved holding chamber (one way valve)
- DPI “Dry powder inhaler”- similar to pMDI except the drug is in powder form
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What are common problems associated with patient use of a MDI?
- Coordinate actuation with inhalation (hand breathing incoordination)
- Too short a period of breath hold after inhalation
- Too rapid an inspiratory flow rate
- Inadequate shaking and mixing / Failure to shake / mix canister contents
- Cessation of inspiration as aerosol strikes
- Actuation at total lung capacity
- Inhaling thru the nose
- Exhaling during actuation
- Holding in wrong position
- Firing of MDI multiple times during single inhalation
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How should a patient be instructed during an aerosol treatment with a dry powder inhaler (DPI); SVN, MDI, to achieve optimal drug deposition in the lower respiratory tract?
- DPI: Inhale/breathe in quickly to disperse powder
- SVN: Breathe normally, everyonce in a while hold in breath
- MDI: Inhale/breathe in slowly.. and deeply, hold breath for x amount of time
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What are the main components of an MDI device?
Drug, Propellant/excipient mixture, canister, metering valve, mouth piece/actuator
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What is the effect of adding additional diluent to the drug in a small volume nebulizer do?
Adding diluent does not alter the amount of drug (dose) in the nebulizer; it simply “expands” the solution volume. Concentration of the solution is less not the amt of drug
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The current propellant used in meter dose inhalers is:
Hydrofluorocarbons (HFCs), or HFAs were then identified as propellants that were nontoxic to the atmosphere and to the patient and that also had properties suitable for MDI aerosol generation.
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Which aerosol delivery device requires the greatest patient generated inspiratory flow rate?
DPI dry powder inhalers
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1 ml is equal to how many drops (gtts) of liquid?
16 drops
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