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Medicated Aerosol Therapy

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Characteristics of Therapeutic aerosols
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1. Output – particle size 1-5 microns, usually targeting the smaller airways 2. Deposition a) inertial impaction b) sedimentation c) diffusion 3. Aging
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Goals of Medicated Aerosol Therapy
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1. provide medication to the targeted organ – the lung 2. Depending on the medication administered a) promote bronchodilation b) promote antiinflammation (steroid) c) provide antibiotic therapy d) provide mucoactive therapy (drug capable of breaking apart mucus, i.e. CF patients)
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Medicated Aerosol Therapy Indications:
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1. Bronchoconstriction/wheezing 2. Inflammation of the airways 3. Infection 4. Excessive mucus production
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Medicated Aerosol Therapy Hazards:
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1. Infection (reservoir with liquid) 2. Airway reactivity 3. Overhydration (in theory) 4. Ineffective airway clearance (can’t cough effectively, be prepared to suction) 5. Drug reconcentration (end of medication has higher concentration. Ned to empty out so next dose doesn’t have high concentration)
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Small Volume Nebulizers (SVN) Max. volume is
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5 or 6 ml
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Small Volume Nebulizers (SVN) Component parts:
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1. jet utilizing Bernoulli Principle 2. compressed gas source 3. capillary tube 4. reservoir to hold medication 5. baffle 6. ambient air inlet 7. patient interface
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Small Volume Nebulizers (SVN) Performance:
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1. residual volume of liquid in the medication cup is called dead volume 2. only 10% of intended medication reaches the lower airways during optimal operation
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Breath Activated Nebulizer (BAN)
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1. delivers 3-4 times the medication 2. only nebulizes on Inspiration 3. eliminates waste during Expiration 4. treatment takes less time (often just 3 min) 5. can be cost prohibitive
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Continuous Nebulization
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1. HEART nebulizer (High Output Extended Respiratory Therapy) 2. HOPE 3. Administration of bronchodilators continuously (pt. needs to wear mask and be monitored continuously) 4. 240 ml reservoir
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vaporizer is
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a visible mist (aerosol). Mist evaporates and creates humidity.
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Small Particle Aerosol Generator (SPAG)
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1. specifically designed to deliver Ribavirin (Virazole) 2. Treatment of Respiratory Syncytial Virus (RSV) 3. Scavenging system to collect escaped aerosol (potent drug with adverse side effects)
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when child is crying, how does E compare to I?
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E is much longer than I making it difficult to administer meds. Need to stop crying, make treatment a game
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pMDI is
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Pressurized Metered Dose Inhaler
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Features of MDI’s
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1. Portable, compact and relatively easy to use. 2. Contains micronized powder, Hydrofluoroalkane (HFA), Liquid propellants, Surfactant 3. Preferred method of bronchodilator delivery
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When could you use a holding chamber with a mask?
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often with kids, sometimes with adults if problems with inspiration
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Distribution of medication in lungs by delivery device
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DPI – 27% MDI – 9% MDI w/ Holding chamber – 20% Nebulizer – 12%
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DPI
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Dry Powder Inhaler
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Soft Mist Inhaler
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newest inhaler on the market delivers a metered dose in a soft mist Respimat – Albuterol plus Ipratropium bromide
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Controlling Environmental Contamination
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greatest occupational exposure is from administering of Ribavirin
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Protection from Environmental Contamination
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1. negative pressure rooms 2. Booths and Stations with HEPA filters 3. PPE