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OS 213 Respiratory Exam 2 > Overview of Therapeutic Modalities in Pulmonary Medicine > Flashcards

Overview of Therapeutic Modalities in Pulmonary Medicine Flashcards

1
Q

Therapeutic modalities include:

A

Systemic therapy
Inhalational therapy
Oxygen Therapy
respiratory Physical Therapy

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2
Q

Pharmacologic Therapy

A

Antibiotics
Bronchodilators
Anti-Inflammatory
Oxygen

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3
Q

Non Pharmacologic Therapy

A

behavior Therapy - Stop Smoking
Occupational therapy
Physical theapy

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4
Q

Routes of Therapies

A

Oral
parenteral
Inhalational

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5
Q

Systemic side effects

A

Beta-2-agonists (Cardiovascular, Metabolic)

Methylxanthines (Aminophylline, Theophylline)

Corticosteroids (HPA axis suppression, water and electrolyte imbalance, psychosis, Bone fractures)

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6
Q

Drug that has oral dosage only

A

Leukotriene receptor agonists

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7
Q

Localized/direct deposition of drugs to the airway

A

Inhalational therapy

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8
Q

Liquid/solid particles suspended in gas medium, Particles sufficiently small to remain airborne for a considerable period of time

A

Aerosols

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9
Q

Commonly used methods of inhalational therapy

A

Nebulization
Metered Dose Inhalers
Dry powder inhalaers

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10
Q

Increasing cross sectional area results in decrease in ______

A

Air flow velocity

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11
Q

Larger particles deposit in??

A

Larger airways,

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12
Q

Smaller particles deposit in???

A

Smaller airways

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13
Q

Beta 2 agonists exert their greatest effect on??

A

Airway smooth muscles

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14
Q

Optimal particle size for beta 2 agonists:

A

3 microns

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15
Q

Ideal region for bronchodilators to serve maximal effect

A

Bronchi and bronchioles

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16
Q

Too small particle size (<1 micron)

A

Exhaled
maybe detected as foreign body and phagocytized
Increased systemic drug delivery

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17
Q

1-5 microns (OPTIMUM PARTICLE SIZE)

A

Reach large and small airways. Bronchodialtion action on airway beta 2 smooth muscle
Local anti-inflammatory action via corticosteroid

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18
Q

Too large (>5 microns)

A

Deposition in posterior oropharynx and swallowed

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19
Q

inertial impaction

A

Momemtum

At bifurcations in RT

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20
Q

gravitational Sedimentation

A

Remaining particles move on to the central lung, the air velocity gradually decreaes to much lower values. (1 to 5 microns)

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21
Q

Stoke’s Law

A

Particles settling under gravity will attain constant terminal setting velocity

22
Q

NEbulizer

A

“the machine/the device”
Jet, ultrasonic

Advantages:

  • Use of passive breathing
  • Good dosage form for pediatric form

Disadvantage

  • Time intensive
  • Inefficient and cumbersome
  • Expensive
  • Needs to be cleaned
23
Q

Pressured Metered Dose Inhaler

A

Use chemical propellants to deliver medication dose to lungs

Most widely used

Metered: Specific/controlled amount to be aerosolized/released

24
Q

Optimal conditions for inhaling MDI

A

Aerosols are actuation of the device at the start of inhalation, inspiratory flow rate of<50 li per min. Followed by 10 seconds breath holding at the end of inspiration

25
Q

Alternative for CFC

A

Hydrofluoroalkanes

26
Q

advantage of MDI

A

Deliver a reliable/ consistent dose of medications directly yo the site of action

Onset of action is quicker

Side effects fewer

Pirtable

27
Q

Disadvantage of MDI

A

Need good coordination of actuation and inhalation

Not very efficient as delivery device-20% or less of the dose

Many have no built in counter

28
Q

Spacer

A

decreases the velocity of particles upon release from the device (normally particles ejected at the very rapid velocity, higher chance of impaction of particles in the back of throat)

29
Q

Aerochamber

A

Small, regular, large, plus

30
Q

Azmacort

A

Built in spacer with device

31
Q

Which device is for your patient? Good actuation-inhalation coordination

A

Inspiratory flow <30 l/min - (pMDI , NEBULIZER)

Inspiratory flow >30l/min (pMDI, DPI, NEBULIZER)

32
Q

Whih device is for your patient? Poor actuation-inhalation coordination

A

Inspiratory flow < 30l/min

(pMDI + Spacer , Nebulizer)

Inspiratory flow >30 l/min
(pMDI + Spacer, DPI, Nebulizer)

33
Q

Soft Mist Inhaler

A

Aerosols with a greater fine particle fraction than most pMDIs DPIs and nebulizer

Aerosol spray produced exits the inhaler more slowly and lasts for a longer time

34
Q

The most effective device is the one____

A

which the patient will use

35
Q

5D’s to consider

A 
Demographics
Device
Doctor
Drug
Disease
36
Q

The fraction or percentage of the inspired air that is made up of O2.

A

Fraction of inspired oxygen

37
Q

factors that increase FiO2

A

Increase oxygen flow

Increase size of reservoir

38
Q

Factors that decrease FiO2

A

Decreased RR

Decreased TV

39
Q

Arterial Blood Gas

A 
pH = 7.35-7.45
pO2 = 80-100 mmHg

pCO2= 35-45 mmHg

HCO3= 22-26 mmol/L

40
Q

Oxygen saturation of 95% –> pO2

A

80

41
Q

Oxygen Concentration

A

FiO2, Mixture of atmospheric oxygen = 21 % and supplied oxygen = 100%

42
Q

HOW MUCH FLOW?

A

16 bpm = 0.5 TV 1

20bpm = 8 TV 16(;i)

25bpm = 12.5 TV 25(li)

35bpm = 17.5 TV 35 (li)

43
Q

Low face mask

A

3 L/min air drawn into mask via the holes + 2 L/min Oxygen into mask from the tube

*Of the 5L of mixed air inspired the 2L from your oxygen supply

44
Q

Face Mask with Reservoir

A

Partial Rebreathing (has holes -can be compensated by room air)

Non-rebreathing (has valves-increases concentration of oxygen by preventing dilution from exhaled air)

45
Q

Venturi Mask

A

High flow: 30L/min into mask, but 25 L/min escapes from mask. So only 5 L/min is inspired

46
Q

Respiratory Physical Therapy

A

Muscles strength building exercises

47
Q

Measure effectiveness of deep breath is by use of

A

incentive spirometers

flutter device

48
Q

Breathing Exercises

A

pursed lip breathing. Exhalation tends to collapse the airway, thus the patient prevents very rapid exhaltion by pursing the lips

Diaphragm should be the main muscle for respiraton

49
Q

Postural Drainage

A

instruct the patient to assume different position

50
Q

MObilization of airway secretions

A

Chest clapping
Vibration
Ultrasound

OS 213 Respiratory Exam 2 (15 decks)

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