The mass of aerosol particles produced by a nebulizer in a given unit time best describes which quality of the aerosol?
output
What measure is used to describe the variability of particle diameters in an aerosol?
GSD geometric standard deviation
What is the retention of aerosol particles resulting from contact with the respiratory tract mucosa called?
deposition
factors affect pulmonary deposition of an aerosol
I. size of the particles II. shape and motion of the particles III. physical characteristics of the airways
What is the primary mechanism for deposition of large, high-mass particles (greater than 5 ⎧m) in the respiratory tract?
inertial impaction
What is the primary mechanism for central airway deposition of particles in the 1- to 5-⎧m range?
sedimentation
As hygroscopic aerosol particles enter the respiratory tract, what do they tend to do?
increase in size because of the absorption of molecular water
A patient with chronic bronchitis is receiving heated water aerosol treatments through a jet nebulizer four times daily to aid in mobilizing retained secretions. After each treatment, you note a dramatic increase in the magnitude of coarse crackles heard on auscultation. Which of the following recommendations would you make to the physician?
Add coughing and postural drainage to the therapy.
What is the preferred method for delivering bronchodilators to spontaneously breathing and intubated, ventilated patients?
metered-dose inhaler
Immediately after firing, the aerosol particles produced by most metered-dose inhalers are about how large?
35 ⎧m
Each firing of a typical metered-dose inhaler delivers about what output volume?
30 to 100 ⎧l
Most of the spray generated by the majority of metered-dose inhalers consists of which of the following?
propellant
About what range of drug dosages can be provided with each firing of a metered-dose inhaler?
50 ⎧g to 5 mg
Which of the following particle distributions is produced by a typical metered-dose inhaler?
3- to 6-⎧m mean mass aerodynamic diameter (MMAD)
When fired inside the mouth, what percentage of the drug dose delivered by a simple metered-dose inhaler (MDI) deposits in the oropharynx?
about 80%
When using a metered-dose inhaler without a holding chamber or a spacer, the patient should be instructed to fire the device at what point?
immediately after beginning a slow inspiration
Before inspiration and actuation of a metered-dose inhaler, the patient should exhale to which of the following?
functional residual capacity
Which of the following agents has been associated with increased intraocular pressure?
anticholinergics
What is a potential limitation of flow-triggered metered-dose inhaler devices?
high flows necessary for actuation
The key difference between a metered-dose inhaler (MDI) holding chamber and a spacer is that the holding chamber incorporates which of the following?
one-way inspiratory valve
After actuating a metered-dose inhaler with a holding chamber, what should the patient be instructed to do?
Continue to breathe through the device for three breaths.
What is the average amount of dead volume in a small-volume jet nebulizer after the device runs dry?
0.5 to 3.0 ml
things that do not affect the performance of small volume jet nebulizers
potency and viscosity
You increase the fill volume from 2 to 4 ml in a small-volume jet nebulizer being used to administer a bronchodilator agent with an aerosol. What effect will this have on the amount of drug delivered?
increase
Which of the following is the effect of aerosol particles entrained into a warm and fully saturated gas stream?
increase in size
To decrease the VDS of a small-volume jet nebulizer during drug administration, what should you do?
continue treatment until nebulizer begins to sputter
A patient with an acute exacerbation of asthma is not responding to the standard dose and frequency of an aerosolized bronchodilator and is now receiving small-volume jet nebulizer (SVN) therapy every 30 minutes. Which of the following would you recommend to the patient’s physician at this time?
Consider continuous nebulization of the drug.
What is the major problem with using large-volume nebulizers for continuous aerosol drug therapy
drug reconcentration and toxicity
A physician has ordered the antiviral agent ribavirin (Virazole) to be administered by aerosol to an infant with bronchiolitis. Which of the following devices would you recommend in this situation?
small-particle aerosol generator (SPAG)
The small-particle aerosol generator (SPAG) produces a small monodisperse aerosol through which of the following?
particle evaporation in a glass drying chamber
When using a small-particle aerosol generator (SPAG) to administer ribavirin (Virazole) to an infant, which pair of flow settings is correct?
7 L/min with total flow no less than 15 L/min
Which of the following are true about a solution that is being aerosolized by an ultrasonic nebulizer?
II.
The temperature of the solution increases.
III.
The solute concentration increases.
Advantages of small-volume ultrasonic nebulizers for drug delivery include all of the following except:
decreased cost
What is the average mean mass aerodynamic diameter (MMAD) generated by the vibrating mesh nebulizers?
2 to 3 ⎧m