ch 36 part ii Flashcards by Christine Deihl

List some types of aerosol generators in use:

pMDIs with or without spacers or holding chambers
DPI’s
Small & large volume jet nebulizers
hand bulb atomizers (including nasal spray pumps)
Ultrasonic nebulizers

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what is the most commonly prescribed method of aerosol delivery?
A.  pMDI
B.  DPI
C.  Small volume nebulizer
D.  Atomizers

A. pMDI

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The pMDI is used to administer?
A.  Antibiotics
B.  Steroids
C.  bronchodilators
D.  anticholinergics

b, c, d

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What method of delivery is often the preferred method for delivering to patients who are intubated?
A.  DPI
B.  Nebulizer
C.  pMDI
D.  Atomizers

C. pMDI

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Drug aerosol delivery systems include all of the following except?
A.  DPI's
B.  small volume jet nebulizers
C.  Metered dose inhalers (MDIs)
D.  Spinning disk nebulizers

D Spinning disk nebulizers

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Immediately after firing, the aerosol particles produced by most metered dose inhalers are about how large?
A.  1 um
B.  5 um
C.  20 um
D.  35 um

Propellant evaporation causes the initially large particles of 35 um generated at the actuator orifice to rapidly decrease in size

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The output volume of pMDIs ranges from:
A.  10 to 50 mcl
B.  30 to 100 mcl
C.  50 to 100 mcl
D.  20 to 100 mcl

B. The output volume of pMDI’s ranges from 30 to 100 mcl. About 60% to 80% by weight consists of propellant with only 1% being active drug

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What % of the pMDI is active drug?
A.  95%
B.  10%
C.  1%
D.  50%

C. 1 %

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pMDI use dispersal agents such as surfactants for what reason?
A.  To propel the aersol
B.  To keep the drug in suspension
C.  To prevent aging
D.  To keep particles the correct size

B. To keep drug in suspension

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Each firing of a typical metered dose inhaler delivers about what output volume?
A.  10 to 30 ul
B.  30 to 100 ul
C.  10 to 30 ul
D.  30 to 100 ml

b. 30 to 100 ul

The output volume of pressurized metered dose inhalers varies from 30 to 100 ul

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Most of the spray generated by the majority of metered dose inhalers consist of which of following?
A.  Active drug
B.  Propellant
C.  Surfactant Agents
D.  Water Solution

B. Propellant

Approximately 60% to 80% by weight of this spray consists of propellant

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About what range of drug dosages can be provided with each firing of a MDI?
A.  5 to 50 mg
B.  50 to 100 mg
C.  5 to 50 ug
D.  50 ug to 5 mg

D. 50 ug to 5 mg

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Which of the following particle distributions is produced by  a typical metered dose inhaler?
A.  2 to 6 um (MMAD)
B.  1 to 3 um MMAD
C.  6 to 9 um MMAD
D.  less than 1 um MMAD

A. 2 to 6 um MMAD

Pressurized metered dose inhalers can produce particles in the respirable range 2 to 6 um of MMAD

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When fired inside the mouth, what percentage of the drug dose delivered by a simple metered dose inhaler deposits in the oropharynx?
A.  about 20 %
B.  about 40%
C.  About 60%
D.  About 80%

D. About 80%

The initial velocity and dispersion of the aerosol plume generate larger particles that decrease in size as they leave the MDI, resulting in about 80% of the dose leaving the actuator to impact & become deposited in the oropharynx

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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?
A. immediately before beginning a slow inspiration
B. immediately after beginning a slow exhalation
C. immediately after beginning a slow inspiration
D. Immediately before beginning a slow exhalation

C. Immediately after beginning a slow inspiration

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Before inspiration and actuation of a metered dose inhaler, the patient should exhale to which of the following?
A.  total lung capacity
B.  residual volume
C.  Functional residual capacity
D.  expiratory reserve volume

C. Functional residual capacity

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After inhalation of the pMDI the patient should inhale to which of the following?
A.  Full residual volume
B.  Total lung capacity
C.  Quick deep, breath
D.  Shallow breath

B. Total lung capacity

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How long should a person wait before taking a new puff from the pMDI?
A.  5 min
B.  15 seconds
C.  30 seconds
D.  1 minute

D. 1 minute

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To ensure delivery of the proper drug dosage with a metered dose inhaler, which of the following must be done before its use?
A. The canister valve stem should be cleaned with a pin
B. The canister should be warmed to hand or body temperature
C. The canister should be vigorously shaken

B & C

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Which of the following groups of patients are most likely to have difficulty using a simple metered dose inhaler for aerosol drug therapy?
A.  patients in acute distress
B.  Infants &amp; young children
C.  elderly persons
D.  All of the above

D. all of the above

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Which of the following agents has been associated with increased intraocular pressure?
A.  Anticholinergics
B.  epinephrine
C.  2 agonists
D.  antibiotics

A. Anticholinergic agents

this could be dangerous for patients with glaucoma

To decrease the likelihood of an opportunistic yeast or fungi infection associated with MDI inhaler steroids, what would you recommend that a patient do?
A. Cut in half the number of puffs or treatments
B. use a spacer or holding chamber
c. Rinse mouth after each treatment

B & C

What is the potential limitation of flow triggered metered dose inhaler devices?
A.  increased pharyngeal impaction
B.  Less effective lung deposition
C.  High flows necessary for actuation
D.  Requires accessory equipment

C. High flows necessary for actuation

Patients experiencing an acute exacerbation of bronchospasm may not be able to generate sufficient flows to trigger the autohaler

For which of the following patients would you recommend against using a flow triggered metered dose inhaler as the sole bronchodilator delivery system?
A. Patient likely to develop acute severe bronchospasm
B. stable elderly patient on maintenance bronchodilator therapy
c. teenage asthmatic who refuses to use a holding chamber
D. A patient who cannot coordinate MDI firing with inhalation

A. Patient likely to develop acute severe bronchospasm

What is a benefit of using the open mouth technique with a pMDI device with no spacer or canister? A. Improves lung deposition by decreasing oropharyngeal impaction B Provides a space for particles to deecelarate while evaporating allowing the particle size to reduce to respirable size C. With a low inspiratory rate it can double the dose delivered to lower respiratory tract from approximately 7 to 14 to 20% D. All of the above

D. All of the above

What are the two primary limitations of MDI: A. High infection rates B. Difficulties with hand breath coordination C. high oropharyngeal deposition D. Loss of too much medicine

B & C

``` Accessory devices that are used to eliminate the problems of pDMIS include: a. breath actuated pMDIs B. Spacers C. Chambers D. All of the above ```

D. all of the above

``` A simple tube spacer may reduce oral deposition by? A. 50% B. 90% C. 99% D. 95% ```

B. 90% A simple tube spacer may reduce oral deposition by 90% whereas a valved holding chamber can reduce oral deposition by as much as 99%

Which of the following are beneficial effects of using a holding chamber with a mdi? A. reduction in oropharyngeal aerosol deposition B. decreased need for hand-breath coordination C. elimination of medication waste

A. reduction in orpharyngeal aerosol deposition | B. decreased need for hand breath coordination

``` The key difference between a metered dose inhaler MDI holding chamber and a spacer is that the holding chamber incorporates which of the following A. larger enclosed space B. one way inspiratory valve C. heated chamber D. series of baffles ```

B. one way inspiratory valve a spacer is a simple valveless extension device that adds distance between the pMDI outlet and the patients mouth

What happens when you have a valve between the pMDI and the chamber and the mouthepiece to particles? A. it reduces the size of the particles inhaled B. It increases the size of the particles inhaled C. It eliminates waste of particles D. It increases the particle deposition in the oropharyngeal areas

A. it reduces the size of particles inhaled The placement of a valve between the pMDI and the chamber and the mouthpiece works like a baffle reducing the size of particles inhaled.

After actuating a nmetered dose inhaler with a holding chamber, what should the patient be instructed to do? A. take a large breath and hold it for 5 seconds B. Continue to breathe through the device for three breaths C. Immediately exhale as fast and as much as possible D. Take on quick breath and remove the holding chamber

B. Continue to breathe through the device for three breaths

Which of the following devices would you select to deliver an aerosolized bronchodilator to a young child? A. Metered dose inhaler (MDI) and spacer B. MDI, holding chamber, and mask C. MDI and holding chamber D. dry power inhaler

B. Holding chambers with masks are available for use in the care of infants, children, and adults

Advantages of dry power inhalers (DPI) drug delivery systems include all of the following except? A. low relative cost B. no propellants required C. no hand breath coordination necessary D. unaffected by humidity

D. DPIs are relatively inexpensive, do not need propellants, and do not require the hand-breath coordination needed for pressurized metered dose inhalers

``` What causes many children & some adults to stop inhaling from there pMDI? A. Full lung capacity B. bad taste C. cold Freon effect D. coughing reaction ```

C. Cold Freon effect

``` In a valved holding chamber where does the exhaled gas go? A. Stored in the chamber B. Mixed with the aerosol C. Re inhaled D. Vented to the atmosphere ```

D. Vented to the atmosphere; Valved holding chambers allow those who cannot control their breathing patterns to be treated with pMDIs

``` This is a simple valveless extension device used with pMDI to add distance. A. Spacer B. Chamber C. Baffle D. reservoir ```

A. Spacer

``` Contains one or more valves that prevent aerosol in the chamber from being cleared on exhalation? A. Reservoir B. Baffle C. Spacer D. Chamber ```

D. Chamber

``` What enhancement to the pMDI allows for less oropharyngeal deposition, higher respirable drug doses, and better protection form poor hand breath coordinations? A. Simple spacers B. Chambers C. Reservoirs D. Baffles ```

B. Chambers

What is a serious drawback of pMDI use with CFCs? A. Lack of counter to indicate the number of doses remaining B. priming C. Temperature D. all of the above

D. all of the above

``` What type of pMDI is more environmentally friendly? A. CFCs B. HFAs C HFCs D. CFHs ```

B HFAs hydrofluoralkane

``` How many patients & healthcare professionals do not perform the technique of administering pMDI correctly? A. 50% B. 2/3 C. 1/3 D. 3/4 ```

b. 2/3 of patients and health care professionals who should teach pMDI use do not perform the procedure properly

``` With this device the patient creates the aerosol by drawing air through a dose of finely milled drug powders with sufficient force to disperse ;& suspend the powder in the air? A. MDI B. DPI C. GSD D. CFC ```

B DPI, dry powder inhalers

Dispersion of the powder into respirable particles depends on what factors: A. hand-breath coordination B. propellant C. Creation of turbulent flow D. ability of the patient to create a high inspiratory flow rate

C & D

Proper use of dry powder inhalers require the patient to be able to do which of the following? A. generate inspiratory flows of 60 L/min or higher B. exhale forcibly through the device before drug delivery C. inhale slowly (less than .5 L/sec) and perform breath hold D. coordinate firing of the DPI with inspiration

A. generate high inspiratory flow of 60 L/min or higher

``` Which of the following devices depends on the patients inspiratory effort to dispense the dose? A. small volume jet nebulizers B. metered dose inhalers C. dry powder inhaler D. ultrasonic nebulizer ```

C. dry powder inhaler

``` Which of the following would be correct instructions for a patient being taught proper use of DPI? A. place mouthpiece 4 cm from mouth B. exhale slowly to FRC C. Inhale slowly (less than 30 l/min) D. Repeat until dose is used up ```

B & D

``` What particle size do you see with the DPI? A. 1 to 3 um B. 5 to 10 um C. less than 1 D. 2 to 4 um ```

A. 1 to 3 um

``` DPIs should not be used in which condition? A. Asthma B. COPD C. Management of acute bronchospasm D. Patients with airway obstructions ```

C & D

For which of the following patient groups is the use of DPI for bronchodilator administration not recommended? A. infants and children younger than 5 B. patients with an acute bronchospastic episode C. patients requiring maintenance therapy

A & B

``` Exhalation into which device can cause loss of drug delivery? A. Small volume jet nebulizers B. Metered dose inhaler C. dry powder inhaler D. ultrasonic nebulizer ```

C. DPI | exhalation into the dry powder inhaler before inspiration can result in loss of drug delivery to the lung