LECTURE 1

Question 1

• It is the suspension of liquid or solid particles in a carrier gas.

Answer 1

Aerosol

Question 2

• Delivery of the drug to the body via the airways by delivering it in an aerosolized form.

Answer 2

Aerosol Therapy

Question 3

Physical Properties
- Delivery of medications via the respiratory tract has several advantages over _______________.

Answer 3

systemic therapy

Question 4

Physical Properties
- Provides more ________ of action and similar efficacy at lower doses

Answer 4

rapid action

Question 5

-
-
-

Answer 5

Diffusion
Particle size
Inertial impaction
Gravitational sedimentation

Question 6

PARTICLE SIZES
1. Bronchodilators and drugs meant to act on the airways should have a diameter of _________.

Answer 6

2-5 um

Question 7

PARTICLE SIZES
2. Drugs intended for peripheral distribution into the lung parenchyma should have a diameter of ________.

Answer 7

1-3 um

Question 8

PARTICLE SIZES
3. Trapped in the nasopharynx and oropharynx

Answer 8

> 5 um

Question 9

PARTICLE SIZES
4. Travel to the respiratory tree but are removed during exhalation without producing any effect

Answer 9

<1 um

Question 10

• results in deposition of aerosol particles.
• the tendency of an object in motion to remain in motion along a straight trajectory

Answer 10

• Inertial impaction
• Inertia

Question 11

INERTIAL IMPACTION
- Gas carrying an aerosol is constantly changing direction at ________ in the airways
- The _____ the mass of a particle, the greater the particle’s inertia
- The _____ of the particle causes it to collide with the surface of the airway and be deposited.

Answer 11

• bifurcation
• larger
• inertia

Question 12

Factors affecting Inertia

Answer 12

• Inspiratory Flow ( higher flow increase inerti)
• Turbulent flow ( turbulent increases impaction)

Question 13

• Particles that enter deep into respiratory tract tend to lose inertia and are deposited

During this stage: the larger the particle, the greater the effect of gravity and the faster is the deposition

Answer 13

Gravitational Sedimentation

Question 14

• Play an important role in deposition of small particles ( _____) in the periphery of the lung
  Occur by direct deposition onto the mucosa or result from collision of aerosol particles causing coalescence and deposition.

Answer 14

• Diffusion
  (1-3um)

Question 15

MODES OF AEROSOL DELIVERY
- Aerosolized pharmacologic agents can be delivered to the lower respiratory tract of spontaneously breathing patients by: ____, ____, ___.

Answer 15

• Small volume nebulizers
• Metered dose inhalers with or without spacer or holding chamber
• Dry powder in haler

Question 16

• most of the delivered drug deposits in the apparatus itself, with little drug depositing in the oropharynx and about _____ of the drug lost to the atmosphere

Answer 16

Small Volume Nebulizer (20%)

Question 17

• little loss of the drug to the atmosphere, however, about ____ of the drug deposits in the oropharynx

Answer 17

Metered Dose Inhaler (80%)

Question 18

• essentially moves the ______ oropharyngeal deposition to deposition in the spacer

Answer 18

Spacer (80%)

Question 19

• It is a disposable device consisting of a _____, _______, ______ and a ______ or capillary system-

Creates the aerosol by combining gas flow and solution at a point of high gas velocity

Answer 19

Small Volume Nebulizer
baffle, gas inlet, reservoir, venturi

Question 20

SMALL VOLUME NEBULIZER performance can be affected by:

Answer 20

• construction of the nebulizer
• dead space volume
• gas flow powering the nebulizer
• drug being nebulized
• volume of solution
• duration of nebulization
• gas used to power the nebulizer
• temperature of solution

Question 21

• Refers to the volume of solution that is trapped in the reservoir that can not be nebulized
• Generally varies between ___ and ____ ml
• _____ to ____% of the drug placed in the nebulizer remains in the dead space volume

Answer 21

• Dead Space Volume
• 1 to 1.5 ml
• 25 to 30%

Question 22

DEAD SPACE VOLUME
- The total drug volume should be at least _____ml.
- The driving gas flow be ___ to ___ L/min
- The resulting total treatment time is about ___ to ___min.
-Have patient inhale slowly ( _____) at normal tidal volumes

Answer 22

• 4mL
• 6 to 8 L/min
• 8 to 12 min
• o.5 L/sec

Question 23

AEROSOL DELIVERY DURING MECHANICAL VENTILATION
Factors affecting aerosol delivery:
-
-
-
-
-
-

Answer 23

• Position of the aerosol generator in the circuit
• Humidity
• Humidification device
• Artificial Airway
• Ventilator circuit
• Ventilator settings

Question 24

• Considered the major impediment to aerosol delivery to the lower respiratory tract

Acts as the primary site of aerosol impaction removing a large portion of the aerosol particle

Answer 24

Artificial Airway

Question 25

- Includes the ____, _____, and ______--- all of which serve as areas of impaction, removing aerosol as a function of circuit length and acuity of angles

Answer 25

Ventilator Circuit - y-piece - elbow connector - corrugated tube

Question 26

- Tends to result in an increase in particle size & diminished aerosol delivery Amount of alteration in particle sizes is a function of relative humidity

Answer 26

Humidity

Question 27

- Using SVN treatment; time can affect total aerosol deposition The longer the treatment time, the greater the dose of drug that is deposited

Answer 27

Ventilator settings

Question 28

POSITION OF THE AEROSOL GENERATOR - If the device is too far from the patient : ______ - If the device is too close to the patient: _______ - When the aerosol generator is placed approximately ______ cms from the Y-piece, the circuit serves as a spacer, improving aerosol delivery

Answer 28

- aerosol may be lost because of impaction - aerosol may be lost secondary to impaction and through the expiratory side of the breathing circuit - 25 to 30 cms

Question 29

POSITION OF THE AEROSOL GENERATOR When an MDI is used, the actuator adapter : - - - - The use of the ____ in the inspiratory limb significantly improves aerosol delivery by one third

Answer 29

- may be paced-in line in the inspiratory limb of the circuit - at the elbow - directly onto the airway - spacer

Question 30

PROPER TECHNIQUE FOR USING SVN - Fill nebulizer with medication and diluent to appropriate fill volume (___ to ___mL) - Place nebulizer in the inspiratory limb of the ventilator circuit ____ to _____ cm from the patient (circuit acts as a spacer) - Establish appropriate flow for nebulizer operation (____ to ___L/min)-intermittent flow from the ventilator’s nebulization system is preferred - Adjust ventilation parameters for optimum drug delivery (  tidal volume,  respiratory frequency, lengthen inspiratory time) - If a pediatric continuous ventilator is used,  ventilator flow to maintain constant tidal volume Turn off continuous flow, if possible Remove passive humidifier or bypass heated humidifier

Answer 30

- 4-6mL - 25 -35cm - 6-8L/min - > vt, < respiratory rate - < ventilator flow