Overview of Therapeutic Modalities in Pulmonary Medicine

Question 1

Therapeutic modalities include:

Answer 1

Systemic therapy
Inhalational therapy
Oxygen Therapy
respiratory Physical Therapy

Question 2

Pharmacologic Therapy

Answer 2

Antibiotics
Bronchodilators
Anti-Inflammatory
Oxygen

Question 3

Non Pharmacologic Therapy

Answer 3

behavior Therapy - Stop Smoking
Occupational therapy
Physical theapy

Question 4

Routes of Therapies

Answer 4

Oral
parenteral
Inhalational

Question 5

Systemic side effects

Answer 5

Beta-2-agonists (Cardiovascular, Metabolic)

Methylxanthines (Aminophylline, Theophylline)

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

Question 6

Drug that has oral dosage only

Answer 6

Leukotriene receptor agonists

Question 7

Localized/direct deposition of drugs to the airway

Answer 7

Inhalational therapy

Question 8

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

Answer 8

Aerosols

Question 9

Commonly used methods of inhalational therapy

Answer 9

Nebulization
Metered Dose Inhalers
Dry powder inhalaers

Question 10

Increasing cross sectional area results in decrease in ______

Answer 10

Air flow velocity

Question 11

Larger particles deposit in??

Answer 11

Larger airways,

Question 12

Smaller particles deposit in???

Answer 12

Smaller airways

Question 13

Beta 2 agonists exert their greatest effect on??

Answer 13

Airway smooth muscles

Question 14

Optimal particle size for beta 2 agonists:

Answer 14

3 microns

Question 15

Ideal region for bronchodilators to serve maximal effect

Answer 15

Bronchi and bronchioles

Question 16

Too small particle size (<1 micron)

Answer 16

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

Question 17

1-5 microns (OPTIMUM PARTICLE SIZE)

Answer 17

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

Question 18

Too large (>5 microns)

Answer 18

Deposition in posterior oropharynx and swallowed

Question 19

inertial impaction

Answer 19

Momemtum

At bifurcations in RT

Question 20

gravitational Sedimentation

Answer 20

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

Question 21

Stoke’s Law

Answer 21

Particles settling under gravity will attain constant terminal setting velocity

Question 22

NEbulizer

Answer 22

“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

Question 23

Pressured Metered Dose Inhaler

Answer 23

Use chemical propellants to deliver medication dose to lungs

Most widely used

Metered: Specific/controlled amount to be aerosolized/released

Question 24

Optimal conditions for inhaling MDI

Answer 24

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

Question 25

Alternative for CFC

Answer 25

Hydrofluoroalkanes

Question 26

advantage of MDI

Answer 26

Deliver a reliable/ consistent dose of medications directly yo the site of action Onset of action is quicker Side effects fewer Pirtable

Question 27

Disadvantage of MDI

Answer 27

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

Question 28

Spacer

Answer 28

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)

Question 29

Aerochamber

Answer 29

Small, regular, large, plus

Question 30

Azmacort

Answer 30

Built in spacer with device

Question 31

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

Answer 31

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

Question 32

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

Answer 32

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

Question 33

Soft Mist Inhaler

Answer 33

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

Question 34

The most effective device is the one____

Answer 34

which the patient will use

Question 35

5D's to consider

Answer 35

``` Demographics Device Doctor Drug Disease ```

Question 36

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

Answer 36

Fraction of inspired oxygen

Question 37

factors that increase FiO2

Answer 37

Increase oxygen flow | Increase size of reservoir

Question 38

Factors that decrease FiO2

Answer 38

Decreased RR | Decreased TV

Question 39

Arterial Blood Gas

Answer 39

``` pH = 7.35-7.45 pO2 = 80-100 mmHg ``` pCO2= 35-45 mmHg HCO3= 22-26 mmol/L

Question 40

Oxygen saturation of 95% --> pO2

Answer 40

80

Question 41

Oxygen Concentration

Answer 41

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

Question 42

HOW MUCH FLOW?

Answer 42

16 bpm = 0.5 TV 1 20bpm = 8 TV 16(;i) 25bpm = 12.5 TV 25(li) 35bpm = 17.5 TV 35 (li)

Question 43

Low face mask

Answer 43

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

Question 44

Face Mask with Reservoir

Answer 44

Partial Rebreathing (has holes -can be compensated by room air) Non-rebreathing (has valves-increases concentration of oxygen by preventing dilution from exhaled air)

Question 45

Venturi Mask

Answer 45

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

Question 46

Respiratory Physical Therapy

Answer 46

Muscles strength building exercises

Question 47

Measure effectiveness of deep breath is by use of

Answer 47

incentive spirometers flutter device

Question 48

Breathing Exercises

Answer 48

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

Question 49

Postural Drainage

Answer 49

instruct the patient to assume different position

Question 50

MObilization of airway secretions

Answer 50

Chest clapping Vibration Ultrasound