Week 2 Ch 40 Aerosols

Question 1

What is an aerosol?

Answer 1

A suspension of solid or liquid particles in gas

Question 2

What devices generate medical aerosols?

Answer 2

Atomizers, Nebulizers or inhalers

Question 3

How do atomizers work?

Answer 3

They turn liquid into droplets

Question 4

How do nebulizers differ from atomizers?

Answer 4

They create finer particles

Question 5

What three factors affect particle size in aerosols?

Answer 5

Substance being nebulized.
Method used to generate aerosol
Environmental conditions

Question 6

Name two methods to measure medical aerosol particle distribution

Answer 6

Cascade Impaction
Laser Diffraction

Question 7

What does MMAD stand for

Answer 7

Mass Median Aerodynamic Diameter

Question 8

What does VMD stand for?

Answer 8

Volume median diameter

Question 9

What is deposition?

Answer 9

The amount of medicine that reaches the lungs

Question 10

What is emitted dose?

Answer 10

Only a fraction of emitted aerosol that will be inhaled

Question 11

What is respirable dose?

Answer 11

Only a fraction of inhaled is deposited in the lungs

Question 12

What is inhaled mass?

Answer 12

Amount of drug inhaled

Question 13

What is respirable mass?

Answer 13

Portion of inhaled mass that can reach the lower airways

Question 14

List the factors influencing deposition

Answer 14

Inspiratory Flow Rate
Flow Pattern
RR
Inhaled Volume
I:E ratio
Breath holding

Question 15

What is inertial impaction?

Answer 15

When suspended particles in motion collide with and are deposited on a surface

Question 16

What happens to smaller particles during inhalation?

Answer 16

They are carried around corners of the airway by the airstream

Question 17

What is sedimentation in aerosol therapy?

Answer 17

Particles settle out of suspension due to gravity

Question 18

What increases sedimentation?

Answer 18

Breath holding after inhalation

Question 19

What is the particle size for upper airways?

Answer 19

5-50 micrometers

Question 20

What is the particle size for the lower airways?

Answer 20

2-5 micrometers

Question 21

What is the particle size for alveolar region?

Answer 21

1-3 micrometers

Question 22

What is the particle size for deep lung tissue?

Answer 22

under .1 micrometers

Question 23

List the hazards associated with aerosol drug therapy

Answer 23

Adverse reaction, infection, airway reactivity and eye irritation

Question 24

What is the most used method for aerosol delivery?

Answer 24

Pressurized Meter Dose Inhalers (pMDI)

Question 25

What are pMDI's used to deliver?

Answer 25

Bronochodilators, anticholinergics, and steroids

Question 26

When is pMDI the preferred method?

Answer 26

For patients that can breathe spontaneously and follow instructions

Question 27

What does a pMDI consist of?

Answer 27

A pressurized canister containing drug in volatile propellant combined with surfactant and dispersing agent

Question 28

What is a major downside of pMDIs

Answer 28

They lack the ability to indicate remaining doses

Question 29

What are the steps for proper pMDI use

Answer 29

Warm by hand, Prime, assemble, uncap, choose open/closed mouth technique, exhale normally. actuate while inhaling slowly, inhale to total lung capacity, hold breath for 10 seconds, wait 1 minute between puffs, disassemble and recap

Question 30

What % of medication from a pMDI is deposited in the oropharynx?

Answer 30

80%

Question 31

What is the actual pulmonary deposition from pMDIs?

Answer 31

10-20%

Question 32

What are the primary limitations of pMDIs

Answer 32

Hand-breathe coordination and high oropharyngeal deposition

Question 33

What can help fix pMDI limitations

Answer 33

Spacers and valve holding chambers

Question 34

What is a DPI?

Answer 34

Dry powder inhaler with breath actuated dosing system

Question 35

How is the dose delivered in a DPI

Answer 35

PT must inhale forcefully to create the dose

Question 36

What are the advantages of DPI

Answer 36

Inexpensive, no hand-breathe coordination needed, and no propellants

Question 37

What is the optimal technique for DPI usage

Answer 37

Assemble, load dose, exhale to FRC, seal lips. inhale deeply and forcefully, try a breath hold, repeat if needed, monitor for reactions and benefits

Question 38

What do nebulizers do?

Answer 38

Generate aerosols from solutions or suspensions

Question 39

What are the three main types of nebulizers?

Answer 39

Pneumatic Jet, Ultrasonic and vibrating mesh

Question 40

What are the two categories of nebulizers by reservoir size?

Answer 40

SVN (5-20 mL) LVN (up to 200 mL)

Question 41

What factors affect nebulizer performance?

Answer 41

Design, gas source, drug type, treatment time and residual volume

Question 42

What are the four types of SVN?

Answer 42

Continuous Nebulizer with simple reservoir Cont. Neb. with collection reservoir bag Breath enhanced nebulizer Breath actuated nebulizer

Question 43

What are the steps for using a SVN?

Answer 43

Assess patient need, select delivery device. place drug in nebulizer cup, set gas flow to 6-10 LPM, coach patient to breathe slowly through mouth, continue until nebulizer sputters, rinse with sterile water and air dry, monitor for adverse response. assess outcomes

Question 44

When are LVNs used?

Answer 44

When traditional dosing is ineffective in managing severe bronchospasm

Question 45

How large is the reservoir in LVNs?

Answer 45

Greater than 200 mL

Question 46

What affects LVN output and particle size?

Answer 46

Pressure and flow

Question 47

What must be monitored during CBT? (Continuous bronchodilator therapy)

Answer 47

Signs of drug toxicity like tachycardia and tremors

Question 48

How do Vibrating Mesh Nebulizers work

Answer 48

Electrical energy applied to a vibrating plate generates aerosol

Question 49

What is the residual volume range for vibrating mesh nebulizers?

Answer 49

0.1-0.4 mL

Question 50

How do vibrating mesh nebulizers compare to others in medication waste?

Answer 50

They waste less medication

Question 51

What is the downside of VMN

Answer 51

expensive

Question 52

What is important when selecting the best aerosol drug delivery system?

Answer 52

Knowing the limitations and strengths of each device to optimize patient treatment.

Question 53

How much medication may actually deposit in the lungs depending on device and patient?

Answer 53

10% or less

Question 54

What situations may reduce drug deposition further?

Answer 54

Mechanical ventilation, severe airway obstruction, poor patient compliance

Question 55

What are the factors associated with reduced aerosol drug deposition in the lungs?

Answer 55

Mechanical ventilation, artificial airways, reduced airway caliber (infants and children). severe airway obstruction, high gas flow, low minute volumes, poor patient compliance or technique, limitation of specific delivery device

Question 56

What is the standard method for determining bronchodilator response?

Answer 56

Conventional spirometry

Question 57

What other methods are used to assess patient response to aerosol therapy?

Answer 57

Patient interviewing and observation, vitals, auscultation, ABG analysis and oximetry

Question 58

What does peak flow measurement help with?

Answer 58

It provides trends if the same device is used from one treatment to the next

Question 59

What is CBT and what is it used for?

Answer 59

Continuous Bronchodilator Therapy. Used for refractory bronchospasm and severe asthma in adults and pediatric patients

Question 60

What are the typical albuterol doses used in CBT?

Answer 60

5-20 mg/hr

Question 61

How often is the patient assessed during CBT?

Answer 61

Every 30 minutes for the first two hours; then hourly

Question 62

What indicates a positive response to CBT?

Answer 62

Increase in PEFR of atleast 10% after the first hour and 50% at the end of therapy

Question 63

What devices are used for aerosol administration during ventilator support?

Answer 63

SVN, Ultrasonic Nebulizer, VM, and pMDI with third party adapter integrated into the vent circuit

Question 64

How is bronchodilator response assessed in ventilated patients?

Answer 64

By measuring changes in peak and plateau pressures, drop in peak pressure, decreased automatic PEEP levels, and breath to breath variations

Question 65

How can environmental contamination from nebulized drugs occur?

Answer 65

From the nebulizer itself or during patient exhalation

Question 66

What drugs have been associated with health risks to caregivers due to aerosol exposure?

Answer 66

Pentamidine and Ribavirin

Question 67

Which nebulizers produce the most secondhand aerosol?

Answer 67

Continuous pneumatic nebulizers

Question 68

What methods help control environmental contamination?

Answer 68

One way valves, filters, negative pressure rooms, treatment rooms and PPE

Question 69

Which disease poses the highest risk of airborne transmission?

Answer 69

TB, chickenpox and covid etc