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The respiratory tract
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Common route for entry of
Gases, vaporsand Aerosol
particles
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Inhalational route of administration
Used for :
Administration of drugs to be absorbed into blood
stream to produce systemic effects Administration of drugs to produce localized
effects
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The lung is an excellent
route for systemic drug absorption
wide surfacearea
of alveolarsurface
Bronchoalveolar
bloodsupply
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Drugs systemically absorbed from alveoli are
usefulgases
inhalationanesthetics
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General inhalation anesthesia
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usefulgases
Oxygen
Hypoxia
Highattitude Pulmonary
edemapneumonia
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Administration at one atmosphere
Hyperbaric oxygen inhalationusually at two atmosphere
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1- Mask
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2- Tent
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3-Nasal cannula
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AEROSOLIZED MEDICATIONS
to produce localized effects
Advantages of aerosolized medications
Onset of action is rapidDirect delivery of the drug to the respiratory
system (efficacy)Systemic side effects are fewer and lesssevere than oral or parenteral therapy(safe)
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Aerosol particles deposition in
the respiratory system
Aerosol particles produced by inhalant
devices include a range of sizes The site of deposition depend on particle size
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>10 orally deposited & swallowed
1-5 m deposited in small airways (therapy)
5-10 m deposited in major airways
10 m
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Bronchial asthma
Topical application of drugs
COPD
SalbutamolTerbutalineFormoterol
Inhaledcorticosteroids
budesonidefluticasone
Inhaledipratropium
bromid
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Disposition of inhaled drugs
Mouth deposition90%
10%
Reach airwaysSwallowed drug
reach intestine and absorbed
1st pass metabolismDrug metabolite
Blood stream
Drug systemic effect + inactive metabolite
Lung pulmonary
absorption
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Aerosol devices for drug delivery
Metered dose inhalers
NebulizersDry powder inhalers
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Metered dose inhalers: MDIs
Five major components in MDI
Drug Propellant / excipient mixture
Canister
Metering valve/spray orifice
Mouthpiece /actuator
Requires ... pt cooperation
.. proper instruction and supervision by practitioner
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Components of MDIs Drug is a suspension of micronized powder or
solution
Propellant
Liquified gas under pressure
Chloroflurocarbons (CFCs)
Excipient: e.g. Oleic acid to preventaggregation of drug particles therebymaintaining suitable particle size in theaerosol plume produced
Metering valve: it contains metered dose ofdrug-propellant mixture
Canister depressed into actuator the drug-propellant mixture in metering valve is released
under pressure
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Guidelines for administering MDI
Removecap
Shake
Exhale
Hold MDISlow deep inspiration (3-
4s)
+actuating canister
Hold breath for up to 10 s
Exhale
Shake
Wait 1 min
Repeat
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Advantage and disadvantage of MDI
Advantages MDIs are portable Treatment time is short
Disadvantage They require hand /face breathing co-ordination CFCs are released into environmentpotential
for damage to protective ozone layer in the earthsatmosphere
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New MDI technology
Breath -actuated MDI ( autohaler)The metered dose is released when thepatient inhale
Use No CFCs propellantsUsehydrofluroalkanes Environment friend No cold Freon effect to cause bronchospasm or
inhibit full inspiration
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Metered dose inhalerspacer device
Extension Add-on attached to MDIs for administration
Advantage
1. Simplify coordination required for good use of MDI
2. Reduce oropharyngeal drug deposition
With inhaled corticosteroids decrease oropharyngeal deposition
1. Decrease opportunistic throat infection
2. Decrease dysphonia
3. Limit swallowed drug amount
Spacer
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MDI content
Full (sink, nozzle down) full (float, nozzle down) Empty (float on side)
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POWDER AEROSOLS
AerolizerDiscus
Turbuhaler
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Advantage of powdered aerosol
Breath-actuated: remove the need for co-ordinate inhalation and actuation of the inhaler
Count of remaining drug doses is simple No CFCs propellant gas
Disadvantages
1. A high airflow is required to disperse the powder
2. Dry powder may be irritant to airways
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Nebulizers
Devices used to administer aerosol from adrug solution kept inside a reservoir
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What is meant by the term dead volume in
an SVN?
Residual amount of drug solution left in
a nebulizer when the nebulizer is nolonger able to generate aerosol
Vary according to the brand between 0.5-1 ml
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How do you solve the problem of dead
volume
So diluent must be added to nebulizersolution
Minimum volume in SVN=3 ml
Optimum volume in SVN= 5ml
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Advantage & disadvantage of nebulizer Advantages
Ability to aerosolize drug mixture(>1 drug) Useful in very young & very old patients or patient
in acute severe asthma exacerbations who can not slow breathing & inspiratory pause is not
obtainable
Disadvantages Equipment required for use is expensive
Treatment times are lengthy (Treatment time 10
minutes ) Contamination is possible with inadequate
cleaning
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Question
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Hyperbaric oxygen inhalation means:
a. Inhalation of pure Oxygen.
b. Inhalation of Oxygen with CO2.
c. Inhalation of 50% Oxygen.
d. Inhalation of O2 at two atmospheres
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True or False:
Dry powder inhaler needs hand facebreathing coordination. F
Non chlorinated propellants are preferredthan chlorinated MDIs. T
Budesonide and fluticasone inhalation are
examples for systemic absorption fromlungs. F
General anesthesia may be applied
through inhalation T
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Fill in the spaces :
Two typical methods of Oxygen delivery
------------------, -----------------------
Two types of dry powder inhalers----------------------------, -----------------------
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Two advantages of nebulizer
---------------------------------,---------------------
Two disadvantages of dry powderinhalation
-------------------------,---------------------
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Rank the following steps for the use Of
MDIs
- Remove the dust cap, and shaking thecanister
- Inhale.- Press down opening a valve at its base
and releasing a jet of air and medicine
- Hold it in the hand by the housing