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Aerosolized Medications

Review of Terms

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Aerosolized Medications

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    1. Aerosolized Medications By Jim Clarke

    2. Review of Terms & Principles Stability - tendency for a drug to remain in suspension Penetration - describes how deeply aerosols reach into the lung

    3. Review of Terms & Principles Deposition - process of particles settling onto lung tissue Mass Median Diameter (MMD) - the particle size in which 50% of particles are bigger or smaller

    4. Particle Size & Lung Deposition Particles >10 - 15 microns land in mouth & nose

    5. Particle Size & Lung Deposition Particles 5 to 10 microns land in upper airways Particles 1 to 5 microns reach lower airways & alveoli These particles are called the “respirable fraction”

    6. Particle Size & Therapeutic Effect Particles > 10 microns: ideal for treatment of nasopharyngeal or oropharyngeal regions Particles 5 to 10 microns: for conditions affecting the larger more central airways

    7. Particle Size & Therapeutic Effect Particles 2 - 5 microns: for conditions affecting mid-size & smaller airways Administration of bronchodilators Particles .5 to 2 microns: for deposition in the alveolar regions

    8. Mechanisms of Deposition Inertial Impaction Gravitational Settling Diffusion Effect of Temperature & Humidity Pattern of Inhalation

    9. Aerosol Delivery Devices Metered Dose Inhaler - MDI Dry Powdered Inhaler - DPI Small Volume Nebulizer - SVN Ultrasonic Nebulizer - USN

    10. How Flowrate Used During SVN Therapy Affects Nebulization Time

    11. Effect of Flowrate on MMAD

    12. How Devices Differ In Terms of Deposition

    13. Other Ways to Administer Aerosols Via IPPB using inline small volume nebulizer present in the circuit SVN in-line with a ventilator circuit MDI’s can also be given inline with a ventilator circuit with the use of a spacer inserted into the circuit

    14. Issues to Consider When Giving “Inline” Aerosols If an artificial nose is being used in the circuit, it must be removed during the Tx A filter may need to be placed on the expiratory side of the circuit to collect exhaled mist

    15. Health of the Lung Affects Deposition of Aerosols Normal individuals have uniform and widespread aerosol deposition Smokers have deposition that tend to miss small airways Persons with COPD have poor peripheral deposition

    16. Break Time!! Ten Minutes Please!!

    17. Calculating Drug Doses

    18. Metric Review Volume Measurements Base unit is the liter 1 Deciliter = .1 liter 1 Centiliter = .01 liter 1 milliliter = .001 liter 1 microliter - .000001 liter

    19. Metric Review Weight Measurements Base unit is the gram 1 Decigram = .1 gram 1 Centigram = .01 gram 1 milligram = .001 gram 1 microgram - .000001 gram

    20. Important Equivalences 1 cc = 1 ml 1 ml = 16 drops (gtts) Therefore 4 drops = 1/4 cc 8 drops = 1/2 cc 12 drops = 3/4 cc

    21. Calculating Doses of Drugs Steps; 1. Write down what you know 2. Determine what is the unknown 3. Let the unknown equal x 4. Solve for x

    22. Example You are asked to give 50 milligrams of a drug that is available in a solution which is 7.5 mg/cc. How many cc’s would you give? Solution available = 7.5 mg/cc Desired amount to give = 50 mg 50 mg = 7.5 mg x 1 cc x = 6.7 cc

    23. Dosage According to Body Weight Drugs may be given based upon how much the patient weighs 15 mg/kg of body weight

    24. Example You are asked to give an antibiotic solution via aerosol in the following dosage schedule - 25 mg/kg of body weight. How much would you give if the patient weighed 110 lbs? First of all convert 110 lbs. to kg - 110 lbs x 1 kg = 50 kg 2.2 lbs

    25. Example Continued Multiply schedule amount times the body weight in kg. 25 mg x 50 kg = 1250 mg kg Easy!!!

    26. Calculating Doses From Percentage Strength Solutions Terms; Solute - material to be dissolved Solvent - material that dilutes (holds) the solute Strength is expressed as a percentage comparison of the solute divided by the solvent Weight to Volume (grams / ml) Solutions by solute to solvent ratio 1:100 or 1:1000

    27. Solving Percentage- Strength Problems Solution strength is based upon the following principle; 1 gram of a solute dissolved in 100 ml of solvent is a 1% solution. Therefore if 1 gram = 1000 mg then 1000 mg = 10 mg/ml 100 ml so then we can say that 1% = 10 mg/ml

    28. Common Percentage Strengths Percentage Strength mg/ml 20% 200 mg/ml 10% 100 mg/ml 5% 50 mg/ml 1% 10 mg/ml 0.5% 5 mg/ml 0.1% 1 mg/ml 0.01% 0.1 mg/ml

    29. Solving Percentage- Strength Problems in Milligrams per Milliliter To express strength as a %, divide the amount of the drug (expressed in mg/ml) by the volume of the solution it is dissolved in 50 mg is dissolved in 250 ml of normal saline therefore: 50 mg x 100 = 20% solution 250 ml

    30. Solving Percentage- Strength Problems in Milligrams per Milliliter To determine how much drug (in mg/ml) is in a % solution; Take the % strength and multiply it by 10 For example; 10% drug is actually 100mg/ml since 10 x 10 = 100 mg/ml

    31. Solving Percentage- Strength Problems in Milligrams per Milliliter To convert from a known ratio of mg/ml to a % strength - divide the ratio by 10 For example A solution contains 200 mg/ml. How is that expressed in % strength? 200 mg/ml = 20% 10

    32. Diluting Drugs To make a solution more dilute (weaker) setup the following; CiVi = CfCf where C = concentration V = volume; i = initial & f = final

    33. Dilution Continued Solve for Cf or Vf depending on what the question is asking. For example; You are asked to give a treatment with Mucomyst that is available as a 10 ml bottle of 20% solution. However the doctor wants the Mucomyst to be given as a 10% solution. How much diluent (saline) must be added to the original vial to create a 10 % solution?

    34. Dilution Example Continued Setup the problem by assigning variables Ci = 20%; Vi = 10 ml Cf = 10%; Vf = ? Solve for the unknown Vf Vf = Ci x Cf 20 x 10 = 20 ml Vi 10 Remember we still must subtract the initial volume from the final volume to arrive at the volume of saline to add; 20ml - 10 ml = 10 ml

    35. HEART Nebulizer Problems To solve these problems; 1. Determine what is the prescribed dose in mg/hr 2. Divide the prescribed dose by the available solution strength to determine how much drug to add to the nebulizer 3. Subtract the answer from #2 from the output of the unit given by the manufacturer to to determine the amount of saline to add

    36. Another Way to Solve HEART Problems Refer to the HEART nebulizer handout Note: you still need to be able to demonstrate proficiency with the method from the previous slide however! The End (Aren’t you glad!)

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