Inhalation nebulizers

Sympathomimetics (including inhaled/nebulized B2-adrenergic agonists), theophylline, and caffeine... 

As described in Section 3.3 in more detah, particles in the aerosol cloud should preferably have an aerodynamic diameter between 0.5 and 7.5 pm. Currently three different types of devices are used to generate aerosol clouds for inhalation nebulizers (jet or ultrasonic), (pressurized) metered dose inhalers (pMDIs) and dry powder inhalers (DPIs). The basic function of these three completely different devices is to generate a drug-containing aerosol cloud that contains the highest possible fraction of particles in the desired size range. 

Asthma Inhalation (nebulization) 20 mg 3-4 times a day. Aerosol Spray Initially, 2 sprays 4 times a day. Maintenance 2-4 sprays 3-4 times a day. 

Prevention of bronchospasm Inhalation (nebulization) 20 mg within I hr before exercise or exposure to allergens, Aerosol Spray 2 sprays within I hr before exercise or exposure to allergens... 

Carry inventory of products necessary for patients to execute a therapeutic plan (e.g., inhalers, nebulizers, glucose monitors, etc.)... 

Inhalation/nebulization is an alternative method of administration of some biopharmaceuticals, for example insulin and GM-CSF (Anderson... 

Administration errors can also occur with devices used to administer and monitor medications. Metered-dose inhalers, nebulizers, infusion pumps. 

Figure 4 Cartoon depicting technique for quantification of nebulizer output and measurement of deposition. On the left, a patient inhales nebulized particles via a Y piece. The exhalation filter captures exhaled particles. On the right, the same patient performs a similar maneuver. The inhaled mass filter captures particles that would have been inhaled. Differences between filters measure deposition. Breathing pattern can be monitored using a pneumotachograph represents the sum of minute ventilation plus nebulizer flow leaving the expiratory arm of the Y piece). (From Ref. 9.)...

Keywords Medical aerosols Metered dose inhaler Nebulizer Pharmaceutical aerosols Respiratory drug delivery... 

The types of devices for medication of the lung include metered dose inhalers, nebulizers, and powder inhalers or insufflators. It is important to... 

Higgins et aL [2] assessed the effects of three concentrations of inhaled nebulized fentanyl citrate solution given for post operative pain relief. Among the 30 studied patients, the patients inhaling a more concentrated solution of fentanyl citrate over 9 minutes showed a moderate analgesic response within 5 min of inhalation. In this study inhaled fentanyl did not prove more effective than the other parenteral formulations. Inhalation of 300 pg of fentanyl from the nebuhzer produced a peak concentration of 0.4 ng/mL at 2 min and a plateau concentration of 0.1 ng/mL at 15 min, while with inhalation of 100 pg, blood levels remained stable at 0.02 ng/mL. 

Dyspnea, which occurs in 70% of terminally ill cancer patients, may be significantly improved by inhaled nebulized fentanyl citrate, as well as the respiratory rate and oxygen satmation. 

Nebulizer solution 20 mg (1 capsule) inhaled QID Aerosol adults and children 5 years and older,... 

The patient demonstrates an understanding of the drug regimen and use of the nebulizer or aerosol inhalator. 

In cases of severe acute asthmatic attacks, bronchodilators and steroids for direct dehveiy to the lungs may be needed in large doses. This is achieved by direct inhalation via a nebulizer device this converts a liquid into a mist or fine spray. The dmg is diluted in small volumes of Water for Injections BP before loading into the reservoir of the machine. This vehicle must be sterile and preservative-fiee and is therefore prepared as a terminally sterilized unit dose in polyethylene nebules. 

A metered dose inhaler with spacer is equivalent to nebulized therapy, may have a more rapid onset, and fewer adverse effects ° 4-8 puff doses... 

Short-acting inhaled p2-agonist by nebulizer or facemask and spacer/holding chamber... 

Albuterol (also known as salbutamol outside the United States), the most commonly used inhaled short-acting 132-agonist, is a racemic mixture (50 50) of albuterol enantiomers. The R-enantiomer is the active component whereas the S-enantiomer is inactive or may be associated with unwanted effects. Levalbuterol, the pure R-enantiomer of albuterol, is available as a solution for nebulization and as an MDI dosage form. Comparative studies show similar efficacy and safety between levalbuterol and albuterol, but the acquisition cost of levalbuterol is substantially higher. 

Because all inhaled corticosteroids are equally effective if given in equipotent doses, product selection should be individualized based on the available dosage form, delivery device, and patient preference. In infants, administration may require the use of a nebulizer or spacer/holding chamber with a facemask. Caregivers should use a soft, damp cloth to wipe the face of infants receiving an inhaled corticosteroid via a facemask to prevent topical candidiasis.18... 

Ipratropium is the most commonly used anticholinergic for treating bronchoconstriction in asthma. It is available as an MDI and solution for nebulization. Ipratropium has an onset of action of approximately 30 minutes and a duration of action of 4 to 8 hours. Care should be taken not to spray the metered-dose inhaler into or allow the nebulized solution to get in the patient s eyes, as it can cause mydriasis and blurred vision. 

Assess whether or not the patient can use an MDI with a spacer or holding chamber. If the patient cannot use the device, determine whether someone can assist the patient with the inhaler device, or whether a nebulizer is necessary. 

Albuterol is the preferred bronchodilator for treatment of acute exacerbations because of its rapid onset of action. Ipratropium can be added to allow for lower doses of albuterol, thus reducing dose-dependent adverse effects such as tachycardia and tremor. Delivery can be through metered-dose inhaler (MDI) and spacer or nebulizer. The nebulizer route is preferred in patients with severe dyspnea and/or cough that would limit delivery of medication through an MDI with spacer. If response is inadequate, theophylline can be considered however, clinical evidence supporting its use is lacking. 

Airway clearance therapy is usually accompanied by bron-chodilator treatment [albuterol (also known as salbutamol outside the United States) by nebulizer or metered-dose inhaler] to stimulate mucociliary clearance and prevent bronchospasm associated with other inhaled agents. A mucolytic agent may be administered to reduce sputum viscosity and enhance clearance. 

Inhaled tobramycin (TOBI ) is typically administered to patients 6 years of age and older in alternating 28-day cycles of 300 mg nebulized twice daily, followed by a 28-day washout or off period to minimize development of resistance. Longterm intermittent administration improves pulmonary function, decreases microbial burden, and reduces the need for hospitalization for IV therapy.24,25 Due to minimal systemic absorption, pharmacokinetic monitoring is not necessary with normal renal function. Lower doses of nebulized tobramycin solution for injection have been used in younger children, and studies are underway using 300 mg twice daily in children under age 6. 

Nebulized colistin using the IV formulation may be an option in patients with tobramycin-resistant strains or intolerance to inhaled tobramycin. Due to an increased risk of bronchoconstriction after colistin inhalation, patients should pre-treat with albuterol and administer the first doses under medical observation.1,5... 

Pulomozyme (DNAse) Solution for inhalation via nebulizer Store at 2-8°C protect from light lmg/mL (2.5 mL) 0.15mg/mL CaCl2, 8.77mg/mL NaCl... 

May mix in same nebulizer with albuterol do not use as first-line therapy only add to / -agonist therapy Not recommended because dose in inhaler is low and has not been studied in acute asthma... 

These agents are effective only by inhalation and are available as metered-dose inhalers cromolyn also comes as a nebulizer solution. 

Administration via metered-dose inhaler (MDI) or dry-powder inhaler is at least as effective as nebulization therapy and is usually favored for reasons of cost and convenience. Refer to Table 80-1 in Chap. 80 for a comparison of the available agents. 

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