Nebulized drugs

INHALATION DRUG DELIVERY SYSTEM DESIGN—NEBULIZED DRUG DELIVERY... 

Historically, nebulized drug therapy has focused on the administration of bronchodilator therapy. These treatments were often titrated to effect thus, differences in qualitative and quantitative performance between nebulizers were not considered. The administration of aerosolized antimicrobial therapy, as well as other biotechnologic agents, requires greater precision and consistency in delivery. 

Bisgaard H. Patient-related factors in nebulized drug delivery to children. Eur Respir Rev 1997 7 376-377. 

New adaptations of existing jet nebulizer technology to produce dosimetric systems for conventional generic nebulized drug delivery— e.g., Halolite and Circulaire... 

Nebulized drug delivery is possibly the most confused area of clinical practice, largely as a result of little or no regulatory control. New nebulizer technology offers greater convenience and portability and a significant increase in aerosol dose delivery. On one hand, this new, more efficient technology offers... 

The patient may be required to receive aerosol pentamidine at home. Before discharge, the nurse checks to make sure that arrangements have been made to deliver the specialized equipment and supplies, such as a Respirgard II nebulizer and diluent, to the home. The nurse also instructs the patient and caregiver on how to administer the drug ... 

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

The mucolytic acetylcysteine may be used as part of the treatment of bronchopulmonary diseases such as emphysema It is primarily given by nebulization but also may be directiy instilled into a tracheostomy to liquefy (thin) secretions. The mucolytic drugs are effective as adjunctive therapy in chronic bronchopulmonary diseases, such as chronic emphysema, emphysema with... 

Nebulizer formulation conforms to sterile product preparation, which means that drug stability in solution in the presence of additives must be evaluated. Historically, it was sufficient to use antimicrobial agents in the formulation, notably benzalkonium chloride. Adding antimicrobials is not now considered an acceptable approach to the formulation of nebulizer solutions. The solubility of the drug is important since it may impact upon the performance of the solution in a selected nebulizer. Additives may form complexes with the drug. 

Performance of nebulizers is not measured in the same manner as pMDIs and DPIs. Since the drug solution is not supplied with the device, the time scale of compatibility is much smaller. Droplet size and distribution and dose delivery are, however, very important. 

Klyashchitsky, B. A., Owen, A. J., Nebulizer-compatible liquid formulations for aerosol pulmonary delivery of hydrophobic drugs glucocorticoids and cyclosporine,... 

In critical evaluation of the effect of a gas, vapor, or aerosol inhaled in to the respiratory tract of an animal, the dosimetric method has been recommended (Oberst, 1961). However, due to the complexity of measuring the various parameters simultaneously, only a few studies on gaseous drugs or chemicals have employed the dosimetric method (Weston and Karel, 1946 Adams et al., 1952 Leong and MacFarland, 1965 Landy et al., 1983 Stott and McKenna, 1984 Dallas et al., 1986, 1989). For studies on liquid or powdery aerosols, modified techniques such as intratracheal instillation (Brain et al., 1976) or endotracheal nebulization (Leong et al., 1988) were used to deliver an exact dose of the test material into the lower respiratory tract (LRT) while bypassing the URT and ignoring the ventilatory parameters. 

When using PFT with a neutral selector, it is quite difficult to avoid any entrance of the chiral selector into the ionization source, particularly at a high pH, where EOF is important. The use of BGE at low pH and/or coated capillary to minimize EOF is therefore mandatory. However, the coaxial sheath gas, which generally assists the ionization process, leads to an aspirating phenomenon of the chiral selector in the MS direction. Javerfalk et al. were the first to apply PFT with a neutral methyl-/i-CD for the separation of racemic bupivacaine and ropivacaine with a polyacrylamide-coated capillary and an acidic pH buffer (pH 3). Cherkaoui et al. employed another neutral CD (HP-/1-CD) with a PVA-coated capillary for the analysis of amphetamines and their derivatives. To prevent a detrimental aspiration effect, analyses were carried out without nebulization pressure. Numerous other studies presented excellent results such as the enantioselective separation of adrenoreceptor antagonist drugs using tandem mass spectrometry (MS/MS) the separation of clenbuterol enantiomers after solid-phase extraction (SPE) of plasma samples or the use of CD dual system for the simultaneous chiral determination of amphetamine, methamphetamine, dimethamphetamine, and p-hydroxymethamphetamine in urine. 

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