have been identified as propellants that are nontoxic to the atmosphere and to the patient and that have properties suitable for MDI aerosol generation
HFA stands for
CFC stands for?
pMDIs can be divided into two categories:
conventional pMDIs and Breath-actuated pMDIs
the conventional pMDI has what kind of design?
A type of device to simplify MDI use is
a breath-actuated adapter
inhalers offer an alternative for individuals who find it difficult to coordinate pMDI actuation with inhalation
Research on the drug content of sprays of albuterol by pMDI has shown that various factors affect
refers to the loss of drug content in the valve even though propellant may seem to discharge a normal dose.
Lose of dose
The MDI should be ______ before the first actuation after standing, so that the metering valve refills with adequately mixed suspension from the canister
Whsy shour the MDU be shaken?
There can be a seperation of suspensions when left standing.
A pause of ________ minutes has been advocated between each puff of a bronchodilator from an MDI, in an attempt to improve distribution of the inhaled drug in the lung
refers to the loss of propellant from the metering valve of the MDI
Lose of prime
Data indicate that dose delivery from CFC-propelled MDIs of albuterol decreases at lower temperatures. A significant decrease of 65% to 70% of the usual dose has been observed at
Aerosol drug delivery with a pMDI is dependent on
Nozle size, sleanliness, and lack of moisture
The two primary techniques for using a pMDI without a spacer are:
The open mouth tech. and the closed mouth tech.
allows for slowing of the particle velocity and evaporation of aerosol droplets, resulting in less oropharyngeal impaction and loss
Spraying a few cm infront of the open mouth
Characteristics of the patient using the pMDI leads to a variability of
The most common error noted is the failure to coordinate
inhaltion w/ actuation
devices were introduced primarily to simplify the complex coordination of aiming, actuation, and breathing with a pMDI
Extentions or reservoirs
is similar to a pMDI except that the drug is in powdered form
requires a high inspiratory flow rate from the patient to dispense the drug. The flow rate needed is usually 30 to 90 L/min
DPIs can be divided into three categories based on the design of their dose containers:
unit-dose DPIs, multiple unit-dose DPIs, and multiple-dose DPIs
These DPIs have individually wrapped capsules that contain a single dose of medication and deliver powder medication from a punctured capsule
Unit-dose or single-dose
What is the lung depostition for MDI (CFC)?
What is the lung depostition for MDI (HFA)?
What is the lung depostition for MDI and Spacer (CFC)?
What is the lung depostition for SVN?
What is the lung depostition for DPI?
The loss with an SVN is primarily in the delivery apparatus (66%), with most of that remaining in
MDI loses about _____ in the actuator.
What is the dose of albuterol in MDI form?
2 puffs or 0.2 mg
what is the dose of albuterol in SCN?
0.5cc or 2.5mg
The ratio of MDI to SVN dose is approximately
1 tsp =
15 mL or 3 tsp
how many drops in 5mL?
1 cup =
what are the two types of drug dose calulations that are generally made?
Those involving fluids, tabs., or caps, and thos involving sols. or a %.
contains a solute, which is dissolved in a solvent, giving a homogeneous mixture
The strength of a solution is expressed as the percentage of solute relative to
total solvent and solute
means parts of the active ingredient (solute) in a preparation contained in 100 parts of the total preparation (solute and solvent).
Nerve impulses are conducted by electrical and chemical means; the chemical portion of nerve transmission is referred to as a
The neurotransmitter is __________ at the myoneural (neuromuscular) junction, at ganglia, and at parasympathetic end sites
The neurotransmitter at sympathetic end sites is generally __________ except at sweat glands and the adrenal medulla, where acetylcholine is the neurotransmitter
control is essential to life and is considered a more discrete, finely regulated system than sympathetic control. effects control the day-to-day bodily functions of digestion, bladder and rectal discharge, and basal secretion of bronchial mucus
verstimulation of the parasympathetic branch would render the body incapable of violent action, resulting in what is termed the SLUD syndrome:
Salvation, lacrimation, urination, and defecation
effects are widespread, mediated by norepinephrine at nerve endings and by circulating epinephrine released from the adrenal medulla.
reacts as a general alarm system and does not exercise discrete controls. This is sometimes characterized as a �fight-or-flight� system
A nerve impulse signal is carried along a nerve fiber by
electrical action potentials
At gaps in the nerve fiber between neurons (synapses), the electrical transmission is replaced by a
the chemical transmission of the electrical impulse, which occurs at the ganglionic synapses and at the end of the nerve fiber, termed the
The neurotransmitter conducting the nerve impulse at skeletal muscle sites is Ach, and this site is referred to as the
neuromuscular junction or myoneural junction
In the parasympathetic branch, the neurotransmitter is also Ach at both the ganglionic synapse and the terminal nerve site, referred to as the
The neurotransmitter acetylcholine is terminated by the enzyme
neurotransmitter reuptake into the presynaptic neuron (uptake-1) and by the enzymes catechol O-methyltransferase (COMT) and monoamine oxidase (MAO) terminate what?
norepinephrine and sympathetic transmission
The autonomic system is generally considered an
nerves run alongside the sympathetic and parasympathetic efferent fibers and carry impulses from the periphery to the cord
These terms are used for acetylcholine and norepinephrine/epinephrine receptors in the two autonomic branches.
cholinergic (cholinoceptor) and adrenergic (adrenoceptor)
Indirect-acting cholinergic agonists inhibit the
stimulates autonomic muscarinic receptors in the iris sphincter and ciliary muscle of the eye to produce pupillary constriction (miosis) and lens thickening
useful in increasing muscle strength in a neuromuscular disease such as myasthenia gravis, in which the cholinergic receptor is blocked by autoantibodies
Neostigmine and edrophonium
is used in the Tensilon test to determine whether muscle weakness is caused by overdosing with an indirect-acting cholinergic agent (causing ultimate receptor fatigue and blockade) or undertreatment with insufficient drug.
undesirable muscarinic effects can be blocked by pretreatment with a parasympatholytic or antimuscarinic drug such as
are used as insecticides, and occasionally patients are seen with toxic exposure and absorption
they have also been used as �nerve gas.� Because they affect Ach, they have an effect on neuromuscular function and muscarinic receptors; there is initial stimulation, then blockade if a high enough dosage is absorbed. Muscle weakness and paralysis can result.
parathion and malathion and the drug echothiophate
can be used in the treatment of organophosphate toxicity in the first 24 hours
pralidoxime chloride or cholinesterase reactivator
block Ach receptors and act as cholinergic antagonists
is usually considered the prototype parasympatholytic, and there is renewed interest in the use of aerosolized analogues
Atropine occurs naturally as the levo isomer in Atropa belladonna, the nightshade plant, and in Datura stramonium, or jimsonweed. The drug is referred to as a
Sympathetic effects on the cardiopulmonary system include
increased heart rate/contractile force, increased blood pressure, bronchodilation, and probable increased secretion from mucous glands in the airway
In the sympathetic branch of the autonomic nervous system, the usual neurotransmitter at the terminal nerve sites is
In the presynaptic neuron, _______ is converted to dopa and then to dopamine, which is converted by dopamine �-hydroxylase to norepinephrine, in the storage vesicles.
The primary method of terminating the action of norepinephrine at the postsynaptic membrane is through a reuptake process, back into the presynaptic neuron. This is termed
Part of terminating norepinephrine. The neurotransmitter action can be ended by two other mechanisms as well: uptake into tissue sites around the nerve terminal, a process termed
norepinephrine can stimulate autoreceptors on the presynaptic neuron, which inhibits further neurotransmitter release. These autoreceptors have been identified as
alpha 2 - receptors
It is a mediated transport system, It is a low-affinity but high-capacity system, It is not as stereochemically specific, it is specific to catecholamines.
The order of affinity for uptake -2 is:
Chemicals structurally related to epinephrine are termed
Two enzymes are available that can inactivate catecholamines such as epinephrine:
catechol O-methyltransferase (COMT) and monoamine oxidase (MAO)
The action of both enzymes on epinephrine (Figure 5-6) is important because COMT is responsible for ending the action of
The effects of adrenergic receptors are mediated by coupling with
These are identified as G protein- linked recptors.