Inhaled Medications (disp)

meds that come in inhaled forms

steroids (lessen swelling)

beta agonists (salbutamol, opens airways)

anticholinergics (ipratropium, relax airways and secretions)

antibiotic - tobramycin (lung infections, like in cystic fibrosis)

albuterl (USA) is what in Canada

salbutamol

MDI

aka wet inhalers

aka HFAs (hydrofluoroalkanes). Used to have CFC (chlorofluorocarbon) propellants

L shaped

long slow breath

SHAKE WELL

MDI examples

salbutamol

beclomethasone

ciclesonide

cromolyn

levalbuterol

Advair

Atrovent

MDI examples to shake well

Flovent HFA

Symbicort

salbutamol

levalbuterol

DPI

dry powder inhalation

do not shake

disk or tube

NO propellant

SHORT fast inhalation

DPI examples

powder capsule:

- Arcapta

- Foradil

- Spiriva

other:

- formoterol

- Advair diskus

- Flovent diskus

- salmeterol

- budesonide

dry powder capsules label

NOT FOR ORAL USE

tell patients to keep in og packaging

can DPI be used with spacers?

no

inhalation is enough to bring drug into airways

while with MDIs, it takes BOTH device compression and inhalation

DPI storage

KEEP DRY

formoterol caps storage

fridge before dispensing

patients can store at room temp

SMI

soft mist inhaler

spring aerosolize meds

no propellant

short tube

SMI examples

- salbutamol/ipratropium

- olodaterol

aerosolize

to break apart into small particles to be suspended in air.

nebulizer (aka breathing machine / treatment)

liq to mist

good for childrenor elderly troubled with inhalers

require outlet or battery

nebulizer parts

mouthpiece/mask

air compressor

cup med is place in

tubing connects cup and compressor

nebulizer meds

salbutamol

levalbuterol

ipratropium

salbutamol + ipratropium can be mixed

for concentrated salbutamol for nebulizer (0.5% , comes in 10 mL bottles in canada) MUST BE diluted with

0.9% saline

(dispense)

some inhaled meds have to be used with a \_______ nebulizer

specific (see package insert)

how do patients use more than 1 breathing medication?

1 a scheduled controller (e.g. steroid)

1 for PRN reliever (SHORT acting beta agonist like salbutamol)

long acting beta agonists that nshould not be used on a PRN basis

formoterol

salmeterol

notify pharmacist if Rx instructs these for PRN

inhaler labels should NOT cover a

dose counter

inhaler use-by dates

in package insert

time allowed after outer wrapping is removed

use whichever is EARLIER: mfr expiry & use-by date

include aux label or mark it

float test

float inhaler in water to find out if empty

NOT reliable (can damage/clog)

if no dose counter

let patient know how many puffs per device