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Transcript of aerosols
.the force responsible is the vapour pressure of propellant
In case of liquefied gas there is equilibrium between liquid phase and its vapour and thus the vapour pressure is constant for each actuation.when propellant is lost through actuation ,more vapour is formed within the container and equilibrium is re-established
2-surface coating aerosols : produce afilm on the surface treated …(relatively larger particles 50-200 micrometer)…..e.g. topical aerosol Q6.what are possible routes of administration of aerosols ?
.anti infective mouth preparation….e.g. BBC®
.dispersion of solid or liquid in gas
.it depend on the power of liquefied or compressed gas (propellant) to expel the contents from the container
.pressure pack or pressurized package
.application :household application and medicinal application Aerosil :
Afumed silic product
Pure silicon dioxide
.Improves the flow properties of powders
.gives thickening effect by dispersing to liquid
.free flow agent:food .biological weapons
.food rheology controller (coating)
.others:film.fiber.ceramics Aerosol OT:
Powerful anionic wetting agent or surfactant
Brand name : DOCUSATE® + DSS®
laxative to treat constipation:minalax®
removing ear wax In case of comprssed gas there is adrop in pressure during use becaue the concentrate is expelled ,the headspace increases and thus the gas expands and there is adecrease in pressure after each actuation
So compressed gas propellant must have high expansion volume i.e 1ml compressed gas gives 200 ml vapour Q3.I found at home different types of aerosols :insecticides ,shaving foam ,topical aerosols…..the final expelled product differs , why ?
.types of aerosols :
1-space aerosols :dispersion of particles or droplets which remain in air for prolonged periods (particles <50 micrometer in size )… e.g.
3-foams : expansion of propellant within an emulsion results in production of small bubbles……..e.g. shaving foams
Q5.I heard that some aerosols harm the ozone layer. HOW ? and how can this problem bs solved ?what type of propellant is used in medicinal aerosols ?
1.CFHC (chloro flouro carbon) is dangerous and can deplet ozone layer
2.we can use HFA (hydroflouroalkane) which is ozone friendly but of lower vapour pressure…e.g.EVOHALER
Skin ulcer and burns
. for bone metabolism (systemic)…..MIACALCIC®
. for rhinitis(local)….RHINOCORT®…..FLIXONASE®
Vaginal and rectal :
.Vaginal in the form of foam,coating aspermicide (contraceptive)
.rectal…e.g. cortifoam®.. containing hydrocortisone (ulcerative colitis)
B2 stimulant : non selective (epinephrine and isoprenaline ) and they are replaced by selective
.short acting(SABA): salbutamol ® in ventoline and vental ®
.There are different types of ventolin ?
Salbutamol works by acting on receptors in the lungs called beta 2 receptors. When salbutamol stimulates these receptors it causes the muscles in the airways to relax. This allows the airways to open.
In conditions where there is narrowing of the airways, such as asthma or COPD it is difficult for air to get in and out of the lungs. By opening the airways, salbutamol makes it easier to breathe.
Salbutamol is most commonly taken using an inhaler device. Inhaling the medicine allows it to act directly in the lungs where it is needed most. It also reduces the potential for side effects occurring in other parts of the body, as the amount absorbed into the blood through the lungs is lower than if it is taken by mouth.
Salbutamol when used as an inhaler is known as a reliever.
Salbutamol is sometimes prescribed to be taken by mouth for people who cannot use inhalers very well. It must be taken regularly in this way to help keep the airways open all the time.
Nebuliser or respirator solutions of salbutamol are used to treat acute asthma attacks in hospital.. It is used to deliver higher doses of the medicine than a standard inhaler.
Long acting (LABA):
Formeterol fumarate in FORADIL®
Beclomethasone in BECOTIDE®
Mast cell stabilizers:
Sodium cromoglycate in INTAL ®
Budesonide and formeterol in SYMBICORT®
Q7.MY physician prescribed corticosteroid inhalation..why didn’t he prescribe tablets ?
.medication taken orally have amuch higher systemic concentrartion than the inhaled ones
.so less side effects
.idea of inhaler is that full dose is delivered to lungs , where it is immediately absorbed by lung tissues and affect locally
.excess drug may be delivered to blood but it will be little
.however one advantage of the tablet is in prolonged released form
.e.g. short acting medication like albuterol, the inhaled version taken every 6 hours but extended released tablet such as volmax® needs to be taken once every 12 hours.
Q8. Iam using corticosteriods inhalation and i got oral trush.what can i do to avoid this side effect on furthur use?(another trade name) patients need to rinse thier mouth after using the inhaler
there is substitute with mdi without cfc propellant. e.g.evohaler. which is an mdi containing hfa as apropellant.
Q9. my friend told me that tribiotic.cortifoam.miacalcic are all aerosol products; is this true?(mention medicinal application) this is true.
cortifoam: containing hydrocortisone for ulcerative colitis.
miacalcic: for bone metabolism.
Q10. I am using acertain type of aerosol (tribiotic).it is not functioning although it is not empty.what happened?what do ihave to do to make it working?
tribiotic is suspension aerosol and the disadvantages of suspension aerosol are :
so pressurized system must be shaken before use even if it is in solution form to ensure uniform distribution of the drug.
Q11. I bought atype of aerosol, but it's expelling force decreases and so does it's effectiveness.why? do you have other types which are better? the force responsible is the vapour pressure of the propellant
in this case,the type of aerosol is of compressed gas and there is drop in pressure during use because the concentrate is expelled,the head space increases and thus the gas expands and there is adecrease in pressure after each actuation.so compressed gas propellant must have high expansion volume.
Q12. why some aerosols must be used inverted and the others up-right?
if it contain adip-tube which reaches into the liquid phase,then it is used up-right.
if it doesn't contain adip-tube,then it's used inverted.
Q13. what are the parts and components of mdi? to which class of aerosol does it belong? mdi consist of micronized drug dissolved in liquefied propellant as well as dpi, it belong to pressurized aerosols. (14)I am an asthmatic patient how can I use MDI?
(15) How can I test the degree of fullness of my MDI to be able to judge when I have to buy a new one?
(1) Knowing how many puffs are already present in the canister prior to use then keeping track of how many puffs you have used. (2) Float test (3) Using the "DOSER" (It fits on top of any MDI, With its self-contained microcomputer, it keeps track of how many doses you've dispensed from the inhaler ,the number of inhalations remaining in the inhaler and displays the number of inhalations taken in the current day. The DOSER also stores the number of inhalations taken in each of the last 30 days in its memory and alerts the user when the MDI is nearly empty).
16)My child is using MDI but he is still young to synchronize his inhalation with actuation, what can I do?
1)Using "BREATH ACTUATED INHALERS“ (AUTOHALER) which releases the drug automatically when the child inhales
(2) Using "SPACER" (which is tube attached to the inhaler that act as a reservoir or holding chamber).that hold the medication that is sprayed by the inhaler. This makes it more easier to use and reduce the need for synchronization between the start of inhalation and actuation of the device.
17)I got bronchoconstriction after using MDI what is your advice?
oIn very rare cases It is suspected that the propellant used in the MDI may cause irritation to bronchi of some asthmatic patients which will lead to bronchoConstriction After using MDI.
o So I advice this patient to use dry powder inhalers (DPI) instead of (MDI).
oFor examble :
oVentoline inhaler , vental inhaler contains salbutamol
oCan be changed with ventolin discus contain salbutamol
oClenil comp , vental comp contains betamethasone + salbutamol
oCan be changed with symbicort contain budesonide + formetrol
Propellant •it produce pressure , and this the medication is expelled when the valve is opened
•It could be used as solvent for the drugs
•HC :flammable , immiscible with water
•CFHC (non flammable , but can deplete ozone layer).
•HFA : ozone friendly ,but of lower vapor pressure
• ex: evohaler
•2-Compressed gases: N2O , CO2 , N2
(18) I was advised to use powder aerosols instead of MDI do you support this and why?
Problems with MDI
1.80% of the drug is deposited in oropharynx.
So upon using corticosteroids:
Oral candidacies (thrush) occurs.
Patient counseling points:
Advise to rinse mouth after inhaler use
i.e. coordination between actuation and inspiration).
This leads to deposition of the powder in the throat and suboptimal dosing.
3.Cold Freon effect.
How to solve the problem ??
For environmental hazards:
MDI without CFC propellant.
e.g. Evohaler® that contains HFA.
For poor synchronization:
1.Breath actuated inhalers (Autohaler®).
Dry powder inhalers (non-pressurized) •They are breath actuated (no need for co-ordination)
•. Dose = drug + inert powder (lactose)
3.The flow of powder is controlled by the patient own inspiratory effect.
They may deliver more drug than pressurized aerosol used incorrectly.
After all of this my advice to the patient is to use
Dry powder inhaler instead of metered dose inhaler
(19)particle size is a critical quality control parameter in case of powder aerosols why? •Because the particle size must be sufficiently small to reach the deep regions of lung .
•But due to this large surface area dry powder tends to aggregate and this will affect flow and may deliver more drug than needed by mistake.
•Incorporation of a mesh or propeller driven by air to break up any aggregates.
A Turbuhaler is a multidose device provide the drug in powder form, it contains no diluent or lubricant but contains drying agent.
The dosing unit consists of a disc with agroup of conical holes and dose counter which when turns red indicates that there are only 20 doses remain.
Symbicort is a medicine that is used for COPD Obstructive and Asthma and is marketed by AstraZeneca.
Contains two medicines : budesonide and formoterol.
How to use ? Step 1: Open the Turbuhaler.
Step 2: Get the medicine ready.
Step 3: Take the medicine.
How to clean your Turbuhaler ?
•Wipe off the mouthpiece with a dry tissue after use.
•Never use any liquid to clean the Turbuhaler.
Other examples : SPINHALER Spinhaler is a single dose device in which drug is supplied in hard capsuls.
The Spinhaler is a two-piece device: a mouthpiece, and abody that contains tiny fan.
Intal It contains the active ingredient sodium cromoglycate (cromolyn sodium ) to reduce inflammation and prevent asthma including exercise-related asthma
How to use the Intal Spinhaler : 1. Hold the Spinhaler upright with the mouthpiece pointing downwards; then unscrew the body.
2. Firmly push an Intal Spincap (coloured end downwards) into the cup of the propeller and then screw the body tightly back onto the mouthpiece.
3. Still holding the Spinhaler upright, slide the outer sleeve down as far as it will go and then back up again.
ROTAHALER The Rotahaler is a single-dose device used with rotacaps.
It consists of two parts the mouthpiece and the rota chamber which contains tin
Ex. Ventolin rotahaler. How to use : DISKUS a dry-powder inhaler that holds 60 doses. SERETIDE DISKUS The active substances are 50 micrograms salmeterol (as salmeterol xinafoate) and 100, 250 or 500 micrograms fluticasone propionate . used for COPD Obstructive and Asthma.
How to use ?
NEBULIZER The nebulizers are devices that vaporize the inhalant solution into afine mist to make easy inspired.
It consists of 4 main parts :
2.a plastic tube (vinyl).
4.a mouthpiece or a mask.
HOW TO USE ? No,we can’t use water for dilution because water will cause ahypotonic solution that make bronchospasm due to vagal reflex, if dilution is required we can use a sterile normal saline. Some drugs may worsen asthma such as : 1.aspirin.
2.anti-inflammatory painkillers such as ibuprofen (eg Nurofen®), diclofenac, etc,
3.betablockers such as propranolol, atenolol, or timolol.
4.some food additives like sulfites and monosodium glutamate.
Anti histaminic play imporatant role in astma : Treat the allergies and inflammation that are rised from elevated histamine levels in airways that trigger attacks in those suffering from atopic asthma attacks.
Ex. hydroxyzine (Atarax, Vistaril) and its breakdown product cetirizine (Zyrtec).
Steroids and other anti-inflammatory drugs work by reducing inflammation, swelling, and mucus production in the airways of a person with asthma.
In long term use what will those do ?
1.Inhaled steroids : may cause oral thrush and hoarsenss.
2.Systemic corticosteroides : may cause money face, weight gain , acne and stomach disturbances.
3. mast cell stabilizers : may cause cough , wheezing and nasal irritation.
4. leukotriene modifiers: may cause headache, stomachache, nausea or vomiting, and nasal congestion.
In the short-term, the drugs have an immediate effect.
But some studies have shown long-term daily use can make the drugs less effective,because of releasing of (plc-beta) in smooth muscles of the lungs which makes the airways highly sensitive to asthma triggers.