Respiratory Care Pharmacology Exam #1 Study Guide

Chapter 1, 2, 3, 5

List the five different names each drug has.

1. Chemical Name

2. Code Name

3. Generic Name (same)

4. Official (same)

5. Trade

Identify the most commonly used source of drug information used in the United States.

United States Pharmacopeia - national formulary (UNP-NF)

• (updated via FDA)

Define an orphan drug.

pharmaceutical agent that is developed to treat certain rare medical conditions. (<200,000 persons).

List all six parts necessary for a prescription.

1. PT name/address/date

2. Rx

3. Inscription

4. Subscription

5. Signature

6. Name of prescriber

Describe what each of the parts of a prescription are.

1. PT name/address/date: pt info

2. Rx: recipe

3. Inscription: Medication prescribed (strength + amount)

4. Subscription: instructions to pharmacist

5. Signature: instructions for PT

6. Name of prescriber: Physician

Discuss the advantages of giving respiratory drugs aerosolized over the oral/systemic method.

 Smaller dose

 Fewer side effects

 Rapid onset

 Targets respiratory system

 No first pass effect

List the 3 phases of drug action.

1. - Phase 1- Drug Administration

   - Phase 2- Pharmacokinetic Phase

   - Phase 3- Pharmacodynamic Phase

• Define the drug administration phase of drug action.

The method by which a drug dose is made available to the body

• Define the five routes of administration for drugs.

- Enteral- Digestive tract, small intestines, systemic effect (body wide)

- Parenteral- Injected, ”beside the intestine”

(intravenous (IV), intramuscular (IM), subcutaneous (SC), intrathecal (IT),

and intraosseous (IO))

- Transdermal- absorbed through skin,

systemic effect, Long term, continuous delivery

- Inhalation- absorbed through the lungs, systemic/local effect

Medical gases (systemic)

Aerosolized medications (local)

- Topical- directly through skin or mucous membranes

Localized effect

Skin creams for rashes

• Explain the four phases of pharmacokinetics.

• 4 Phases of Pharmacokinetics

  • Absorption - drug into the blood stream

  • Distribution - bloodstream to the site of action.

  • Metabolism - Breakdown of the drug.

  • Elimination - Removal of the drug or the waste product of the

  drug

Remember which organ mainly metabolizes drugs and which organ is mainly responsible for excretion

Liver = Metabolized

Kidneys = Eliminate

• Define the first-pass effect

Drug metabolised before its allowed to do what it wants to do

• List routes of administration that bypass the first-pass effect.

- Injection - Buccal - Transdermal - Rectal - Inhalation

(anything besides entral)

• Explain what the plasma half-life of a drug is.

A measure of how quickly the original drug dose becomes half of what is was originally.

• propofol

• Define pharmacodynamics.

drug affect on the body

• Explain the difference between a drug that is an agonist and an antagonist.

- Agonist- Stimulates receptor

- Antagonist- Blocks receptor

• Define tolerance

Decreasing intensity of response to a drug overtime

• List aerosol therapy uses in Respiratory Care.

- 1. Humidification

- 2. Improve mobilization / clearance

- 3. Delivery of aerosolized drugs to the respiratory tract

• Define the terms penetration and deposition.

- Penetration- how far can the drug get into the lung

- Deposition- how particles deposit out of suspension to remain in the lung

• Define mass median diameter (MMAD).

percentage of my total output of particles are the “correct” size.

• List the area of deposition for the different particle sizes.

- Nose- 10 particles

- Mouth- 15 particles

- Central airways - 5-10 particles

- Lower respiratory tract- 2-5 particles

- Terminal Airway - 0.8-3 particles

• Define inertial impaction, gravitational settling, and diffusion of aerosol particles.

• Inertial Impaction → Larger, heavier particles, crash into the airway walls and stick.

• Gravitational Settling → Medium-sized particles settle out of the air and drop onto airway surfaces because of gravity

• Diffusion (Brownian Motion) → tiny particles move randomly/bounce around until they hit and stick to the airway walls

• Recall which method of aerosol administration is the most effective

- pMDI/VHC Nonelectrostatic, most effective because more medicine gets to lungs

- DPI least affective

• List the three types of nebulizers.

• jett

• fibratin mesh

• ultra sonic

• Describe in general terms how a jet nebulizer works.

Gas mixes with liquid suspension/med to suspend particle in air. If particle too big it hits the baffle and iit falls back into cup. If correct size it gets iinhaled.

• List the appropriate liter flow range for a jet nebulizer.

6-8 liters per minute

• Explain factors that affect jet nebulizer function.

- Fill Volume- increasing the volume increases the time of effective nebulization at any

given flow rate

- Flow Rate- increasing the flow rate decreases the particle size and shifts the MMAD

lower

- Type of Gas- use of gases other than oxygen or air can change the performance of a

neb

- Device Interface- Mouthpieces offer greater lung deposition than facemasks\

- Type of Solution- Mucomyst vs. Albuterol

List the five parts of an MDI.

- Canister

- Propellant

- Drug formulary

- Metering valve

- Actuator and dose counter

• Compare CFC and HFA propellants used in MDIs.

- CFC- The FDA has banned the use of this propellent due to ozone layer

- HFA- Hydrofluoroalkane- Change resulted in higher lung deposition and better functioning of devices

• List the three types of MDIs

- Conventional pMDIs

- Breath-Actuated pMDIs

- Respimat Soft Mist Inhaler

• Explain how the three types of MDIs work.

- Conventional pMDIs- When the cannister is pushed into the actuator, the drugpropellent mixture is released under pressure.

- Breath-Actuated pMDIs- Activated when the patient breathes in, releasing the

medication.

- Respimat Soft-Mist Inhaler- Turning the base one-half turn to the right draws a

predetermined volume of solution into the micropump, the dose is released as tension

is released from the spring

• Explain factors affecting how MDIs work.

- Loss of dose

- Shaking the canister

- Actuation timing

- Loss of prime

- Storage temp

- Nozzle size and cleanliness

- Breathing technique

- Patient characteristics

• Compare and contrast the different accessory devices available for use with MDIs.

valve holding chamber , nonelectrostatic charge, spacer

• List the necessary inspiratory flow range needed for a patient to use a DPI.

30-90 liters per minute

• Describe the three different types of DPIs.

- Unit-dose DPI

- Multiple Unit-Dose DPI

- Multiple-dose DPI

• Discuss factors affecting DPI performance.

Inspiratory flow

humidity

Clinical efficacy

• List factors respiratory therapists should consider when recommending an aerosol device for patients

- devices for desired drug available

- Cognitive

- least expensive

- convenient for the patient or family

-Provider preference

• Given a clinical scenario, choose an appropriate device (HHN, MDI, or DPI) for a pt

HHN:  useful in acute/severe cases or poor coordination.

MDI:  most common, need coordination → spacer helps.

DPI: require strong inspiratory flow (not for kids or weak patients).

List the two organ systems that control the body.

- The Nervous system

- The endocrine system

• Explain how the nervous system is broken down

- Divided into 2 parts, the central and peripheral nervous system

CNS : brain and spinal cord

PNS : sensory neurons, somatic neurons

ANS : parasympathetic branch and the sympathetic branch

• Contrast the parasympathetic and sympathetic nervous systems.

- Parasympathetic Nervous System

• Rest and digest

• Considered a more discrete, finely regulated system

• Responsible for day-to-day body functions (digestion, bladder and rectal discharge, and bronchial mucus secretion)

- Sympathetic Nervous System -

• Fight or flight

• Heart rate and blood pressure increases

• Blood flow shifts from periphery to the muscles and heart

• Blood sugar increases

• Bronchi dilate

• Not essential for life

o -mimetic IS

Mimics

o -lytic IS

Cancels out

Agonist IS

Stimulates

Antagonist IS

blocks

Parasympathomimetic IS

Mimics parasympathetic

Parasympatholytic IS

Cancels out

Sympathomimetic IS

Mimics sympathetic system

Sympatholytic IS

Cancels out sympathetic

Cholinergic IS

related to acetylcholine

o Muscarinic IS

acetylcholine receptor

o Anticholinergic IS

blocks the action of acetylcholine

• Describe the effects of the parasympathetic and sympathetic nervous system on the body.

Parasympathetic

- Cardiopulmonary system- decreases in heart rate, blood pressure, and respiratory rate

- Eye- miosis- constriction of the pupil

- GI tract- increased motility

- Insulin secretion - increased

Sympathetic

- Sympathetic effects on the cardiopulmonary system- Increase in HR, BP, and RR, bronchodilation

- Eye- Mydriasis

- GI tract- decreased motility

- Insulin secretion- decreased

• Define what a direct and indirect cholinergic drug is.

- Direct- mimic acetylcholine, methacholine- used as a diagnostic tool for asthma

- Indirect- inhibit cholinesterase enzyme, neostigmine- myasthenia gravis, reversal of

nondepolarizing muscle relaxant

• Describe what an anticholinergic drug does.

- Blocks acetylcholine receptors

• List some effects of an anticholinergic drug on the body.

- Bronchodilation

- Preoperative drying of secretions

• Define the three types of sympathetic receptors

A1- vasoconstriction

- B1- increase in rate and force of cardiac contraction

- B2- relax bronchial smooth muscle and vascular beds of skeletal muscles

• Describe the location of the three types of sympathetic receptors.

- A1- blood vessels

- B2- trachea to terminal bronchioles

-B1 - heart and kidneys

• Describe the effect of the three types of sympathetic receptors on the body when stimulated

A1 vasoconstriction

B1

B2 bronchodilation + mucus clearance.