Ch. 1-3 Respiratory Care Pharmacology

Define Pharmacology

The study of drugs

Define orphan drugs

A drug for a rare disease

* affecting less than 200,000 people

Drugs available to the public without prescription are known as what?

Over the counter drugs (OTC)

How often should qid be administered?

4x a day

or every 6hrs

Define pharmacy

The preparation and dispensing of drugs

Define theraputics

The art of treating diseases with drugs

Which phase of the drug is made available to the body?

Administration

What is the drug’s portal entry into the body?

Route of administration

Name the routes of administration

Ointment, enteral, and inhalation

Name parenteral routes

Subcutaneous, intraperitoneal, intravenous, intradermal, and intramuscular

Define first pass

Initial metabolism in the liver of a drug taken orally before the drug reaches the systematic circulation

What is the primary site of drug excretion

Kidney

Approximately what % of inhaled aerosol reaches the lower respiratory tract with current devices?

10%-30%

The proportion of the drug available from the lung is known as

L/T ratio

Define hypersensitivity

Allergic or immune-medicated reaction to a drug

* can be serious, requiring airway maintenance or ventilatory assistance

What size aerosol particle will most likely deposit in the glottis to help with subglottic swelling?

5-10μm

What is the main use of aerosol therapy?

1. Humidify
2. Mobilize secretions
3. Deliver drugs

What particle size is for pulmonary diagnostic and therapeutic applications?

1-10μm

Define aerosol

Suspension of liquid or solid particles 0.001-100μm in diameter in a carrier gas

What % of aerosol reaches the lower respiratory tract, regardless of the type of delivery being used?

10%-15%

What is the purpose of an end-inspiratory hold when giving aerosol treatments?

Gravitational settling

What is dead volume and how much may be left over?

The amount of drug left over when the treatment is done

0\.5mL

What liter flow should you give a treatment and if it’s less than 6, what should you do?

6-9

turn it up

What is the liter flow when giving an antibiotic?

10-12

All MDIs are powered by which propellant?

HFA

Problems associated with the use of an MDI

* failure to coordinate
* most of the medicine may end up in the mouth/throat

If the patient does not have a spacer with an MDI, how far should you instruct them to hold the MDI away from their mouth?

At least 2 fingers

How long should you wait before giving another puff with an MDI?

1-5 minutes

Your patient complains that the 1st dose of her MDI has no effect on her bronchospasm, what should you tell her to do?

Disregard the 1st dose

Your patient is putting her MDI in the refrigerator, what would you do?

Tell her not to do that, because temperature will affect it. An MDI should be kept at room temperature

What is the liter flow for the use of DPI

(Patient needs to suck in fast)

30-90

How would you give a treatment to a baby?

Use a mask or reservoir

What is the most common error associated with pMDIs

Exhaling into the device when you should be inhaling

You have a college student that spends time at college and is very busy. She has been ordered albuterol-front door bronchodilator (Adrenergic, Beta-sympathomimetic) and the doctor wants to know what suggestion you should make

Change to MDI

If I say piezoelectric principle, you should think of what device?

Ultrasonic

Bronchodilation action of adrenergic drug is due to stimulation of what receptor?

Beta 2

What side effects can you have using Ventolin?

Tremors

If the patient’s heart rate goes up 20% or 20 beats, what should you do?

Stop the treatment, notify the nurse, and chart it

Combivent is a combination of what 2 drugs?

Albuterol and Atrovent

What is the most common side effect of Anticholinergic drugs?

Dry mouth

Why should you caution patients taking __anticholinergic drugs__ to avoid allowing aerosol to come in contact with their eyes?

It can cause pupil dilation and paralysis

What anticholinergic drug is the generic name for Atrovent?

Ipratropium Bromide

What anticholinergic drug is the generic name for Spirvia?

Tiotropium Bromide

Theophylline and caffine are examples of what?

Methylxanthines

Why do we give short acting B2 agonists (SABAs)?

Help relieve acute, reversible airflow obstruction

B1 stimulates what?

Heart

In what patients has continuous nebulization been seen?

Patients with severe asthma

How many mLs would you give of albuterol for an adult dose?

0\.5mL

The patient’s saturation or p-ox falls after giving a breathing treatment. What is your response?

**That it is normal because of increased perfusion to poorly ventilated areas**

* some breathing treatments can cause __paradoxical hypoxemia__

What are aerosol agents

Group of aerosol drugs for pulmonary applications that includes __adrenergic, anticholinergic, mucoactive, corticosteroid, antiasthmatic, antiinfective agents, and surfacts instilled directly into the trachea__

What is airway resistance (Raw)?

Measure of the impedance to ventilation caused by the movement of gas through the airway

What is Cystic Fibrosis (CF)?

Inherited disease of the exocrine glands, affecting the pancreas, respiratory system, and apocrine glands

* symptoms usually begin in infancy
* increased electrolytes in sweat, chronic respiratory infection, and pancreatic insufficiency

What is the generic name?

__Name assigned to a chemical__ by the United States Adopted Name (USAN) Council __when the chemical appears to have therapeutic use__ and the manufacturer wishes to market the drug

What is the offical name?

In the event that __an experimental drug becomes fully approved__ for general use and is admitted to the United States Pharmacopeia-National Formulary (USP-NF), __the generic name becomes the official name__

What is Pneumocytis Jiroveci?

Organism causing Pneumocystis pneumonia in humans, seen in immunosupressed individuals, such as those with __**HIV**__

What is Pseudomonas aeruginosa?

A gram negative organism

What is Respiratory Syncytial Virus (RSV)

Causes inflammation of the bronchioles

Define toxicology

The study of toxic substances and their pharmacologic actions, including antidotes and poison control

What is the trade name?

Brand name or proprietary name given to a drug by a particular manufacturer

What is the study of respiratory care pharmacology?

The application of pharmacology to cardiopulmonary disease and critical care

How many different names does a drug have?

5

What are the different names for a drug?

1. Chemical
2. Code
3. Offical
4. Generic
5. Trade/Brand

What is the process of drug approval like?

Lengthy, expensive, and involves multiple phases

How much does it cost to bring a new drug to the market?

About $2 billion

Certain drugs for rare diseases, which may not return the cost of their development are called what?

Orphan drugs

Acetylcysteine (orphan drug)

For acetaminophen (Tylenol) overdose

Pentamidine Isethionante (orphan drug)

Prevent Pneumocystis jiroveci pneumonia in high-risk patients

How many parts are there to a perscription?

6

1

Patient’s name and address and the date

2

Rx (take)

3

Inscription (name and quantity of drug)

4

Subscription (directions for preparing drug)

5

Signature (transcription)

6

Name of prescriber

ā

before

bid

twice daily

c̄

with

L

Liter

npo

nothing by mouth

P̄

after

po

as needed

qh

every hour

q3h

every 3 hours

q4h

every 4 hours

s̅ 

without

tid

3 times daily

What is the therapeutic purpose of Adrenergic agents?

__Reduce airway resistance (Raw__) and improve ventilatory flow rates in airway obstruction, resulting from __COPD__, asthma, CF, and acute bronchitis

Adrenergic Agents

* Albuterol
* Arformoterol
* Formoterol
* Levalbuterol
* Salmeterol
* Racemic Epinephrine

end in “ol”

What is the therapeutic purpose of corticosteroids?

Reduction and control of airway __inflammatory__ response usually associated with asthma

Corticosteroid agents

Budesonide (Pulmacort)

* end in “ide” and “ate”

Anticholinergic agents

* Ipratropium Bromide
* Tiotropium Bromide

end in “ide”

Mucoactive agents

* Acetylcysteine
* Dornase Alfa
* Saline
* Mannitol

Antiinfective agents

* Pentamidine
* Ribavirin
* Tobramycin

What is the therapeutic purpose of Prostacyclin Analogs

Treat pulmonary hypertension

What is an agonist?

A chemical or drug that binds to a receptor and __creates an effect__ on the body

What is an antagonist?

A chemical or drug that binds to a receptor but __does not create an effect__ on the body; it blocks the receptor site from accepting an agonist

Define inhalation

Taking a substance, typically in the form of gases, fumes, vapors, mists, aerosols, or dusts, into the body by breathing in

What is local effect?

Limited to the area of treatment

What is parenteral?

Administration of a substance in any way other than the intestine, most commonly an __injection__

What is systemic effect?

Pertains to the whole body, whereas the target for the drug is not local, possibly causing side effects