Rau’s Respiratory Care Pharmacology — Final Exam Study Guide

Rau’s Respiratory Care Pharmacology — Final Exam Study Guide

1. Principles of Drug Action

  • Pharmacokinetics:

    • Definition: Study of how the body absorbs, distributes, metabolizes, and eliminates drugs, often summarized with the acronym ADME.

    • Absorption: The process by which a drug enters the bloodstream.

    • Distribution: The dispersion or dissemination of substances throughout the fluids and tissue of the body.

    • Metabolism: The chemical alteration of a drug by the body.

    • Elimination: The removal of the drug from the body, primarily through the kidneys or liver.

  • Pharmacodynamics:

    • Definition: The study of the effects of drugs and their mechanisms of action in the body.

    • Key Concepts:

    • Drug–receptor interaction: How drugs bind and affect their receptors in the body.

    • Agonists: Drugs that activate receptors to produce a biological response.

    • Antagonists: Drugs that bind to receptors but do not activate them, blocking the action of agonists.

2. Indications of Medications

  • Acetylcysteine: Used for thick secretions and mucus plugging.

  • Albuterol / Xopenex / Brovana / Duoneb: Treats bronchospasm in asthma and COPD (Chronic Obstructive Pulmonary Disease).

  • Atropine / Atrovent: Indicated for bronchodilation and drying secretions.

  • Budesonide: Provides control of chronic inflammation in asthma.

  • Dornase Alfa: Used for mucus thinning in Cystic Fibrosis.

  • Epinephrine / Racemic Epi: Effective for stridor, croup, and upper airway swelling.

  • Hypertonic Saline: Mobilizes secretions for conditions like Cystic Fibrosis and mucus plugging.

  • Lidocaine: Suppresses cough reflex during airway procedures.

  • Pentamidine: Used for the prevention/treatment of PCP pneumonia.

  • Surfactant: Treats neonatal respiratory distress syndrome.

  • Tobramycin: Effective against Cystic Fibrosis pseudomonas infections.

3. Route of Administration

  • Inhaled:

    • Fastest delivery to the lungs with fewer systemic effects, making it preferred for respiratory therapy.

  • Oral / IV / IM:

    • Systemic action and potentially increased side effects.

  • Endotracheal:

    • Emergency route for medication administration.

4. Side Effects of Major Respiratory Medications

High-Yield Side Effects

  • Acetylcysteine:

    • May cause bronchospasm, foul odor, nausea.

  • Albuterol / Xopenex / Brovana:

    • Potential side effects include tachycardia, tremor, anxiety.

  • Atropine / Atrovent:

    • Can cause dry mouth, cough, blurred vision.

  • Budesonide:

    • Risk of oral thrush, hoarseness.

  • Dornase Alfa:

    • Possible voice changes, throat irritation.

  • Duoneb:

    • Combined side effects from β agonist and anticholinergic actions.

  • Epinephrine / Racemic Epi:

    • Side effects may include tachycardia, hypertension, anxiety.

  • Hypertonic Saline:

    • Can induce cough, irritation, bronchospasm.

  • Lidocaine:

    • High doses may lead to numbness, CNS effects.

  • Pentamidine:

    • Side effects may include cough, bronchospasm, altered blood glucose.

  • Surfactant:

    • May cause transient desaturation during administration.

  • Tobramycin:

    • Risks include hoarseness, nephrotoxicity, ototoxicity.

5. Receptors for Respiratory Drugs

  • Beta-2 Receptors: Targeted by Albuterol, Xopenex, Brovana, Epinephrine.

  • Muscarinic M3 Receptors: Targeted by Atrovent, Atropine, Duoneb.

  • Non-receptor Local Action:

    • Examples include Acetylcysteine, Dornase Alfa, Surfactant.

6. Advantages of Aerosolized vs Systemic Medications

  • Aerosolized Medications:

    • Provide lower doses, have fewer systemic effects, and ensure rapid airway action.

  • Systemic Medications:

    • Necessary when inhalation is not effective or for whole-body effects.

7. Advantages of Duoneb

  • Combines β agonist bronchodilation with anticholinergic bronchodilation.

  • Provides greater bronchodilation, especially effective in COPD exacerbations.

8. Anticholinergic vs Cholinergic / Parasympathetic vs Sympathetic Autonomic System

High-Yield Concepts

  • Parasympathetic (Cholinergic):

    • Main neurotransmitter: Acetylcholine.

    • Effect: Causes bronchoconstriction and increases mucus production.

  • Anticholinergic:

    • Mechanism: Blocks acetylcholine action, leading to bronchodilation (e.g., Atrovent, Spiriva).

  • Sympathetic (Adrenergic):

    • Neurotransmitters: Epinephrine / Norepinephrine.

    • Effect: Induces bronchodilation.

9. Bronchodilators — Cholinergic vs Anticholinergic

  • Cholinergic Stimulation: Causes bronchoconstriction.

  • Anticholinergic Drugs: Cause bronchodilation by blocking muscarinic receptors.

10. SABA vs LABA

Characteristics

  • SABA:

    • Examples: Albuterol, Levalbuterol.

    • Intended use: Rescue medications.

    • Duration of effect: Lasts 4–6 hours.

  • LABA:

    • Examples: Salmeterol, Formoterol, Brovana.

    • Intended use: Maintenance medications.

    • Duration of effect: Lasts approximately 12 hours.

11. Corticosteroids — Main Functions

  • Decrease airway inflammation and hyperresponsiveness.

  • Reduce mucus production.

  • Note: Do not provide immediate relief from symptoms.

12. Mucolytics and Pulmozyme

  • Acetylcysteine:

    • Mechanism: Breaks disulfide bonds in mucus.

  • Dornase Alfa:

    • Function: Acts as a DNA enzyme, thinning mucus in Cystic Fibrosis.

13. Racemic Epinephrine vs Albuterol

  • Racemic Epinephrine:

    • Action: Provides alpha-1 vasoconstriction for upper airway issues such as stridor or croup.

  • Albuterol:

    • Selective for β agonists targeting lower airway bronchospasm.

14. Xanthines

  • Theophylline / Caffeine:

    • Function: Serve as weak bronchodilators and phosphodiesterase (PDE) inhibitors.

    • Warning: Narrow therapeutic window with risk of toxicity.

15. Sources of Medications

  • Natural: Derived from plant, animal, or mineral sources (e.g., epinephrine).

  • Synthetic: Created in laboratories (e.g., albuterol).

  • Biological: Produced via DNA technology (e.g., Pulmozyme, Surfactant).

16. Beta-2 Agonist Dilators vs Inflammation

  • Beta-2 Agonists: Primarily treat bronchoconstriction.

  • Inflammation: Requires intervention with corticosteroids.

17. Function of Mucus

  • Protects airway, captures particles, and humidifies inspired air.

18. Diseases Related to Excess Mucus

  • Conditions include chronic bronchitis, asthma, and cystic fibrosis.

19. Endogenous vs Exogenous Drugs

  • Endogenous: Produced naturally by the body (e.g., epinephrine, cortisol).

  • Exogenous: Pharmacological agents provided from outside sources (e.g., albuterol, Pulmozyme).

20. Bronchodilation vs Bronchoconstriction

  • Bronchodilation: Promoted by β agonists and anticholinergics.

  • Bronchoconstriction: Caused by cholinergic stimulation, inflammation, and mucus accumulation.

21. Nebulizer Particle Size

  • Optimal particle size for airway deposition is between 1–5 microns.

22. Main Cells in Asthma

  • Key cells include mast cells, eosinophils, and T-lymphocytes.

23. Drug Names — Trade, Chemical, Brand

Types of Drug Names

  • Chemical Name: Scientific designation representing the drug’s composition.

  • Generic Name: The official, non-proprietary name (e.g., albuterol).

  • Brand/Trade Name: Name given by the manufacturer (e.g., Ventolin, ProAir).

24. What Medication is Used for Caffeine?

  • Caffeine, classified as a methylxanthine, is utilized in the treatment of apnea of prematurity.

    • Mechanism: Increases respiratory drive and reduces apnea frequency in neonates.

25. Primary Neurotransmitters

  • Parasympathetic Neurotransmitter: Acetylcholine.

  • Sympathetic Neurotransmitters: Epinephrine and Norepinephrine.