Respiratory Care Pharmacology: Introduction

• Chapter 1 is an introduction to respiratory care pharmacology

Pharmacology and Drugs

• Drugs are any chemicals altering the organism's functions or processes.
• Pharmacology studies drugs, their origins, properties, and interactions with living organisms
• Respiratory Care Pharmacology applies pharmacology to cardiopulmonary disease and critical care.
• Pharmacy involves preparation and dispensing of drugs.
• Pharmacognosy identifies sources of drugs.
• Pharmacogenetics studies the interrelationship of genetic differences and effects
• Therapeutics focuses on treating disease with drugs.
• Toxicology studies toxic substances and their pharmacologic action.

Drug Naming Conventions

• Chemical name
• Code name
• Generic name
• Official name
• Trade (Brand) name

Drug Sources

• Animals provide thyroid hormone, insulin, and pancreatic dornase.
• Plants provide khellin, atropine, digitalis, reserpine, eucalyptus oil, pine oil, and anise.
• Minerals provide copper sulfate, magnesium sulfate, and mineral oil.

Drug Approval Process in the United States

• Chemical isolation and identification occurs.
• Animal studies are conducted.
• An Investigational New Drug approval is given.
• Phase I.
• Phase II.
• Phase III.
• A New Drug Application is submitted.
• The Food and Drug Administration has a new drug classification system.
• Orphan drugs are available.

Prescriptions

• Parts of a prescription include:
• Patient name, address, and date
• Rx symbol
• Inscription
• Subscription
• Sig (instructions)
• Name of the prescriber
• Over-the-counter drugs do not require prescriptions.
• Generic substitution in prescriptions involves any manufacturer's version of the prescribed drug, not a specific brand, and is generally less expensive.

Common Prescription Abbreviations

• q means every
• qh means every hour
• qid menas four times daily
• qod means every other day
• qd means every day
• q2h means every 2 hours
• q3h means every 3 hours
• q4h means every 4 hours
• po means per os (by mouth)
• prn means as needed.
• IM means intramuscular.
• IV means intravenous.
• tid means three times daily.

Respiratory Care Pharmacology Overview

• Involves aerosolized agents given by inhalation.
• Offers five advantages.
• Related drug groups include:
• Anti-infective agents
• Neuromuscular blocking agents
• Central nervous system agents
• Antiarrhythmic agents
• Antihypertensive and antianginal agents
• Anticoagulant and thrombolytic agents
• Diuretics

Advantages of Aerosolized Agents Given by Inhalation

• Aerosol doses are smaller than systemic doses for the same purpose.
• Side effects are usually fewer and less severe compared to oral or parenteral delivery.
• The onset of action is rapid.
• Drug delivery is targeted to the respiratory system, reducing systemic bioavailability.
• Inhalation of aerosol drugs is painless, relatively safe, and often convenient, depending on the device.

Adrenergic Agents

• Beta-Adrenergic agents cause relaxation of bronchial smooth muscle and bronchodilation.
• This reduces airway resistance and improves ventilatory flow rates in airway obstruction from COPD, asthma, cystic fibrosis, and acute bronchitis.
• Examples: Albuterol, Arformoterol, Formoterol, Levalbuterol, Salmeterol.
• Alpha-Adrenergic agents cause topical vasoconstriction and decongestion.
• Used to treat upper airway swelling.
• Example: Racemic Epinephrine

Anticholinergic Agents

• Relaxation of cholinergically induced bronchoconstriction.
• Improves ventilatory flow rates in COPD and asthma.
• Examples: Glycopyrrolate bromide, Ipratropium Bromide, Tiotropium Bromide

Mucoactive Agents

• Modify the properties of respiratory tract mucus.
• Current agents reduce viscosity and promote clearance of secretions.
• Examples: Acetylcysteine, Dornase Alfa, Mannitol, Hyperosmolar Saline

Antiasthmatic Agents

• They prevent onset/development of the asthmatic response.
• Achieved through inhabitation of chemical mediators of inflammation.
  • Examples: Cromolyn Sodium, Montelukast, Omalizumab.

Anti-infective Agents

• These inhibit or eradicate specific infective agents.
  • Pneumocystic Jiroveci Carinii (PCP) is treated with Pentamidine.
  • RSV is treated with Ribavirin.
  • Pseudomonas Aeruginosa In CF or Influenza A and B is treated with TOBI.

Exogenous Surfactants

• Usage is by direct intratracheal instillation.
• Restores more normal lung compliance in RDS of newborns.
• Examples: Beractant, Calfactant, Poractant Alfa, Lucinactant

Prostacyclin Analogs

• Clinically indicated for pulmonary hypertension to decrease shortness of breath.
• Also, to increase walking distance.
• Examples: Iloprost, Treprostinil

Introduction to respiratory care pharmacology including study of drugs, their origins, properties, and interactions with living organisms. Overview of drug naming conventions and drug sources. Respiratory Care Pharmacology applies pharmacology to cardiopulmonary disease and critical care.