Rau Reading

Guideline in Reading

You are responsible for the lecture material and all reading material.

Please study accordingly QUIZ 1 on pharmacology will cover Ch. 1-3,

5-7 in the reading QUIZ 2 on pharmacology will include

lecture and reading 8-14 Pharmacology exam will cover all

respiratory pharm

Reminder

5 Quizzes 100 points (20 each) 4 Exams 400 points (100 each) 1 Presentations 40 points 4 Homeworks 20 points (5 each) 1 final exam 200 points I WILL DROP 1-2 QUIZZES Total: 760 points

Grades

Skip: Page 6 animal studies and investigational

drug approval, new drug application

Chapter 1. Basic Concepts

Know/Read: ◦ Key terms page 2◦ Naming drugs page 4◦ Orphan drugs (definition) page 6◦ Prescription (what constitutes a proper

prescription) page 6-7◦ Over the counter drugs (definition) page 7◦ Pharmacology overview page 8-10

Chapter 1.

Skip: Volume distribution pg 16 Plasma time curves and half life page 18-19 Lung Availability/total systemic availability

ratio page 21 Potency versus maximal effect page 27 Therapeutic index page 27

Chapter 2: Principles of Drug Action

Read/Know (all material not skipped) In particular:

◦ Key terms◦ Drug administration phase

Including routes of administration; enteral, parenteral, transdermal, topical, inhalation

◦ The pharmacokinetic phase Definition, absorption (factors affecting it),

distribution (may skip volume distribution) Metabolism (biotransformation, first pass effect) Elimination (plasma clearance)

Ch. 2

Read/Know (all material not skipped) In particular:

◦ Pharmacokinetics of inhaled aerosol drugs page (Local vs systemic effect, aerosols in pulmonary disease; skip lung availabilty)

◦ The pharmacodynamic phase Drug receptors, receptor activation, ion channels, G-

protiens, agonists/antagonists, drug interactions, drug responsiveness

Ch. 2

Read/Know (all material not skipped) In particular:

◦ Pharmacogenetics

Ch. 2

Skip: ◦ Measurement of particle size distributions◦ Lung Deposition and loss patterns with traditional

aerosol devices

Chapter 3 Administration of Aerosolized Agents

Read/Know:◦ Key terms◦ Physical principles of inhaled aerosol drugs◦ Aerosol particle size distributions MMAD in

particular◦ Particle size and lung disposition

Particle size and therapeutic effect page Mechanisms of deposition (inertial impaction,

gravitational settling, diffusion) Effect of temperature and humidity

Chapter 3

Read/Know:◦ Aerosol devices for drug delivery

Ultrasonic SPAG SVN

Dead volume, filling volume/treatment time, effect of flow rate, type of power gas, type of solution

Metered dose inhalers Technical description, correct use of MDI, factors affecting

inhaler performance, breath actuated inhalers, HFA MDI inhaler reservoir devices Electrostatic charge

Chapter 3

Read/Know:◦ Dry powder inhalers page 54-55◦ Clinical Application of aerosol delivery page 55-56◦ Administration by IPPB, face mask and

endotracheal tube page 60

Chapter 3

Skip:◦ NOTHING ALL GOOD MATERIAL

Chapter 5 The Central and Peripheral Nervous System

Know/Review:◦ Key terms pg 81◦ The nervous system pg 81-85

Neurotransmitters, parasympathetic and sympathetic regulation, efferent/afferent nerve fibers

◦ Parasympathetic branch page 85-87 Muscarinic and nicotinic receptors

Chapter 5 The Central and Peripheral Nervous System

Know/Review:◦ Cholinergic agents page 87-88

Direct and indirect acting◦ Anticholingergic agents page 89

Atropine, parasympatholytic effects◦ Sympathetic Branch page 90-94

Adrenergic neurtotransmitter function, enzyme inactivation, receptor types, TABLE 5-5, Beta receptors, alpha receptors; you can skip dopaminergic receptors

Chapter 5 The Central and Peripheral Nervous System

Know/Review:◦ Sympathomimetic adrenergic and sympatholytic

antiadrenergic agents (page 94) Table 5-6◦ Neural control of lung function

Airway smooth muscle, lung blood vessels, mucus glands

◦ Parasympathetic innervation (muscarinic receptors; M1-3)

◦ May skip Non adrenergic inhibitory nerves page 99-101

Chapter 5 The Central and Peripheral Nervous System

Skip:◦ Any chemical structure/line graphs◦ Keyhole theory page 107◦ Resorcinol agents page 109◦ Bitolterol page 110-111◦ Oral and parenteral routes page 121-122◦ Skip page 126-127

Chapter 6: Adrenergic Bronchodilators

Know/read:◦ Key terms page 104◦ Clinical indications page 104-115

Short acting, long acting, racemic epi indication◦ Specific adrenergic agents

Catecholamines, stereoisomers (basic concept), TABLE 6-1, Saligen agents, Pirbuterol, Levalbuterol

Long Acting bronchodilators; salmeterol, formoterol, arformeterol, antiinflammatory effects, clinical use

Chapter 6

Know/read:◦ MODE of ACTION page 116-120

Beta receptor and alpha receptor activation, alpha 1 activation, Salmertol, formoterol and arfometerol mode of action pg 119-120

◦ Routes of administration page 120-121 Continuous nebulization, inhalation route

◦ Adverse side effects page 122-126 Tremor, cardiac, tolerance, loss of bronchoprotection,

CNS effects MAY SKIP THE REST

Chapter 6

Skip:◦ Clinical pharmacology page 135-136◦ Vagally mediated reflex bronchoconstriction page

139-140

Chapter 7 Anticholinergics

Know/read:◦ Key terms page 133◦ Clinical indication page 133◦ Specific agents page 133-135◦ TABLE 7-1◦ Pharmacological effects of anticholinergics page

137 Tertiary ammonium compounds, quaternary

compounds

Ch. 7

Know/read:◦ Mode of action page 138-143

Muscarinic receptor subtypes TABLE 7-4◦ Adverse effects page 142-143

BOX 7-1◦ Clinical Application page 143-146

COPD Asthma Combination Respiratory care assessment page 147

Ch. 7

Skip: ◦ All chemical structures◦ Structure activity relations page 153◦ Antagonism of Adenosine page 154◦ Titrating theophylline doses page 155-156◦ Factors affecting theophylline activity page 157

Chapter 8. Xanthines

Know/Read:◦ Key Terms page 151◦ Clinical indications page 151-152

Asthma, COPD, apnea of prematurity◦ Specific Xanthine agents page 152◦ General properties page 152-153◦ Inhibition of Phosphodiesterase page 153◦ Theophylline side effects page 156-157◦ Clinical uses page 158-159

Asthma, COPD, muscle strength, central ventilatory drive, cardiovascular, antiinflammatory, apnea of prematurity

Ch. 8

Skip: ◦ Table 9-2◦ Source of airway secretions (you know this

already) page 164◦ Nature of mucus secretion/structure and

composition of mucus page 168-171 (NOT ALL OF IT SEE NEXT SLIDE)

◦ Physical properties of mucus page 172-174◦ F-actin depolymerizing drugs page 177-178◦ Expectorants EXCEPT ONES LISTED IN FOLLOWING

SLIDE page 178

Chapter 9. Mucus Controlling Drugs

Skip: ◦ Mucokinetic agents (review bronchodilator effect

on cilia but skip the rest) page 179◦ Mucoregulator medications page 179◦ Other mucoactive agents page 180◦ Gene therapy page 180-181◦ Review page 181-183 but we have already gone

over in class◦ Future agents page 183-184

Chapter 9. Mucus Controlling Drugs

Know/read:◦ Key terms page 163◦ Clinical indication page 164◦ Factors affecting mucocilliary transport page 168◦ Food intake and mucus production page 168◦ Nature of mucus secretion page 168-172

Mucus composition, mucus in disease states (chronic bronchitis, asthma, bronchorrhea, plastic bronchitis, cystic fibrosis)

Ch. 9

Know/read:◦ Mucoactive agents page 174◦ TABLE 9-4 pahe 174◦ Mucolytics and mucocilliary clearence page 175◦ N-Acetylcysteine page 175-176◦ Dornase alfa page 176-177◦ Expectorants page 178

Sodium Bicarbonate, Guaifenesin

◦ RT assessment of mucoactive drug page 184

Ch. 9

Skip: ◦ Lipids and Proteins page 195-196◦ Future directions of surfactant page 200-201◦ RT assessment page 201 (you will learn this with

neonates)◦ Any specific detail on the administration of

surfactant beyond endotracheal delivery

Chapter 10. Surfactant Agents

Know/Read:◦ Key terms page 192◦ Perspective page 192◦ Application to the lung page 192◦ Clinical indications for exogenous surfactant page

192-193◦ Composition of pulmonary surfactant page 193◦ TABLE 10-1 you don’t need to know the

formulations

Ch. 10

Know/Read:◦ Production of Surfactant page 196◦ Types of surfactant page 196-197◦ Specific types page 198

Survanta, Infasurf, Curosurf (don’t worry about the details for administration)

◦ Mode of Action page 199-200◦ Hazards page 200

Ch. 10

Skip:◦ TABLE 11-2◦ Any chemical structure◦ Any nasal steroids◦ BOX 11-2◦ Topical steroids ◦ Table 11-3

Chapter 11. Corticoid Steroids

Know/Read:◦ Key terms page 205◦ Clinical indications page 205◦ Physiology of corticoid steroids page 205-209◦ TABLE 11-1 (skip azmacort and Aerobid)◦ Page 208 review◦ Diurnal cycle page 209◦ Nature of inflammation page 209-212◦ Aerosolized agents page 212-214; Skip Azmacort and

Aerobid◦ KNOW DOSES ONLY FOR: QVAR, ADVAIR, FLOVENT,

PULMICORT, SYMBICORT= ADULT DOSES

Ch. 11

Know/read:◦ Mode of action page 215

Effect on WBC’s, beta receptors Hazards and side effects page 217-219

◦ Both aerosolized and systemic◦ Topical side effect with aerosol administration

Clinical Application page 220◦ Asthma, COPD

Ch. 11

Skip:◦ BOX 12-2◦ Chemical structures◦ Cell sources of leukotrienes and biochemical

pathways page 236-238◦ Leukotriene production page 238◦ CysLT receptors page 238-239◦ Dosages for anti leukotrienes◦ Churg-Strauss Syndrome page 243◦ RSV page 244

Chapter 12: Non-Steroidal Antiasthma agents

Read/Know:◦ Key terms page 226◦ Clinical indication page 227◦ Mechanisms in inflammation in asthma page 227-

228◦ Immunological response page 228-230◦ Cromolyn Sodium page 230-234

Skip nasal drugs, clinical efficacy page 234 Clinical application page 234

◦ Tilade page 235-236 Skip clinical efficacy

Ch. 12

Read/Know:◦ Antileukotriene agents page 238

SKIP ALL DOSAGES, CELL SOURCES AND BIOCHEMICAL PATHWAYS

Zileuton page 239 basic mode of action only Accolate page 240 basic mode of action only Singulair page 241 mode of action Role of antileukotriene drugs in asthma page 241-

243 SKIP TABLE 12-2 AND BOX 12-3 Monoclonal antibodies page 244

Omalizumab (mode of action)

Ch. 12

Skip:◦ Side effects with parenteral pentamidine page

255◦ Aerosol therapy for prophylaxis of PCP page 256◦ Other treatments for RSV page 261-262◦ Clinical efficacy of Tobi page 264-265

Chapter 13. Antiinfective Agents

Know/Read:◦ Key terms page 252◦ Description of PCP page 253-254◦ Nebupent dosage not important (read though)

page 254◦ Administration of Nebupent page 254◦ Nebulizer performance page 255◦ Mode of action page 255◦ Side effects of aerosolized nebupent only page

255◦ Environmental contamination page 256

Ch. 13

Know/Read:◦ Ribavirin page 257◦ Clinical use page 257◦ SKIP NATURE OF VIRAL INFECTION you know this◦ RSV infection page 258◦ SKIP dosage page 258◦ Administration with SPAG page 258-259◦ Mode of action page 259-260◦ Side effects page 260◦ Aerosolized Tobi page 262-263

Skip parenteral use Side effects of Tobi page 264 Skip clinical efficacy

Zanamivir page 265 (skip dosage and table 13-2)Basic mode of action and adverse effects

Ch. 13

Read entire chapter but… Don’t worry about specific names or

dosages, just read to understand basic mechanisms and production and resistance of anti microbials, anti fungals and anti virals

Chapter 14 Antimicrobials