Rau's Respiratory Care Pharmacology

Cover
IFC
Half Title
Title
Copyright
Dedication
Contributors
Preface
Acknowledgments
Contents
Unit A - Basic Concepts and Principles in Pharmacology
1 - Introduction to Respiratory Care Pharmacology
Pharmacology and the Study of Drugs
Naming Drugs
Sources of Drug Information
Sources of Drugs
Process for Drug Approval in the United States
Chemical Isolation and Identification
Animal Studies
Investigational New Drug Approval
Phase 1
Phase 2
Phase 3
New Drug Application
FDA New Drug Classification System
Orphan Drugs
The Prescription
Over-the-Counter Drugs
Generic Substitution in Prescriptions
Respiratory Care Pharmacology: An Overview
Aerosolized Agents Given by Inhalation
Related Drug Groups in Respiratory Care
References
2 - Principles of Drug Action
Drug Administration Phase
Drug Dosage Forms
Drug Formulations and Additives
Routes of Administration
Enteral
Parenteral (Injectable)
Transdermal
Inhalation
Topical
Pharmacokinetic Phase
Absorption
Aqueous Diffusion
Lipid Diffusion
Carrier-Mediated Transport
Pinocytosis
Factors Affecting Absorption
Distribution
Volume of Distribution
Metabolism
Site of Drug Biotransformation
Enzyme Induction and Inhibition
First-Pass Effect
Elimination
Plasma Clearance
Maintenance Dose
Plasma Half-Life
Time–Plasma Curves
Pharmacokinetics of Inhaled Aerosol Drugs
Local Versus Systemic Effect
Inhaled Aerosols in Pulmonary Disease
Distribution of Inhaled Aerosols
Oral Portion (Stomach)
Inhaled Portion
Lung Availability/Total Systemic Availability Ratio
Pharmacodynamic Phase
Structure–Activity Relationships
Nature and Type of Drug Receptors
Drug Receptors
Lipid-Soluble Drugs and Intracellular Receptor Activation
Drug-Regulated Ion Channels
Receptors Linked to G Proteins
Dose–Response Relationships
Potency Versus Maximal Effect
Therapeutic Index
Agonists and Antagonists
Drug Interactions
Terms for Drug Responsiveness
Pharmacogenetics
References
3 - Administration of Aerosolized Agents
Physical Principles of Inhaled Aerosol Drugs
Aerosol Particle Size Distributions
Measurement of Particle Size Distributions
Particle Size and Lung Deposition
Fine Particle Fraction
Particle Size and Therapeutic Effect
Particles greater than 10 µm
Particles 5 to 10 µm
Particles 2 to 5 µm
Particles 0.8 to 3.0 µm
Mechanisms of Deposition
Inertial Impaction
Gravitational Settling
Diffusion (Brownian Motion)
Effect of Temperature and Humidity
Aerosol Generators for Drug Delivery
Nebulizers
Types of Small Volume Nebulizers
Jet (Pneumatic) Nebulizers
Jet Nebulizer With Reservoir Tube
Jet Nebulizer With Collection Bag or Elastomeric Ball
Breath-Enhanced Jet Nebulizer
Breath-Actuated Jet Nebulizer
Manual Breath-Actuated Jet Nebulizer
Mechanical Breath-Actuated Jet Nebulizer
Mesh Nebulizers
Active Vibrating Mesh Nebulizer
Passive Mesh Nebulizer
Ultrasonic Nebulizers
Factors Affecting Jet Nebulizer Performance
Dead Volume (Residual Volume)
Filling Volume and Treatment Time
Effect of Flow Rate and Pressure
Type of Power Gas
Device Interface
Type of Solution
Pressurized Metered Dose Inhalers
Technical Description
Chlorofluorocarbon Versus Hydrofluoroalkane Propellants
Equivalence and Safety
Improved Drug Delivery With Hydrofluoroalkane Formulation
Types of Pressurized Metered Dose Inhalers
Conventional Pressurized Metered Dose Inhaler
Breath-Actuated Pressurized Metered Dose Inhaler
Respimat Soft Mist Inhaler
Breath-Actuated Pressurized Metered Dose Inhaler Accessory Devices
Factors Affecting Metered Dose Inhaler Performance
Loss of Dose
Shaking the Canister
Timing of Actuation Intervals
Loss of Prime
Storage Temperature
Nozzle Size and Cleanliness
Breathing Technique
Patient Characteristics
Correct Use of a Pressurized Metered Dose Inhaler
Accessory Devices for Pressurized Metered Dose Inhalers
Types of Pressurized Metered Dose Inhaler Accessory Devices
Design Variables
Electrostatic Charge
Size
Dose Counters
Dry Powder Inhalers
Types of Dry Powder Inhalers
Unit-Dose Dry Powder Inhalers
Multiple Unit–Dose Dry Powder Inhalers
Multiple-Dose Dry Powder Inhalers
Factors Affecting Dry Powder Inhaler Performance and Drug Delivery
Intrinsic Resistance
Inspiratory Flow Rate
Humidity
Clinical Efficacy
Selecting an Aerosol Device
Clinical Application of Aerosol Delivery Devices
Recommendations Based on Clinical Evidence
Aerosol Delivery of Short-Acting β2 Agonists in the Emergency Department
Aerosol Delivery of Short-Acting β2 Agonists in the Hospital
Intermittent Versus Continuous Nebulizer Delivery of β2 Agonists
Aerosol Delivery of β2 Agonists to Patients Receiving Mechanical Ventilation
Aerosol Delivery of Short-Acting β2 Agonists for Asthma in the Outpatient Setting
Delivery of Inhaled Corticosteroids for Asthma
Delivery of β2 Agonists and Anticholinergic Agents for Chronic Obstructive Pulmonary Disease
Factors to Consider
Lung Deposition and Loss Patterns With Traditional Aerosol Devices
Equivalent Doses Among Device Types
Lung Deposition With Newer Aerosol Devices
Clinical Equivalence of Metered Dose Inhalers and Nebulizers
Age Guidelines for Use of Aerosol Devices
Patient–Device Interface
Administration by Intermittent Positive-Pressure Breathing
Face Mask and Blow-by Administration
Mechanical Ventilation Administration
Adjunct Systems for Aerosol Therapy
Technological Adjuncts for Aerosol Therapy
Recommendations for the COVID-19 Pandemic
References
4 - Calculating Drug Doses
Systems of Measure
Metric System
International System of Units
Household Units of Measure
Calculating Doses From Prepared-Strength Solutions
Calculating With Proportions
Answer
Answer
Drug Amounts in Units
Answer
Calculations With a Dosage Schedule
Answer
Additional Examples: Prepared-Strength Drugs
Answer
Answer
Answer
Answer
Calculating Doses From Percent-Strength Solutions
Types of Percent Preparations
Weight to Weight
Weight to Volume
Volume to Volume
Solutions by Ratio
Ratio by Grams to Milliliters
Ratio by Simple Parts
Solving Percent-Strength Solution Problems
Answer
Answer
Summary
Quantity Sufficient
Percent Strengths in Milligrams per Milliliter
Diluents and Drug Doses
Additional Examples: Solutions
Answer
Answer
Answer
Answer
Answer
Reference
5 - Central and Peripheral Nervous Systems
Nervous System
Autonomic Branches
Parasympathetic and Sympathetic Regulation
Neurotransmitters
Efferent and Afferent Nerve Fibers
Terminology of Drugs Affecting the Nervous System
Parasympathetic Branch
Cholinergic Neurotransmitter Function
Muscarinic and Nicotinic Receptors and Effects
Muscarinic Effects
Nicotinic Effects
Subtypes of Muscarinic Receptors
Cholinergic Agents
Direct-Acting Cholinergic Agents
Indirect-Acting Cholinergic Agents
Cholinesterase Reactivator (Pralidoxime)
Anticholinergic Agents
Atropine as a Prototype Parasympatholytic Agent
Parasympatholytic (Antimuscarinic) Effects
Sympathetic Branch
Adrenergic Neurotransmitter Function
Enzyme Inactivation
Sympathetic (Adrenergic) Receptor Types
α and β Receptors
β1 and β2 Receptors
α1 and α2 Receptors
Dopaminergic Receptors
Sympathomimetic (Adrenergic) and Sympatholytic (Antiadrenergic) Agents
Neural Control of Lung Function
Sympathetic Innervation and Effects
Airway Smooth Muscle
β Receptors.
α Receptors
Lung Blood Vessels
Mucous Glands
Parasympathetic Innervation and Effects
Muscarinic Receptors in the Airway
M1 Receptors
M2 Receptors
M3 Receptors
Muscarinic Receptors on Blood Vessels
Nonadrenergic, Noncholinergic Inhibitory Nerves
Nonadrenergic, Noncholinergic Excitatory Nerves
References
Unit B
Drugs Used to Treat the Respiratory System
6 - Adrenergic (Sympathomimetic) Bronchodilators
Clinical Indications for Adrenergic Bronchodilators
Indication for Short-Acting Agents
Indication for Long-Acting Agents
Indication for Racemic Epinephrine
Specific Adrenergic Agents and Formulations
Catecholamines
Adrenergic Bronchodilators as Stereoisomers
Epinephrine
Keyhole Theory of β2 Specificity
Metabolism of Catecholamines
Resorcinol Agents
Saligenin Agents
Levalbuterol: (R)-Isomer of Albuterol
Long-Acting β-Adrenergic Agents
Extended-Release Albuterol
Salmeterol
Bronchodilator Effect
Formoterol
Bronchodilator Effect
Arformoterol
Indacaterol
Olodaterol
Vilanterol
Antiinflammatory Effects
Clinical Use
Mechanism of Action
β-Receptor and α2-Receptor Activation
α1-Receptor Activation
Long-Acting β Agonists: Mechanism of Action
Routes of Administration
Inhalation Route
Continuous Nebulization
Delivery Methods
Toxicity and Monitoring
Oral Route
Parenteral Route
Adverse Side Effects
Tremor
Cardiac Effects
Tolerance to Bronchodilator Effect
Loss of Bronchoprotection
Central Nervous System Effects
Fall in Arterial Oxygen Pressure
Metabolic Disturbances
Propellant Toxicity and Paradoxical Bronchospasm
Sensitivity to Additives
Compatibility of Other Agents With Bronchodilators
β-Agonist Controversy
Asthma Morbidity and Mortality
Respiratory Care Assessment of β-Agonist Therapy
Before Treatment
During Treatment and Short Term
Long Term
For Long-Acting β Agonists
General Contraindications
References
7 - Anticholinergic (Parasympatholytic) Bronchodilators
Clinical Indications for Use
Indication for Anticholinergic Bronchodilators
Indication for Combined Anticholinergic and β-Agonist Bronchodilators
Anticholinergic Nasal Spray
Specific Anticholinergic (Parasympatholytic) Agents
Clinical Pharmacology
Structure–Activity Relationships
Pharmacologic Effects of Anticholinergic (Muscarinic Antagonist) Agents
Tertiary Ammonium Compounds
Respiratory Tract Effects
Central Nervous System Effects
Eye Effects
Cardiac Effects
Gastrointestinal Effects
Genitourinary Effects
Quaternary Ammonium Compounds
Respiratory Tract Effects
Central Nervous System Effects
Eye Effects
Cardiac Effects
Gastrointestinal Effects
Genitourinary Effects
Mechanism of Action
Vagally Mediated Reflex Bronchoconstriction
Muscarinic Receptor Subtypes
Adverse Effects
Clinical Application
Use in Chronic Obstructive Pulmonary Disease
Use in Asthma
Combination Therapy: β-Adrenergic and Anticholinergic Agents in Chronic Obstructive Pulmonary Disease
Additive Effect of β Agonists and Anticholinergic Agents
Sequence of Administration
Respiratory Care Assessment of Anticholinergic Bronchodilator Therapy
Before Treatment
During Treatment and Short Term
Long Term
General Contraindications
References
8 - Xanthines
Clinical Indications for the Use of Xanthines
Use in Asthma
Use in Chronic Obstructive Pulmonary Disease
Use in Apnea of Prematurity
Specific Xanthine Agents
General Pharmacologic Properties
Structure–Activity Relationships
Proposed Theories of Activity
Inhibition of Phosphodiesterase
Antagonism of Adenosine
Catecholamine Release
Titrating Theophylline Doses
Serum Levels of Theophylline
Dosage Schedules
Theophylline Toxicity and Side Effects
Factors Affecting Theophylline Activity
Clinical Uses of Theophylline
Use in Asthma
Use in Chronic Obstructive Pulmonary Disease
Nonbronchodilating Effects of Theophylline
Respiratory Muscle Strength
Respiratory Muscle Endurance
Central Ventilatory Drive
Cardiovascular Effects
Antiinflammatory Effects
Use in Apnea of Prematurity
Respiratory Care Assessment of Xanthines
Before Treatment
During Treatment and Short Term
Long Term
General Contraindications
References
9 - Mucus-Controlling Drug Therapy
Drug Control of Mucus: A Perspective
Clinical Indication for Use
Classification of Mucoactive Medications
Physiology of the Mucociliary System
Source of Airway Secretions
Terminology: Mucus, Phlegm, and Sputum
Surface Epithelial Cells
Submucosal Mucous Glands
Ciliary System
Factors Affecting Mucociliary Transport
Food Intake and Mucus Production
Secretory Hyperresponsiveness and Mucus Hypersecretion
Nature of Mucus Secretion
Structure and Composition of Mucus
Epithelial Ion and Water Transport
Secretions in Disease States
Chronic Bronchitis
Asthma
Bronchorrhea
Plastic Bronchitis
Cystic Fibrosis
Physical Properties of Mucus
Surface Forces
Viscoelasticity and Cohesivity
Rheology or Viscoelasticity
Mucus as a Viscoelastic Material
Spinnability (Cohesivity) of Mucus
Non-Newtonian Nature of Mucus
Mucoactive Agents
Mucolysis and Mucociliary Clearance
Mucolytics and Expectorants
N-Acetyl-l-Cysteine and Other Thiol Mucolytics
Indications for Use
Mode of Action
Hazards
Incompatibility With Antibiotics in Mixture
Dornase alfa (Pulmozyme)
Indication and Use in Cystic Fibrosis
Mode of Action
Dose and Administration
Adverse Effects
Clinical Application and Evaluation
Filamentous Actin-Depolymerizing Drugs: Thymosin β4
Expectorants
Iodide-Containing Agents
Sodium Bicarbonate
Guaifenesin (glycerol guiacolate)
Dissociating Solvents
Oligosaccharides
Mucokinetic Agents
Bronchodilators
Surface-Active Phospholipids
Mucoregulatory Medications
Other Mucoactive Agents
Antiproteases
Hyperosmolar Saline and Mannitol
Gene Therapy
Using Mucoactive Therapy With Physiotherapy and Airway Clearance Devices
Insufflation-Exsufflation; Cough Assist
Active Cycle of Breathing and Forced Expiratory Technique Maneuver
Autogenic Drainage
Exercise
Positive Airway Pressure
High-Frequency Chest Wall Compression
Oscillatory Positive Expiratory Pressure
Chest Wall Compression
Future Mucus-Controlling Agents
Respiratory Care Assessment of Mucoactive Drug Therapy
Before Treatment
During Treatment and Short Term
Long Term
General Contraindications
References
10 - Surfactant Agents
Physical Principles
Surfactant
Surface Tension
Laplace’s Law
Application to the Lung
Clinical Indications for Exogenous Surfactants
Identification of Surfactant Preparations
Composition of Pulmonary Surfactant
Lipids
Proteins
Surfactant Protein A (SP-A)
Surfactant Proteins B and C (SP-B and SP-C)
Surfactant Protein D (SP-D)
Production and Regulation of Surfactant Secretion
Types of Exogenous Surfactant Preparations
Natural and Modified Natural Surfactant
Synthetic Surfactant
Synthetic Natural Surfactant
Specific Exogenous Surfactant Preparations
Beractant (Survanta)
Indications for Use
Dosage
Administration
Calfactant (Infasurf)
Indications for Use
Dosage
Administration
Side-Port Adapter
Catheter Administration
Poractant Alfa (Curosurf)
Indications for Use
Dosage
Administration
Lucinactant (Aerosurf)
Hazards and Complications of Surfactant Therapy
Airway Occlusion, Desaturation, and Bradycardia
High Arterial Oxygen Values
Overventilation and Hypocapnia
Apnea
Pulmonary Hemorrhage
Future Directions in Surfactant Therapy
Respiratory Care Assessment of Surfactant Therapy
Before Treatment
During Treatment and Short Term
Long Term
General Contraindications
References
11 - Corticosteroids in Respiratory Care
Clinical Indications for Use of Inhaled Corticosteroids
Identification of Aerosolized Corticosteroids
Physiology of Corticosteroids
Identification and Source
Hypothalamic–Pituitary–Adrenal Axis
Hypothalamic–Pituitary–Adrenal Suppression With Steroid Use
Diurnal Steroid Cycle
Alternate-Day Steroid Therapy
Nature of Inflammatory Response
Inflammation in the Airway
Aerosolized Corticosteroids
Aerosolized Corticosteroid Agents
Beclomethasone Dipropionate (Qvar RediHaler)
Fluticasone Propionate (Flovent HFA, Flovent Diskus, and ArmonAir Respiclick/Digiclick)
Fluticasone Furoate (Arnuity Ellipta)
Budesonide (Pulmicort Flexhaler, Pulmicort Respules)
Mometasone Furoate (Asmanex Twisthaler, Asmanex HFA)
Ciclesonide (Alvesco)
Albuterol/Budesonide (AIRSUPRA)
Fluticasone Propionate/Salmeterol (AdvairDiskus, Advair HFA, Wixela Inhub AirDuo Respiclick/Digiclick)
Mometasone Furoate/Formoterol (Dulera)
Budesonide/Formoterol (Symbicort, Breyna)
Fluticasone Furoate/Vilanterol (Breo Ellipta)
Fluticasone Furoate/Umeclidinium/Vilanterol (Trelegy Ellipta)
Budesonide/Glycopyrrolate/Formoterol (Breztri Aerosphere)
Intranasal Corticosteroids
Pharmacology of Corticosteroids
Mechanism of Action
Effect on White Blood Cell Count
Effect on β Receptors
Hazards and Side Effects of Steroids
Systemic Administration of Steroids
Systemic Side Effects With Aerosol Administration
Topical (Local) Side Effects With Aerosol Administration
Oropharyngeal Fungal Infections
Dysphonia
Other Complications or Precautions
Clinical Application of Aerosol Steroids
Use in Asthma
Early Use of Corticosteroids in Asthma
Inhaled Corticosteroids for Acute Severe Asthma
Clinical Use of Inhaled Corticosteroids
Use in Chronic Obstructive Pulmonary Disease
Respiratory Care Assessment of Inhaled Corticosteroid Therapy
Before Treatment
During Treatment and Short Term
Long Term
General Contraindications
References
12 - Nonsteroidal Antiasthma Agents
Clinical Indications for Nonsteroidal Antiasthma Agents
Identification of Nonsteroidal Antiasthma Agents
Mechanisms of Inflammation in Asthma
Immunologic (Allergic) Response
Cromolyn-Like (Mast Cell–Stabilizing) Agents
Cromolyn Sodium (Disodium Cromoglycate)
Dosage and Administration
Solution for Nebulization
Metered Dose Inhaler
Nasal Solution (NasalCrom)
Mechanism of Action
Pharmacokinetics
Clinical Efficacy of Cromolyn Sodium
Use for Cough Associated With Angiotensin-Converting Enzyme Inhibitor
Anti–Sickle Cell Effects
Clinical Application of Cromolyn Sodium
Dosage Regulation
Antileukotriene Agents
Leukotrienes and Inflammation
Cell Sources of Leukotrienes
Biochemical Pathways
Leukotriene Production
Cysteinyl Leukotriene Receptors and Effects of Leukotrienes
Zileuton (Zyflo)
Dosage and Administration
Mechanism of Action
Pharmacokinetics
Hazards and Side Effects
Zafirlukast (Accolate)
Dosage and Administration
Mechanism of Action
Pharmacokinetics
Hazards and Side Effects
Montelukast (Singulair)
Dosage and Administration
Mechanism of Action
Pharmacokinetics
Hazards and Side Effects
Role of Antileukotriene Drugs in Asthma Management
Protection Against Specific Asthma Triggers
Chronic Persistent Asthma
Antileukotrienes in Relation to Corticosteroids
Churg-Strauss Syndrome
Summary of Clinical Use of Antileukotriene Therapy
Monoclonal Antibodies
Dosage and Administration
Mechanism of Action
Hazards and Side Effects
Summary of Clinical Use of Monoclonal Antibodies
Respiratory Care Assessment of Nonsteroidal Antiasthma Agents
Before Treatment
During Treatment and Short Term
Long Term
General Contraindications
References
13 - Aerosolized Antiinfective Agents
Clinical Indications for Aerosolized Antiinfective Agents
Indication for Aerosolized Pentamidine
Indication for Aerosolized Ribavirin
Indication for Aerosolized Tobramycin
Indication for Aerosolized Aztreonam
Indication for Inhaled Zanamivir
Identification of Aerosolized Antiinfective Agents
Aerosolized Pentamidine (NebuPent)
Introduction of Aerosolized Pentamidine
Rationale for Aerosol Administration
Description of Pneumocystis Pneumonia
Dosage and Administration
Dosage
Administration
Nebulizer Performance
Mechanism of Action
Side Effects
Side Effects With Parenteral Pentamidine
Side Effects With Aerosol Administration
Preventing Airway Effects
Environmental Contamination by Nebulized Pentamidine
Environmental Precautions
Aerosol Therapy for Prophylaxis of Pneumocystis Pneumonia: Clinical Application
Ribavirin (Virazole)
Clinical Use
Nature of Viral Infection
Respiratory Syncytial Virus Infection
Dosage and Administration
Dosage
Administration
Mechanism of Action
Side Effects
Environmental Contamination With Aerosolized Ribavirin
Palivizumab (Synagis)
Clinical Use
Dosage and Administration
Mechanism of Action
Adverse Reactions
Clinical Efficacy
Aerosolized Tobramycin (TOBI; Bethkis; Kitabis Pak)
Clinical Use
Dosage and Administration
Mechanism of Action
Side Effects
Side Effects With Parenteral Administration
Ototoxicity
Nephrotoxicity
Neuromuscular Blockade
Cross-Allergenicity
Fetal Harm
Side Effects With Aerosolized Tobramycin
Precautions in Use of Aerosolized Tobramycin
Clinical Efficacy
Aerosolized Aztreonam (Cayston)
Clinical Use
Dosage and Administration
Mechanism of Action
Precautions in Use of Nebulized Aztreonam
General Considerations in Aerosolizing Antibiotics
Inhaled Zanamivir (Relenza)
Clinical Use
Dosage and Administration
Mechanism of Action
Adverse Effects
Bronchospasm and Deterioration of Lung Function
Undertreatment of Bacterial Infection
Allergic Reactions
Other Adverse Effects
Clinical Efficacy and Safety
Respiratory Care Assessment of Aerosolized Antiinfective Agents
Before Treatment
During Treatment and Short Term
Pentamidine
Ribavirin
Tobramycin
Aztreonam
Zanamivir
Long Term
General Contraindications
Pentamidine
Ribavirin
Tobramycin
Aztreonam
Zanamivir
References
14 - Antimicrobial Agents
Principles of Antimicrobial Therapy
Identification of Pathogen
Susceptibility Testing and Resistance
Host Factors
Pharmacodynamics
Antimicrobial Combinations
Monitoring Response to Therapy
Antibiotics
Penicillins
Mechanism of Action
Clinical Uses
Natural Penicillins
Penicillinase-Resistant Penicillins
Aminopenicillins
Carboxypenicillins
Ureidopenicillins
β-Lactam and β-Lactamase Inhibitor Combinations
Adverse Reactions and Precautions
Cephalosporins
Mechanism of Action
Clinical Uses
First-Generation Cephalosporins
Second-Generation Cephalosporins
Third-Generation Cephalosporins
Fourth-Generation Cephalosporins
Fifth-Generation Cephalosporins
Adverse Reactions and Precautions
Carbapenems
Mechanism of Action
Clinical Uses
Adverse Reactions and Precautions
Monobactams (Aztreonam)
Mechanism of Action
Clinical Uses
Adverse Reactions and Precautions
Aminoglycosides
Mechanism of Action
Clinical Uses
Adverse Reactions and Precautions
Tetracyclines
Mechanism of Action
Clinical Uses
Adverse Reactions and Precautions
Tetracycline Derivatives
Mechanism of Action
Clinical Uses
Adverse Reactions and Precautions
Macrolides, Azalides, and Ketolides
Mechanism of Action
Clinical Uses
Adverse Reactions and Precautions
Fluoroquinolones
Mechanism of Action
Clinical Uses
Adverse Reactions and Precautions
Other Antibiotics
Chloramphenicol
Mechanism of Action
Clinical Uses
Adverse Reactions and Precautions
Colistin (Colistimethate)
Mechanism of Action
Clinical Uses
Adverse Reactions and Precautions
Daptomycin
Mechanism of Action
Clinical Uses
Adverse Reactions and Precautions
Trimethoprim-Sulfamethoxazole
Mechanism of Action
Clinical Uses
Adverse Reactions and Precautions
Clindamycin
Mechanism of Action
Clinical Uses
Adverse Reactions and Precautions
Metronidazole
Mechanism of Action
Clinical Uses
Adverse Reactions and Precautions
Glycopeptides
Vancomycin
Mechanism of Action
Clinical Uses
Adverse Reactions and Precautions
Telavancin, Delbavancin, and Oritavancin
Mechanism of Action
Clinical Uses
Adverse Reactions and Precautions
Quinupristin and Dalfopristin
Mechanism of Action
Clinical Uses
Adverse Reactions and Precautions
Oxazolidinones
Linezolid
Mechanism of Action
Clinical Uses
Adverse Reactions and Precautions
Antimycobacterials
Isoniazid
Mechanism of Action
Adverse Reactions and Precautions
Rifampin, Rifabutin, and Rifapentine
Mechanism of Action
Adverse Reactions and Precautions
Pyrazinamide
Mechanism of Action
Adverse Reactions and Precautions
Ethambutol
Mechanism of Action
Adverse Reactions and Precautions
Streptomycin
Mechanism of Action
Adverse Reactions and Precautions
Antifungals
Polyenes
Mechanism of Action
Clinical Uses
Adverse Reactions and Precautions
Azoles
Mechanism of Action
Clinical Uses
Adverse Reactions and Precautions
Echinocandins
Mechanism of Action
Clinical Uses
Adverse Reactions and Precautions
Flucytosine
Mechanism of Action
Clinical Use
Adverse Reactions and Precautions
Antiviral Agents
Acyclovir and Valacyclovir
Mechanism of Action
Clinical Uses
Adverse Reactions and Precautions
Penciclovir and Famciclovir
Mechanism of Action
Clinical Uses
Adverse Reactions and Precautions
Ganciclovir and Valganciclovir
Mechanism of Action
Clinical Uses
Adverse Reactions and Precautions
Cidofovir
Mechanism of Action
Clinical Uses
Adverse Reactions and Precautions
Foscarnet
Mechanism of Action
Clinical Uses
Adverse Reactions and Precautions
Amantadine and Rimantadine
Mechanism of Action
Clinical Uses
Adverse Reactions
Oseltamivir, Zanamavir, and Peramivir
Mechanism of Action
Clinical Uses
Adverse Reactions and Precautions
Baloxavir Marboxil
Mechanism of Action
Clinical Uses
Adverse Reactions and Precautions
COVID-19 Antivirals
Remdesivir
Mechanism of Action
Clinical Uses
Adverse Reactions and Precautions
Molnupiravir and Nirmatrelvir/Ritonavir
Mechanism of Action
Clinical Uses
Adverse Reactions and Precautions
Biologics
COVID-19 and Monoclonal Antibodies
Raxibacumab and Obiltoxaximab
Mechanism of Action
Clinical Uses
Adverse Reactions and Precautions
Respiratory Care Assessment of Antibiotic Therapy
Before Treatment
During Treatment and Short Term
Long Term
General Contraindications
References
15 - Cold and Cough Agents
Sympathomimetic (Adrenergic) Decongestants
Topical Application
Systemic Application
Antihistamine Agents
Effect of Histamine
Histamine Receptors
Antihistamine Agents
Effects of Antihistamines
Structure–Activity Relationships
Use With Colds
Treatment of Seasonal Allergic Rhinitis
Expectorants
Efficacy and Use
Use in Chronic Bronchitis
Mechanism of Action
Expectorant Agents
Iodine Products
Guaifenesin (Glycerol Guaiacolate)
Topical Agents
Parasympathomimetics (Cholinergic Agents)
Cough Suppressants (Antitussives)
Agents and Mechanism of Action
Use of Cough Suppressants
Cold Compounds
Treating a Cold
Respiratory Care Assessment of Cold and Cough Agents
Before Treatment
During Treatment and Short Term
Long Term
General Contraindications
References
16 - Selected Agents of Pulmonary Value
α1-Proteinase Inhibitor (Human)
α1-Antitrypsin Deficiency
Genetics
Indication for Drug Therapy
Dosage and Administration
Warnings and Adverse Reactions
Respiratory Care Assessment of Therapy of α1-Proteinase Inhibitor (Human)
Before Treatment
During Treatment and Short Term
Long Term
General Contraindications
Smoking Cessation Drug Therapy
Indication for Use
Drug Formulations
Nicotine Transdermal System
Nicotine Polacrilex (Nicotine Resin Complex)
Bupropion
Varenicline (Chantix)
Precautions
Clonidine (Catapres)
Nortriptyline (Pamelor)
E-Cigarettes
An Alternative or Substitute for Tobacco
Respiratory Care Assessment of Smoking Cessation Drug Therapy
Before Treatment
During Treatment and Short Term
Long Term
General Contraindications
Nitric Oxide
Indication for Use
Dosage and Administration
Pharmacology of Nitric Oxide
Effect on Pulmonary Circulation
Toxicity
Contraindications
Respiratory Care Assessment of Nitric Oxide
Before Treatment
During Treatment and Short Term
Long Term
General Contraindications
Synthetic Analogs of Prostacyclin
Iloprost (Ventavis)
Indication for Use
Dosage and Administration
Precautions
Treprostinil (Tyvaso)
Indication for Use
Dosage and Administration
Precautions
Respiratory Care Assessment of Synthetic Analogs of Prostacyclin
Before Treatment
During Treatment and Short Term
Long Term
General Contraindications
Phosphodiesterase 4 Inhibitor
Roflumilast (Daliresp)
Indication for Use
Dosage and Administration
Precautions
Respiratory Care Assessment of Phosphodiesterase 4 Inhibitor
Before Treatment
During Treatment and Short Term
Long Term
General Contraindications
Cystic Fibrosis Transmembrane Conductance Regulators
Indication for Use
Dosage and Administration
Precautions
Respiratory Care Assessment of CFTR Agents
Insulin Human (Recombinant DNA Origin)
Insulin Human (Afrezza)
Indication for Use
Dosage and Administration
Precautions
Respiratory Care Assessment of Inhaled Insulin
Before Treatment
During Treatment and Short Term
Long Term
General Contraindications
References
17 - Neonatal and Pediatric Aerosolized Drug Therapy
Off-Label Use of Drugs in Neonatal and Pediatric Patients
Factors Affecting Neonatal and Pediatric Aerosol Drug Delivery
Effect of Age on Aerosol Lung Dose
Effect of Small Tidal Volumes, Short Respiratory Cycles, and Low Flow Rates
Effect on Small Volume Nebulizer
Effect on Reservoir Dose
Nebulized Drug Distribution
Clinical Response to Aerosolized Drugs in Neonatal and Pediatric Patients
Selection of Delivery Devices
Nebulizers
Pressurized Metered Dose Inhalers
Dry Powder Inhalers
Use of Selective Agents in Neonatal and Pediatric Patients
Antibiotics
Mucoactive Agents
Aerosol Surfactants
Antiinflammatory Drugs and Antibiotics
Aerosolized Peptides and Proteins
Prostacyclin Analogs for Pulmonary Hypertension
Adherence, Compliance, and Cooperation During Aerosol Therapy
Facemasks Design, Fitting, Crying, and “Blow-By”
High-Flow Nasal Cannula
Nebulizer Hood
Parent Education on Inhalation Therapy
Aerosol Administration in Intubated Neonatal and Pediatric Patients
Summary
References
Unit C
Critical Care, Cardiovascular, and Polysomnography Agents
18 - Skeletal Muscle Relaxants (Neuromuscular Blocking Agents)
Uses of Neuromuscular Blocking Agents
Physiology of the Neuromuscular Junction
Nondepolarizing Agents
Mechanism of Action
Pharmacokinetics of Nondepolarizing Agents
Metabolism
Adverse Effects
Cardiovascular Effects
Histamine Release
Inadequate Ventilation
Reversal of Nondepolarizing Blockade
Depolarizing Agents
Mechanism of Action
Metabolism
Reversal
Adverse Effects
Sensitivity to Succinylcholine
Neuromuscular Blocking Agents and Mechanical Ventilation
Precautions and Risks
Use of Sedation and Analgesia
Interactions With Neuromuscular Blocking Agents
Choice of Agents
Monitoring of Neuromuscular Blockade
References
19 - Diuretic Agents
Renal Structure and Function
Glomerular Filtration
Electrolyte Filtration and Reabsorption
Acid–Base Balance
Diuretic Groups
Thiazide and Thiazide-Like Diuretics
Loop Diuretics
Carbonic Anhydrase Inhibitors
Potassium-Sparing Diuretics
Osmotic Diuretics
Diuretic Combinations
Drug Interactions
Adverse Effects
Hypovolemia
Hypokalemia
Acid–Base Disorders
Glucose Changes
Ototoxicity
Special Situations
Pregnancy, Lactation, and Children
Acute Respiratory Distress Syndrome
Diuretic Use in Neonates and Infants
Furosemide and Fluid Overload
References
20 - Drugs Affecting the Central Nervous System
Neurotransmitters
Psychiatric Medications
Antidepressants
Mood Stabilizers
Antipsychotics
Drugs for Alzheimer Dementia: Cholinesterase Inhibitors
Anxiolytics
Barbiturates
Other Hypnotics
Ethyl Alcohol
Pain Treatment
Nonsteroidal Antiinflammatory Drugs
Opioid Analgesics
Routes of Opioid Administration
Opioid Inhalation
Local Anesthetics
Epidural Analgesia
Combinations of Analgesic Classes
Chronic Pain Syndromes
Anesthesia
Conscious Sedation
Standards for Providing Conscious Sedation
Central Nervous System and Respiratory Stimulants
References
21 - Vasopressors, Inotropes, and Antiarrhythmic Agents
Overview of Cardiovascular System
Factors Affecting Blood Pressure
Agents Used in the Management of Shock
Catecholamines
Norepinephrine (Levophed) and Epinephrine (Adrenalin Chloride)
Isoproterenol (Isuprel)
Dopamine
Phenylephrine
Vasopressin (Pitressin)
Midodrine (Proamatine)
Angiotensin II – GIAPREZA
Vasopressor-Induced Extravasation and Management
Inotropic Agents
Dobutamine
Phosphodiesterase Inhibitors: Inamrinone and Milrinone
Cardiac Glycosides: Digoxin (Lanoxin)
Electrophysiology of Myocardium
Ablation With Radiofrequency Current
Implantable Cardioverter-Defibrillators
Pharmacology of Antiarrhythmics
Class IA
Quinidine
Procainamide
Disopyramide
Class IB
Lidocaine
Mexiletine
Tocainide
Class IC
Flecainide (Tambocor)
Propafenone (Rythmol)
Class II
β Blockers
Class III
Amiodarone (Cordarone)
Dronedarone (Multaq)
Dofetilide (Tikosyn)
Sotalol (Betapace and Betapace AF)
Ibutilide (Corvert)
Class IV
Calcium Channel Blockers
Miscellaneous
Digoxin (Lanoxin)
Adenosine (Adenocard)
Management and Pharmacotherapy of Advanced Cardiac Life Support
Sudden Cardiac Death
Epinephrine
Vasopressin
Atropine (AtroPen)
Sodium Bicarbonate
Magnesium Sulfate
Alternative Routes of Medication Administration
Intraosseous Route
Endotracheal Route
References
22 - Drugs Affecting Circulation: Antihypertensives, Antianginals, Antithrombotics
Hypertension
Epidemiology and Etiology
2020 and 2021 Management of Hypertension Guidelines Update
Pathophysiology
Hypertensive Crisis
Hypertension Pharmacotherapy
Angiotensin-Converting Enzyme Inhibitors
Angiotensin II Receptor Blockers
Direct Renin Inhibitors
Calcium Channel Blockers
β Blockers
Diuretics
Potassium-Sparing Diuretics
Thiazide and Thiazide-Like Diuretics
Loop Diuretics
Aldosterone Antagonists
Centrally Acting Adrenergic Agents
α1-Adrenergic Antagonists
Antiadrenergic Agents
Vasodilators
Angina
Epidemiology, Etiology, and Pathophysiology
Pharmacotherapy
Nitrates
Ranolazine
Antithrombotic Agents
Formation and Elimination of Acute Coronary Thrombus
Anticoagulant Agents
Heparins: Unfractionated Heparin and Low-Molecular-Weight Heparin
Direct Thrombin Inhibitors
Direct Oral Anticoagulant Agents
Warfarin (Coumadin)
Direct Oral Anticoagulants and Drug Interactions
Potential Reversal Agents for Direct Oral Anticoagulants
Four-Factor Prothrombin Complex Concentrate (Kcentra) for Warfarin Reversal
2021 CHEST Anticoagulation Guidelines Update
Antiplatelet Agents
Aspirin
Dipyridamole
Clopidogrel (Plavix)
Ticlopidine (Ticlid)
Prasugrel (Effient)
Ticagrelor (Brilinta)
Cangrelor (Kangreal)
Cilostazol (Pletal) and Pentoxifylline (Trental)
Vorapaxar (Zontivity)
Glycoprotein IIb/IIIa Inhibitors
Thrombolytic Agents
References
23 - Sleep and Sleep Pharmacology
History of Treatment of Sleep Disorders
Progession of Sleep
Neurophysiologic Mechanisms
Arousal and Wakefulness
Ascending Reticular Activating System
Thalamic Mechanisms of Arousal
Sleep Onset and Processes That Maintain Sleep
Two-Process Model of Sleep Regulation
Circadian Processes and Chronobiology
Circadian Timing System
Suprachiasmatic Nucleus: The Central Oscillator
Circadian Rhythm and Metabolism
Chronopharmacology
Melatonin as a Chronobiotic and Chronohypnotic Agent
Sleep Disorders: Causes and Treatments
Insomnia
Restless Legs Syndrome and Periodic Limb Movement Disorder
Narcolepsy
Parasomnias
References
Appendix A - Answers to Self-Assessment Questions and Clinical Scenarios
Appendix B - Units and Systems of Measurement
Appendix C - Acceptable Mixtures of Most Commonly Prescribed Respiratory Care Drugs
Glossary of Selected Terms
Index
IBC