1 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use.

2 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Chapter 14 Introduction to Respiratory Care Pharmacology

3 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Receptor Site Therapy Receptor sites are specialized cells that will respond predictably to an outside (external to the cell) stimulus. Airways of the lung contain a multitude of receptor sites.

4 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Adrenergic Receptor Sites Alpha receptors Beta-1 receptors Beta-2 receptors

5 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Cholinergic Receptors Cells that respond when stimulated by acetylcholine Muscarinic effect Nicotinic effect

6 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Mechanisms of Bronchospasm Bronchospasm can result from: – Adrenergic stimulation –Cholinergic stimulation –Other mechanisms

7 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Mast Cell Degranulation Specialized cells in the lungs that are located in the smooth muscle of the bronchi, the intra-alveolar septa, and the submucosal glands –Leukotrienes –Histamine –Prostaglandins

8 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Action of Sympathomimetic Drugs Mimic the actions of the sympathetic nervous system Stimulate the beta-1 and beta-2 receptor sites Most commonly used drugs to reverse bronchospasm

9 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Specific Sympathomimetic Drugs Salmeterol Xinafoate Formoterol Fumarate Pirbuterol Acetate Albuterol Sulfate Levalbuterol Isoproterenol Epinephrine Terbutaline Sulfate Racemic Epinephrine Arfomoterol Tartrate (Brovana)

10 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Phosphodiesterase Inhibitors Aminophylline –Intravenous or oral –Should be monitored, dosage adjusted to maintain a therapeutic level of 10 to 20 ‑ mcg/100 ‑ ml Theophylline –Tablet and elixir –Should be titrated until therapeutic blood level of 10 to 20 ‑ mcg/100 ‑ ml

11 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Anticholinergic Drugs Block the cholinergic receptor sites, preventing that route of bronchospasm Provide a third pathway for bronchodilation –Ipratropium Bromide –Tiotroprium Bromide

12 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Corticosteroids in Respiratory Care Prednisone Dexamethasone Budesonide Beclomethasone Dipropionate Triamcinolone Acetonide Flunisolide Fluticasone Propionate Mometasone furoate

13 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Combination Therapy Drugs Fluticasone Propionate— Salmeterol (Advair) Albuterol Sulfate – Ipratroprium bromide Formoterol Fumarate – Budesonide

14 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Cromolyn Sodium and Asthma Management Cromolyn sodium is a prophylactic agent –It prevents mast cell degranulation Nedocromil Sodium Montelukast (Singulair) Zarfirlukast Zileuton

15 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Mucoactive Agents Decrease the viscosity of pulmonary secretions, increase mucus production, hydrate retained secretions, or affect the composition of mucus proteins –Acetylcysteine (Mucomyst) –Dornase alfa (Pulmozyme)

16 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Use of Bland Aerosols in Respiratory Care The goals of bland aerosol therapy include: –Modification of medical gases –Mobilization of pulmonary secretions –Sputum induction

17 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Aerosolized Antimicrobial Agents Antimicrobial agents such as antibiotics have been aerosolized for the treatment of pulmonary infections –Antibiotics –Antiviral agents –Antiprotozoal agents

18 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Metered Dose Inhalers Small, portable aerosol-dispensing device –Hand-operated and powered by an HFA propellant –Each activation of the trigger dispenses a known dose of medication –Greatest difficulty in MDI application is patient instruction

19 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Dry Powder Inhalers (DPI) Creates an aerosol by drawing air through a small dose of dry powder –Some require a greater inspiratory flow for adequate aerosolization – Inhalation should be followed by a breath hold of up to 10 seconds

20 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Metered Dose Inhaler Position the patient Monitor the patient Instruct the patient Assemble the equipment (continues)

21 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Metered Dose Inhaler (continued) Administer the medication Monitor the patient following therapy Clean the patient’s room and chart procedure

22 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Use of a Spacer With a Metered Dose Inhaler Position the patient Monitor the patient Instruct the patient Assemble the equipment (continues)

23 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Use of a Spacer With a Metered Dose Inhaler (continued) Administer the medication Monitor the patient following therapy Clean the patient’s room and chart procedure

24 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Dry Powder Inhalers Diskhaler Diskus Turbuhaler Handihaler Aerolizer Twisthaler