Term
| Respiratory Care Pharmacology |
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Definition
| The application of pharmacology to the treatment of cardiopulmonary disease and critical care |
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Term
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Definition
| Any chemical that alters the organism's functions or processes |
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Term
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Definition
| The study of drugs (chemicals), including their origin, properties, and interactions with living organisms |
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Term
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Definition
| The identification of sources of drugs, from plants & animals |
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Term
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Definition
| A disease that affects fewer than 200,000 persons in the US |
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Term
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Definition
| The study of the interrelationship of gentic differences and drug effects |
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Term
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Definition
| The art of treating diseases w/drugs |
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Term
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Definition
| The study of toxic substances and their pharmacological actions, including antidotes and poison control |
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Term
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Definition
| The name indicating the drug's chemical structure |
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Term
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Definition
| Name assigned by a manufacturer to an experimental chemical that shows potential as a drug (Ex:aerosol SCH 1000, which whas the code name for ipratropium bromide, a parasympathetic bronchodilator) |
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Term
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Definition
| Name assigned to a chemical by the US Adopted Name(USAN) Council when the chemical appears to have therapeutic use and the manufacturer wishes to market the drug |
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Term
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Definition
| The name of a drug other than its trademarked name |
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Term
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Definition
| In the event that an experimental drug becomes fully approved for general use and is admitted to the US Pharmacopeia-National Formulary (USP-NF), the generic name becomes the official name. B/c an officially approved drug may be marketed by many manufacturers under different names, its recommended that clinicians use the offical name (which is nonproprietary, not brand names) |
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Term
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Definition
| This is the brand, or proprietary name, given by a particular manufacturer (Ex: The generic drug named albuterol is currently marketed by Schering-Plough as Proventil and by GlaxoSmithKline as Ventolin) |
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Term
| United States Pharmacopia-National Formulary |
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Definition
| Book of standards containing info about medications, dietary supplements and medical devices. The FDA considers this book the official standard for drugs marketed in the US) |
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Term
| Physicians Desk Reference |
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Definition
| Another source of drug information. Although prepared by manufacturers of drugs, and therefore potentially lacking the objectivity of the preceding source, this annual volume provides useful info, including descriptive color charts for drug identification, names of manufacturers, and general drug actions |
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Term
| Major steps in the process of marketing a drug in the US |
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Definition
-Isolation & Identification of the chemical
-Animal studies
-General Effects
(-Special effects on organ systems
-toxicology studies)
-Investigational New Drug (Ind) Approval
(-Phase 1 studies=small #, healthy subjects
-Phase 2 studies-small #, subjects w/disease
-Phase 3 studies=large, multicenter studies)
-New drug application (NDA)
-Reporting system for first 6 mo |
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Term
| How long does it usually take for the three studies to be completed |
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Definition
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Term
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Definition
| The drug is investigated in a small group healthy subjects to establish its activity. This is the basis for the pharmacokinetic description of the drug (rates of absorption, distribution, metabolism, and elimination) |
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Term
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Definition
| The drug is next investigated as a treatment for a small # of individuals with the disease the drug is intended to treat |
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Term
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Definition
| The drug is investigated in large, multicenter studies to establish safety and effiacy |
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Term
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Definition
| A drug or biological product for the diagnosis or treatment of a rare disease |
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Term
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Definition
| The written order for a drug, along with any specific instructions for compounding, dispensing, and taking the drug |
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Term
| What are the parts of a prescription |
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Definition
1. Pt's name + address, + the date the prescription was written
2. Rx (meaning "recipe" or "take thou") directs the pharmacist to take the drug listed and prepare the medication. This is referered to as the superscription
3. The inscription lists the name + qty of the drug being prescribed
4. When applicable, the physician includes a subscription, that is, directions to the pharmacist on how to prepare the medication
5. Sig (Signa) means "write". The transcription or signature is the info the pharmacist writes on the label of the medication as instructions to the pt
6. Name of the presciber |
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Term
| Since passage of what act must physicians include their registration # |
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Definition
| Controlled Substances Act of 1971 |
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Term
| When must physician's include their registration # |
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Definition
| When prescribing narcotics or controlled substances |
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Term
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Definition
| Available w/o prescription |
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Term
| What is a generic prescription |
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Definition
| Manufacturer of the generic substitute has not invested the considerable time & money in developing the original drug product, presumably the generic substitute will be less expensive to the consumer than the original proprietary brand |
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Term
| What is the intention of delivering drugs by the oral inhalation or nasal inhalation routes? |
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Definition
| To provide a local topical treatment of the respiratory tract |
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Term
| Advantages of delivering drugs by the oral inhalation or nasal inhalation routes |
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Definition
-Aerosol doses are smaller than those used for the same purpose & given systematicallly
-Side effects are usually fewer and less severe w/aerosol delivery than w/oral or parenteral delivery
-The onset of action is rapid
-Drug delivery is targeted to the respiraroty system, w/lower systemic bioavailability
-The inhalation of aerosol drugs is painless, relatively safe and may be convenient depending on the specific delivery device used |
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Term
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Definition
-Drug administration phase
-Pharmacokinetic phase
-pharmacodynamic phase |
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Term
| What is drug administeration |
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Definition
| The method by which a drug dose is made available by the body |
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Term
| What is the drug dosage form? |
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Definition
| The physical state of the drug in association with nondrug components (Ex: Tablets, capsules, + injectable solutions) |
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Term
| What is the route of administeration |
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Definition
| The portal entry of the drug into the body (Oral/enteral, injection, or inhalation) |
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Term
| 5 Broad categories of routes of administration |
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Definition
-Enteral
-Parenteral
-Transdermal
-Inhaltation
-Topical |
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Term
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Definition
| Refers literally to the small intestine-administration of drugs intended for absorption anywhere along the gastrointestinal tract) |
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Term
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Definition
| "besides the small intestine", which implies any route of administeration besides other then enteral |
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Term
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Definition
| Application of drugs to the skin to produce a systemic effect (patches) |
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Term
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Definition
| Drugs can be applied directly to the skin (eyedrops, lotion, cream)Phar |
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Term
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Definition
| Pertains to the whole body, whereas the target for the drug is not local, possibly causing side effects |
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Term
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Definition
| Injected directly into the vein allowing nearly instantaneous access to the systemic circulation. Drugs can be given as a bolus in which case the entire dose is given rapidly |
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Term
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Definition
| Injected deep into a skeletal muscle. B/c the drug must be absorbed from the muscle into the systemic circulation, the drug effects occur more gradually than with the IV inj, although typically more rapidly than by oral route |
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Term
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Definition
| Injected into the subcutaneous tissue beneath the epidermis and dermis |
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Term
| What kind of effect can inhalation drugs give |
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Definition
| Either a systemic or local effect |
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Term
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Definition
| Limited to the area of treatment |
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Term
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Definition
| Time course and disposition of a drug in the body based on its apsorption, distribution, metabolism, and elimination |
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Term
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Definition
| Describes what the body does to the drug |
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Term
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Definition
| Describes what the drug does to the body |
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Term
| Where does aqueous diffusion occur |
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Definition
| In the aqueous compartments of the body such as the interstitial spaces or within a cell |
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Term
| Difference b/t lipid soluble and lipid insoluble |
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Definition
Lipid soluble- nonionized, non polar drug
Lipid insoluble-ionized, polar, water soluble drug |
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Term
| What are the molecules embedded in the membrane that can transport some substances |
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Definition
| Special carrier molecules |
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Term
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Definition
| Descibes the incorporation of a substance into a cell by a process of membrane engulfment and transport of the substance to the cell interior in vesicles, thereby allowing translocation across a membrane barrier |
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Term
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Definition
| Amt of drug that reaches the systemic circulation |
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Term
| What can influence bioavailability |
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Definition
| Absorption and inactivation caused stomach acids and by metabolic degradation, which can occur before the drug reaches the main systemic compartment |
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Term
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Definition
| Minimal Inhibitory Concentration, the lowest concentration of a drug at which a microbial population is inhibited (Giving the least amt of drug possible to accomplish) |
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Term
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Definition
| The process by which a drug is transported to its sites of action, eliminated, or stored |
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Term
| The ______ is the primary site of drug metabolism and biotransformation |
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Definition
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Term
| The _____ are the site of primary drug excretion, although drug and metabolites can be excreted in the feces as well |
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Definition
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Term
| What is the name of the graph that shows the concentration of a drug in the plasma over time |
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Definition
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Term
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Definition
| The duration of action of a drug is known as its half life. This is the period of time required for the concentration or amount of drug in the body to be reduced by one-half. Measure of how quickly the drug is eliminated from the body. |
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Term
| Difference between the local and systemic effect of inhaled aerosols |
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Definition
Local-exemplified by a nasally inhaled decongestant such as oxymetazoline (Afrin), or by an inhaled bronchodilator aerosol, such as albuterol (Proventil, Ventolin) to dilate the lower airways
Systemic-Exemplified by the administration of inhaled zanamivir (Relenza) to treat influenza, inhaled morphine for pain control, or inhaled insulin aerosol for systemic control of diabetes |
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Term
| What is the intention of the use of inhaled aerosols in the treatment of respiratory diseases? What is the rationale behind this? |
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Definition
| A local, targeted effect in the lung and airway. The rationale for the inhalation route in therapy of the lung is to maximize lung disposition while minimizing body (systemic) exposure and unwanted side effects |
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Term
| The inhaled route of administration can involve both ________ and _________ ______. The systemic level of an inhaled drug and possible extrapulmonary side effects depend on both ________ and _______ _______ of the drug. |
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Definition
Gastrointestinal; Lung; Distribution
Gastrointestinal: Lung; Absorption |
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Term
| The sources of the total systemic level of a drug are quantified in the L/T ratio-the _____ the ratio, the more the systemic drug level is from the lung, as a result of efficient lung delivery, high first-pass metabolism, or both |
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Definition
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Term
| What is the oral portion of a drug subject to? |
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Definition
| The swallowed aerosol drug is subject to gastrointestinal absorption, distribution, and metabolism as with an orally administered drug. |
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Term
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Definition
| Lung availability/total systemic availability ratio. Quantifies the efficiency of aerosol drug delivery to the lung and is based on the distribution to the airway and gastrointestinal tract |
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Term
| Where does the clinical or therapeutic effect come from? The systemic or extrapulmonary effect? |
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Definition
Clinical or therapeutic-Comes from the inhaled drug deposited in the airways.
-Systemic or extrapulmonary-comes from the total amt of drug absorbed into the system |
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Term
| Factors that increase the lung availability/total systemic availability (L/T) ratio with inhaled drugs |
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Definition
-Efficient delivery devices (high airway & low gastrointestinal delivery)
-Inhaled drugs w/high first-pass metabolism
-Mouthwashing, including rinsing & spitting
-Use of a reservoir device (spacer, holding chamber) to decrease oropharyngeal deposition and swallowed drug amount |
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Term
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Definition
| The mechanisms of drug action by which a drug molecule causes its effect in the body |
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Term
| What does L/T ratio suggest about aerosol delivery devices? |
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Definition
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Term
| 3 injections commonly considered parenteral |
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Definition
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Term
| _______ describes the mechanism of activity by which drugs cause their effects in the body. The principle concept is the _____ ______ ______. |
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Definition
| Pharmacodynamics, Drug target protein |
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Term
| Structure-activity relation (SAR) |
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Definition
| The relationship b/t a drug's chemical structure and its clinical effect or activity |
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Term
| What are most drug receptors |
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Definition
| Proteins, or polypeptides, whose shape and electric charge provide a match to a drug's corresponding chemical shape or charge |
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Term
| What is the basis on which corticosteroids cause a cell response |
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Definition
| Intracellular receptor activation by lipid-soluble drugs |
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Term
| A variety of terms describe the dose-response relation of drugs, as they combine with their corresponding receptors, and drug interactions. These include: |
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Definition
| Potency, Maximal effect, Therapeutic index, agonists, and antagonists, synergism, additivity, potentiation, and reactions such as idiosyncratic, hypersensitivity, tolerance, and tachyphylaxis |
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Term
| What is the response of a drug proportional to? |
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Definition
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Term
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Definition
| Refers to the concentration or dose of a drug producing 50 % of that drugs maximal response. |
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Term
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Definition
| The greatest response that can be produced by a drug, a dose above which no further response can be elicited |
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Term
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Definition
| comparison of the amount of a therapeutic agent that causes the therapeutic effect to the amount that causes drug toxicity |
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Term
| What is the clinical therapeutic effect? |
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Definition
| Represents safety margin of drug (the smaller therapeutic index, the greater the possibility of crossing from a therapeutic effect to a toxic effect) |
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Term
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Definition
| Drug/chemical that binds to a corresponding receptor and initiates a cellular effect or response (has efficacy) |
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Term
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Definition
| Drug/chemical that is able to bind to a receptor but causes no response (zero efficacy) |
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Term
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Definition
| A direct chemical interaction b/t drug and biologic mediator, which inactivates the drug |
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Term
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Definition
| Can occur when two drugs each produce an effect , and the two effects cancel eachother. |
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Term
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Definition
| Occurs when a drug has affinity for a receptor, but no efficacy, and at the same time blocks the active agonist from binding to and stimulating the receptor |
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Term
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Definition
| Occurs when two drugs act on a target organ by different mechanisms of action, and the effect of the drug pair is greater than the sum of the separate effects of the drugs (1 + 1=3) |
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Term
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Definition
| Occurs when two drugs act on the same receptors and the combined effect is the simple linear sum of the two drugs effects, up to a maximal effect (1+1=2) |
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Term
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Definition
| A special case of synergism in which one drug has no effect but can increase the activity of the other drug (0+1=2), 1st has no effect but combine w/2nd=gr8 effect |
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Term
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Definition
| An effect that is the opposite of, or unusual, or an absense of effect, compared w/the predicted usual effect in an individual |
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Term
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Definition
| An allergic or immune-mediated reaction to a drug, which can be serious, requiring airway maintenance or ventilatory assistance |
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Term
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Definition
| Describes a decreasing intensity of response to a drug over time |
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Term
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Definition
| Describes a rapid decrease in responsiveness to a drug |
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Term
| _______ refers to hereditary differences in the way the body handles specific drugs |
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Definition
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Term
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Definition
| Delivery of aerosol particles to the lungs/respiratory tract |
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Term
| 3 main uses of aerosol therapy in respiratory care |
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Definition
-Humidification of dry inspired gases, using bland aerosols
-Improved mobilization & clearance of respiratory secretions, including sputum induction, using bland aerosols of water, and hypertonic or hypotonic saline
-Delivery of aerosolized drugs to the respiratory tract |
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Term
| An ____ is a suspension of solid or liquid particles whose deposition in the respiratory tract is determined by inertial impaction, gravitational settling, and perhaps less importantly, diffusion |
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Definition
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Term
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Definition
| Describing the tendancy of aerosol particles to remain in suspension |
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Term
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Definition
| Referring to the depth within the lung reached by particles |
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Term
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Definition
| Describing the process by which particles deposit out of suspension to remain in the lung |
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Term
| How efficient are newer aerosol generating devices? |
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Definition
| 30-50 % or more of the dose reaches the lungs |
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Term
| What is one of the major factors influencing aerosol deposition in the lung? |
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Definition
| Particle size of the drug |
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Term
| How is optimal deposition in the normal human lung achieved? |
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Definition
| It is achieved for particles of 3 microns inhaled w/low inspiratory flows of less than 1 L/sec and tidal volumes of 1 L; total lung deposition is divided almost equally throughout the 23 lung generations |
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Term
| What factors affect lower respiratory tract deposition? |
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Definition
| age, disease, breathing patterns |
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Term
| What are particles greater than 5-10 microns useful for? |
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Definition
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Term
| What are particles greater than 10 microns useful for? |
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Definition
| Nasopharyngeal and oropharyngeal regions |
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Term
| What are particles 2-5 microns useful for? |
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Definition
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Term
| What are particles 0.8-3.0 microns useful for? |
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Definition
| terminal airways and alveolar region |
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Term
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Definition
| A function of particle size (mass) and velocity,and increases with larger size and higher velocities (larger the particle=faster velocity) |
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Term
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Definition
| Also called sedimentation. Function of particle size and time. Settling will be greater for larger particles with slow velocities, under the influence of gravity. |
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Term
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Definition
| Affects particles less than 1 micron and is a function of time and random molecular motion |
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Term
| Common devices for the delivery of inhaled aerosol drugs include: |
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Definition
| Nebulizers, Metered dose inhalers, and dry powder inhalers |
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Term
| Reservoir devices such as _____ and ______ can reduce oropharyngeal deposition of drug and simplify hand-breathing coordination with MDIs |
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Definition
| Spacers; Holding chambers |
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Term
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Definition
| A device used for making a fine spray or mist (also known as an aerosol generator) Breaks liquid into gas so pt can inhale itA |
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Term
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Definition
| Electric powered devices operating on the piezoelectric principle and capable of high output |
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Term
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Definition
| Small particle aerosol generator device-large reservoir nebulizer capable of holding 300 mL of solution for long periods of nebulization. Operates on jet-shearing principle |
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Term
| Which medication is associated with the use of a SPAG |
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Definition
| Aerosolized antiviral drug ribavirin |
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Term
| Most of the loss with an SVN occurs in the ____, whereas an MDI and DPI lose drug in the ____ and _____. Addition of a _____ to an MDI shifts loss from the throat to the reservoir |
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Definition
| Device; Mouth and gastrointestinal tract; Reservoir device |
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Term
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Definition
| Small volume nebulizers-small reservoir, gas powered aerosol generators, also referred to as handheld nebulizers |
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Term
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Definition
| Handheld nebulizers, updraft nebulizers, unit dose nebulizers |
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Term
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Definition
| Amt of drug solution remaining in the reservoir when the device begins to sputter, and aerosolization ceases (worthless, doesn't get to patient) |
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Term
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Definition
| -Ability to aerosolize many drug solutions -Ability to aerosolize drug mixtures (more than one drug) -Minimal coordination required for inhalation -Useful in very young or very old, debilitated pts or those in acute distress -Effective w/low inspiratory flows or volumes -Drug concentrations can be modified if desired |
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Term
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Definition
-Equipment required is expensive & cumbersome
-Lengthy treatment times compared to traditional nebulizers
-Variability in performance characteristics among different brands
-Contamination possible w/inadequate cleaning
-A wet, cold spray occurs w/mask delivery
-An ext power source needed |
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Term
| If the dead volume is not discarded and the nebulizer rinsed, what can happen? |
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Definition
| An increasingly concentrated solution and drug dose could be administered with subsequent treatments |
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Term
| Patient compliance is directly proportional to what? |
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Definition
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Term
| What volume of solution is recommended for nebulization? |
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Definition
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Term
| What is the average optimal volume and flow rate for many nebulizers? |
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Definition
| Volume of 5 mL with a 10-L/min flow rate |
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Term
| What is the typical emitted dose and loss pattern for a traditional SVN? |
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Definition
| 12.4 % makes it to lungs, 1.5-oropharynx, 66.3-device loss, 19.7-exhaled |
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Term
| 3 Categories of gas powered nebulizers |
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Definition
-Constant output
-Breath enhanced
-Dosimetric |
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Term
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Definition
| Traditional nebulizer, in which aerosol is produced constantly during inspiration and expiration. Emitted aerosol is lost to the environment during exhalation or breath hold. This loss is the basis for using 6 in of expiratory reservoir tubing |
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Term
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Definition
| Allows more aerosol release during inspiration with decreased output during exhalation or breath hold. (Dont see much in hospitals, too expensive) |
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Term
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Definition
| Aerosol is released only during inspiration and all released aerosol is available for patient inhalation (No aerosol is lost during expiration and theres usually substantial reduction in dead volume loss) |
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Term
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Definition
| Small pressurized canisters for oral and nasal inhalation of aerosolized drugs, they contain multiple doses of accurately metered drug |
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Term
| 5 Major components found in an MDI |
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Definition
| Drug, propellant/excipient mixture, canister, metering valve, mouthpiece/actuator |
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Term
| Since 12/31/2008 has come and gone, what is the power source of MDIs now? |
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Definition
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Term
| The effectiveness of treatment with an aerosolized drug delivered by an MDI depends on what? |
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Definition
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Term
| What % of patients do not use their MDI correctly? |
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Definition
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Term
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Definition
| Refers to loss of drug content in the valve even though propellant may seem to discharge a normal dose |
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Term
| What does shaking of the canister mean? |
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Definition
| The MDI should be shaken before the first actuation after standing , so that the metering valve refills with adequately mixed suspension from the canister |
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Term
| What is the timing of actuation intervals? |
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Definition
| 1-5 minutes before each puff of a bronchodilator from an MDI |
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Term
| What is the difference (if any) of lung function between an open mouth and a closed mouth technique? |
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Definition
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Term
| Should an extension device be used? |
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Definition
| Yes, a spacer/holding chamber |
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Term
| Is use of an MDI with extension device as effective as an SVN treatment? |
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Definition
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Term
| What does loss of prime mean? |
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Definition
| Refers to the loss of propellant from the metering valve of the MDI. When this occurs, little or no drug will be discharged on actuation |
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Term
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Definition
| A conventional pressurized MDI canister is fitted within the Autohaler actuator. The MDI canister is triggered by a spring thru a triggering mechanism activated when the patient inhales |
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Term
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Definition
| Any extension attached to an MDI (spacers, holding chamber, auxiliary device) |
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Term
| Difference between a spacerand valved holding chamber |
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Definition
Spacer-Simple extension w/no 1 way valves
Valved holding chamber-spacer with a 1 way valve |
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Term
| Advantages of Reservoir devices |
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Definition
-Reduced oropharyngeal drug loss
-Separation of MDI actuation and inhalation
-Allows use of MDI during acute airflow obstruction with dyspnea
-Available with mask for children |
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Term
| Disadvantages of reservoir devices |
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Definition
-Large & cumbersome
-Additional expense compared with MDI alone
-Some assembly required
-Possible source of bacterial contamination with inadequate cleaning |
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Term
| Reducing electrostatic charge in a reservoir device can significantly _____ drug delivery. |
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Definition
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Term
| 2 Methods of reducing electrostatic charge |
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Definition
| Simply washing the chamber with water and standard household detergent |
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Term
| The ____ the spacer the more drug available |
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Definition
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Term
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Definition
| Dry powder inhaler, similar to an MDI except that the drug is in powdered form |
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Term
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Definition
| It is breath actuated, meaning that less hand coordination is needed |
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Term
| Main disadvantage of a DPI |
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Definition
| It requires a high inspiratory flow rate from the patient to dispense the drug |
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Term
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Definition
-small & portable
-short preparation and administration times
-no hand coordination needed
-no inspiratory hold or head tilt needed
-no CFC propellants
-no "cold, Freon effect" to cause bronchoconstriction or inhibit full inspiration
-simple determination of remaining drug doses |
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Term
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Definition
-only a limited range of drugs to date
-pts are not as aware of the dose inhaled as with an MDI and may distrust delivery
-moderate to high inspiratory flow rates are needed for powder dispersion
-relatively high oropharyngeal impaction and deposition can occur
-a device such as the Rotahaler is single dose and must be loaded before each use |
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Term
| What kind of inspiratory flow is needed with DPIs |
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Definition
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Term
| With any DPI it is absolutely essential that patients not ____ into the device before ____. |
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Definition
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Term
| What are some factors to consider when selecting the proper aerosol device? |
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Definition
-Patient or clinical preference
-Convenience of device
-Practicality of device
-Durability of device
-Cost & reimbursement
-Drug availability
-Ability of all prescribed drugs to be delivered by same device |
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Term
| Is the use of IPPB for delivery of aerosolized drugs supported? |
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Definition
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Term
| Is face mask delivery of aerosolized drugs more efficient? |
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Definition
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Term
| What effect does the diameter of an endotracheal tube play? |
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Definition
| The narrower the tube, the lower percentage of drug that is delivered to the patient |
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Term
| Should an HME (heat and moisture exchanger) be bypassed when delivering an aerosol? |
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Definition
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Term
| What is the effect of heliox on aerosol delivery? |
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Definition
| The use of heliox (a less dense gas) can increase particle disposition |
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Term
| Where should the nebulizer be placed when a patient is being mechanically ventilated? |
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Definition
| 30 cm from the ETT, instead of between the circuit Y and the ETT |
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