RT 240 - Advanced Respiratory Care Pharmacology

1. Demonstrate an understanding of the various routes, interactions, and Therapeutic Index of medications.
   1. Define Pharmacology and Pharmacy.
   2. Explain the five different names that may be given to drugs.
   3. Describe the three basic phases of drug action.
   4. Describe the various routes of drug administration.
   5. Explain those factors controlling the Pharmacokinetic Phase.
   6. Define those terms describing drug-receptor interaction.
   7. Define those terms describing drug interactions.
   8. Explain the Therapeutic Index (TI).
   9. Calculate drug dosages from:
      1. Tablets
      2. Prepared strength liquids
      3. Capsules
      4. Percentage-strength solutions
2. Demonstrate an understanding of the Central and Peripheral nervous systems.
   1. Describe the basic organization of the Central and Peripheral nervous systems.
   2. Define the following terms:
      1. Parasympathomimetic
      2. Parasympatholytic
      3. Sympathomimetic
      4. Sympatholytic
      5. Muscarinic effect
      6. Nicotinic effect
   3. Characterize the parasympathetic branch in terms of:
      1. Neurotransmitter
      2. Effects
      3. Termination of impulse
   4. Explain the mechanism of action for parasympathomimetics:
      1. Direct acting
      2. Indirect acting
   5.  For parasympatholytics, explain:
      1. Mechanism of action
      2. Primary uses
   6. Characterize the sympathetic branch in terms of:
      1. Neurotransmitters
      2. Effects
      3. Termination of impulse
      4. Enzyme inactivation
   7. Explain the activity of the sympathetic receptor types:
      1. Alpha-one
      2. Alpha-two
      3. Beta- one
      4. Beta-two
   8. Describe the autonomic effects in the cardiopulmonary system.
   9. Explain how the automatic control of the lung is mediated through:
      1. Sympathetic innervation and its effect on airway smooth muscle, pulmonary blood vessels, and mucus glands.
      2. Parasympathetic innervation and its effect on airway smooth muscle, pulmonary blood vessels, and goblet cells.
3. Demonstrate an understanding of adrenergic bronchodilators.
   1. Describe the clinical applications for the use of adrenergic bronchodilators.
   2. Describe the structural- activity relations of the following:
      1. Catecholamines
      2. Resorcinols
      3. Saligenins
      4. Prodrug
   3. Describe the mode of action of adrenergic bronchodilators.
   4. For each of the following agents, state the receptor activity, onset, peak, and duration of action, dosage and dosage interval, brand name:
      1. Epinephrine
      2. Racemic epinephrine
      3. Isoproterenol
      4. Isoetharine
      5. Metaproterenol
      6. Terbutaline
      7. Albuteral
      8. Pirbuterol
      9. Bitolterol
      10. Salmeterol
   5. Describe the advantages of the inhalation route for administration of adrenergic bronchodilators.
   6. State the adverse side effects of adrenergic bronchodilators.
4. Demonstrate an understanding of parasympatholytic agents.
   1. Describe the history and development of the parasympatholytic agents.
   2. Describe the mechanism (mode) of action for:
      1. Parasympatholytic agents
      2. Xanthines
   3. Explain the concept of vagally-mediated reflex bronchoconstriction, mucus production, mast cell degranulation, and its parasympatholytic blockade.
   4. Describe the role of topical anesthetics in the inhibition of the vagally-mediated reflex.
   5. Explain the role of C-GMP in the autonomic control of the lung.
   6. Differentiate the tertiary and quaternary forms of the anticholinergics in terms of absorption and distribution.
   7. Describe the site of action of the parasympatholytics.
   8. Describe the pharmacologic effects of:
      1. Parasympatholytic agents
      2. Xanthines
   9. Explain the side effects of:
      1. Parasympatholytic agents
      2. Xanthines
   10. Explain the clinical application of:
       1. Parasympatholytic agents
       2. Xanthines
   11. Explain the effects of various plasma levels of theophylline.
   12. Explain why monitoring plasma levels of theophylline is important.
   13. Describe those factors that effect the elimination of theophylline.
   14. State the trade name, generic name, strength, dosage, onset, peak, and duration of action of the following:
       1. Atropine
       2. Ipatropium
5. Classify cardiovascular agents.
   1. State the trade name, mechanism of action, indications, dosages, and precautions for each of the classifications of cardiovascular agents and their representative examples.
6. Demonstrate an understanding of the Mucociliary System
   1. Describe the function of the following secretory structures of the Mucociliary System:
      1. Ciliated pseudostratified columnar cells
      2. Goblet cells
      3. Clara cells
      4. Microvilli
      5. Submucosal glands (a. Mucus cells, b. Serous cells)
   2. Explain the characteristic function of the Ciliary System.
   3. Describe the nature of normal mucus secretion.
   4. Describe the effects of various disease states on mucus.
   5. Describe the physical properties of mucus.
   6. Define the following terms:
      1. Cohesion
      2. Adhesion
      3. Rheology
      4. Viscosity
      5. Elasticity
   7. Explain the three general mechanisms of action for mucolytics.
   8. For acetylcysteine, explain the following:
      1. Concentrations
      2. Dosage
      3. Mode of action
      4. Hazards
      5. Use in Acetaminophen overdose
   9. Describe the effect of bland aerosols on mucus.
   10. Explain the use of surface active agents in the treatment of:
       1. Pulmonary edema
       2. IRDS
   11. For Dornase Alpha (Pulmozyme), Explain the following:
       1. Dosage
       2. Mode of action
       3. Clinical application
       4. Hazards
7. Demonstrate an understanding of the agents used in cold remedies.
   1. Describe the use of the following agents, in cold remedies:
      1. Sympathomimetics
      2. Antihistamines
      3. Expectorants
      4. Cough suppressants
   2. Explain the advantages and disadvantages of topical vs systemic application of decongestants.
   3. Identify common representative agents from each class listed in objective 1.
   4. Describe the mechanism of action and potential side effects of the agents listed in objective 1.
8. Demonstrate an understanding of hormones.
   1. Identify three types of hormones produced by the adrenal cortex.
   2. Describe the production and control of endogenous conrticosteroids.
   3. Explain the function of endogenous corticosteroids.
   4. Explain the concept of adrenal suppression and its impact on the use of exogenous glucocrticoids.
   5. Describe the daily production of endogenous glucocorticoids in terms of plasma levels.
   6. Explain the general mechanism of action, anti-inflammatory action, and the effect on Beta-receptors of glucocorticoids.
   7. State the generic name, trade name, and standard dosage of the corticosteroids covered in class.
   8. Describe the side-effects, hazards, and precautions in the use of both aerosolized and systemic glucocorticoids.
   9. Describe the clinical application of corticosteroids in respiratory care.
9. Demonstrate an understanding of an allergic asthmatic response.
   1. Describe the pathophysiology of asthma.
   2. Explain the allergic asthmatic response.
   3. Describe the role of each of the following in humoral immunity:
      1. IgG
      2. IgA
      3. IgE
   4. Explain the mode of action and clinical application of cromolyn sodium and nedocromil sodium.
   5. Identify by trade name various forms of cromolyn sodium and nedocromil sodium.
   6. Describe the dosage regulation and side effects of cromolyn sodium and nedocromil sodium.
   7. Describe the mode of action, side effects, and clinical uses of:
      1.  Zafirlukast (Accolate)
      2.  Zileuton (Zyflo)
10. Demonstrate an understanding of antibiotics.
    1. Define the term antibiotic.
    2. Describe the modes of action of antibiotics.
    3. Define the following terms in regard to the use of antibiotics:
       1. Bactericidal
       2. Bacteriostatic
       3. Broad spectrum
       4. Narrow spectrum
    4. For each of the following groups of antibiotics, give representative examples, state the mode of action, precautions or hazards, and uses:
       1. Penicillins
       2. Cephalosporins
       3. Aminoglycosides
       4. Tetracyclines
       5. Erythromycin
    5. Explain the historical significance of Sulfonamides.
    6. Describe the mode of action and uses of TMP-SMZ.
    7. Describe the mode of action, hazards and toxicity, and use of Amphotericin B.
    8. Explain the use of Nystatin.
    9. Explain the two basic principles of drug treatment for TB.
    10. List the drugs used in the nine-month treatment of TB.
    11. Explain how exposure to the TB organism or a positive tuberculin reaction may be managed.
    12. Explain three specific problems viral infections pose.
    13. Describe the mechanism of viral infection and replication.
    14. Describe the mechanisms of action of anti-viral agents and give a representative example.
    15. Explain the use of the following agents:
        1. Zidovudine (AZT)
        2. Ribavirin
        3. Amantadine
    16. Describe the use of aerosolized anti-infectives in respiratory care.
    17. Explain the rationale for the use of aerosolized anti-infectives.
11. Demonstrate an understanding of medications involving the neuromuscular junction.
    1. Describe the physiology of neuromuscular junction.
    2. For both nondepolarizing and depolarizing neuromuscular blockers:
       1. Explain the mode of action
       2. Explain the hazards and side effects
       3. State the generic and proprietary names
       4.  Describe their use in respiratory care
12. Demonstrate an understanding of diuretics.
    1. Describe the mechanism of action, indications for each of the five major diuretic groups.
    2. Describe the adverse effects of the Thiazide and Loop Diuretics.