Pharmacology and Therapeutics in Respiratory Care

by Witek, Theodore J., Jr.; Schachter, E. Neil, M.D.

• ISBN13: 9780721634838
• ISBN10: 0721634834
• Format: Hardcover
• Copyright: 1994-01-01
• Publisher: W B Saunders Co

Summary

PHARMACOLOGY AND THERAPEUTICS IN RESPIRATORY CARE is designed primarily for undergraduate respiratory care students and practicing clinicians. The text is divided into three sections which will discuss the scientific basis for therapy, drug classes used in respiratory care, and topical and practical therapeutic and research issues that are overlooked in most respiratory care textbooks.

Table of Contents

PART I SCIENTIFIC BASIS FOR THERAPY	1	(135)
Basic Drug Science Applied to Respiratory Care	3	(28)
Pharmacokinetics	3	(12)
Administration and Absorption	4	(1)
Drug Transfer Across Membranes	4	(3)
Bioavailability	7	(1)
Distribution, Clearance, and Half-Life	8	(4)
Biotransformation and Elimination	12	(3)
Pharmacodynamics	15	(6)
Receptors and Post-Receptor Events	15	(1)
Receptors and Their Subtypes	15	(2)
Quantifying Interactions Between Drug and Receptor	17	(2)
Agonists	19	(1)
Antagonists	19	(2)
Pharmacotherapy	21	(10)
The Scientific Basis for Inhalation Therapy	21	(1)
Delivery	21	(1)
Treating the Patient as a Unique Individual	22	(1)
Regulation and Development of Drugs	22	(5)
Sources of Information about Drugs	27	(4)
Delivery of Drugs by Aerosol	31	(26)
Definition and Description of Aerosols	32	(1)
General Factors Affecting Aerosol Deposition	33	(1)
Generation and Delivery of Aerosols	34	(12)
Small Volume Nebulizers	34	(3)
Ultrasonic Nebulizers	37	(2)
Metered Dose Inhalers	39	(5)
Dry Powder Inhalers	44	(2)
Other Delivery Methods	46	(1)
Selection of an Aerosol Delivery Device	46	(3)
Financial Considerations	48	(1)
Special Considerations in Aerosol Therapy	49	(8)
Aerosol Delivery During Mechanical Ventilation	49	(1)
Nasal Delivery of Aerosols	49	(1)
Occupational Safety and Health	50	(1)
Environmental Issues	51	(6)
Pulmonary Smooth Muscle	57	(30)
Contractile Tissue	58	(3)
Description of Smooth Muscle	61	(2)
Cellular Energetics Associated with Smooth Muscle Activity	63	(2)
Activation of Smooth Muscle	65	(1)
Autonomic Control of the Airway	65	(7)
Parasympathetic Innervation	65	(2)
Sympathetic Innervation	67	(3)
Nonadrenergic Noncholinergic Innervation	70	(2)
Other Modulators of Smooth Muscle Tone	72	(5)
Prostaglandins	72	(2)
Histamine	74	(1)
Serotonin	74	(1)
Leukotrienes	75	(1)
Bradykinin	75	(1)
Platelet Activating Factor	75	(1)
Carbon Dioxide and pH	76	(1)
Oxygen	76	(1)
Temperature	76	(1)
Airway Smooth Muscle and Bronchial Hyperresponsiveness	77	(2)
Pulmonary Vascular Smooth Muscle	79	(2)
Summary	81	(6)
Mucus and Its Clearance in Health and Disease	87	(22)
Basic Physiology of Mucus, Cilia, and Cough	88	(9)
Mucus	88	(5)
Cilia and Mucociliary Clearance	93	(2)
Cough	95	(2)
Abnormalities in Mucus, Cilia, and Cough	97	(3)
Abnormal Mucous Secretion	97	(1)
Abnormal Ciliary Function	97	(1)
Persistent Cough	97	(3)
Mucociliary Clearance and Cough: Clinical Observations	100	(1)
Asthma	100	(1)
Chronic Bronchitis and Emphysema	100	(1)
Bronchiectasis	100	(1)
Cystic Fibrosis	101	(1)
Carcinoma of the Lung	101	(1)
Tuberculosis	101	(1)
Rhinitis	101	(1)
Clinical Characteristics of Airway Secretion	101	(8)
Macroscopic Characteristics	102	(1)
Microscopic Characteristics	103	(6)
Airway Immunology in Health and Disease	109	(26)
Immune Responses	109	(16)
Nonspecific Immune Responses	110	(3)
Specific Immune Responses	113	(1)
Humoral Responses	114	(5)
Antibody Structure and Classes of Immunoglobulin	119	(3)
Functional Roles of Antibodies	122	(1)
Complement System	122	(2)
Cell-Mediated Immunity	124	(1)
Immunologic Deficiency and Hypersensitivity Diseases	125	(5)
Immunologic Deficiency Diseases	125	(2)
Diseases Due to Altered Immune Function	127	(3)
Immunologic Testing for Disease	130	(1)
Summary	131	(4)
PART II RESPIRATORY CARE DRUGS	135	(216)
Adrenergic Agents	137	(30)
Adrenergic Pharmacology	138	(6)
The Autonomic Nervous System	138	(1)
Adrenergic Receptors	139	(3)
Second Messengers and Intracellular Events	142	(2)
Adrenergic Agonists: The Relation Between Structure and Activity	144	(4)
Structure and Function of Sympathomimetic Amines	144	(4)
Uptake and Metabolism of Sympathomimetic Amines	148	(1)
Effects of Adrenergic Agonists	148	(6)
General Effects on the Airway	148	(1)
Effects Outside of the Airway	149	(5)
The Clinical Utility of Adrenergic Agonists	154	(3)
Bronchodilators	154	(2)
Nasal Decongestants	156	(1)
Specific Adrenergic Agents	157	(10)
Beta-Adrenergic Bronchodilators	157	(5)
Alpha-Adrenergic Nasal Decongestants	162	(5)
Antimuscarinic Drugs	167	(16)
Muscarinic Pharmacology	168	(4)
Nicotinic Versus Muscarinic Action of Acetylcholine	168	(1)
Muscarinic Innervation	168	(1)
Muscarinic Receptors	168	(1)
Subtypes of Muscarinic Receptor	169	(2)
Post-Receptor Events	171	(1)
Effects of Antimuscarinic Drugs	172	(2)
General Effects on the Airway	172	(1)
Other Effects	173	(1)
Use of Antimuscarinic Drugs	174	(4)
Asthma	174	(1)
Chronic Bronchitis and Emphysema	175	(2)
Differences in Asthma and Chronic Obstructive Pulmonary Disease	177	(1)
Rhinitis	177	(1)
Antimuscarinic Agents	178	(5)
Chemistry	178	(1)
Pharmacokinetics	179	(1)
Method of Administration	179	(1)
Tolerance	179	(1)
Safety and Side Effects	179	(4)
Theophylline and Other Methylxanthines	183	(24)
Sources, Chemistry, and Preparations	184	(1)
Mechanisms of Action	185	(6)
Phosphodiesterase Inhibition	187	(2)
Adenosine Antagonism	189	(1)
Enhanced Release of Catecholamines	190	(1)
Prostaglandin Inhibition	190	(1)
Pharmacologic Effects in the Respiratory System and Treatment of Obstructive Lung Disease	191	(2)
Nocturnal Symptoms of Asthma	191	(1)
Mucociliary Function	192	(1)
Enhancement of Diaphragmatic Function	192	(1)
Treatment of Asthma	192	(1)
Treatment of Chronic Obstructive Pulmonary Disease	193	(1)
Other Pharmacologic Effects of Methylxanthines	193	(2)
Central Nervous System	193	(1)
Cardiovascular System	194	(1)
Renal System	194	(1)
Skeletal Muscle	194	(1)
Gastric Mucosa and Muscle Tone of the Esophageal Sphincter	194	(1)
Pharmacokinetics of Theophylline	195	(6)
Absorption	195	(1)
Distribution	195	(2)
Metabolism and Elimination	197	(2)
Clinical Use: Dose and Route of Administration	199	(2)
Adverse Reactions and Overdose	201	(2)
Summary	203	(4)
Corticosteroids	207	(32)
Corticosteroids and the Adrenal Glands	208	(2)
Structure and Metabolism of Corticosteroids	210	(2)
Mechanisms of Action of Glucocorticoids	212	(2)
Physiologic and Pharmacologic Effects of Glucocorticoids	214	(4)
Intermediate Metabolism	214	(1)
Water and Electrolyte Balance	215	(1)
Gastrointestinal Tract	215	(1)
Cardiovascular Function	215	(1)
Central Nervous System	215	(1)
Endocrine System	216	(1)
Anti-Inflammatory and Anti-Immunologic Properties of Glucocorticoids	216	(1)
Release of Mediators	216	(1)
Interaction Between Glucocorticoids and β-Adrenergic Receptors	217	(1)
Vascular Permeability	217	(1)
Clinical Indications for the Use of Glucocorticoids to Treat Lung Disease	218	(2)
Obstructive Airway Diseases	218	(1)
Other Pulmonary Conditions	219	(1)
Adverse Effects of Glucocorticoids	220	(2)
Osteoporosis and Glucocorticoids	222	(3)
Administration of Glucocorticoids	225	(1)
Refractoriness to Glucocorticoids in the Treatment of Asthma	226	(1)
Topical Glucocorticoids in the Management of Airway Disease	226	(1)
Nonsteroidal Strategies to Reduce Glucocorticoid Dependence	227	(2)
Troleandomycin	227	(1)
Cytotoxic Agents	228	(1)
Glucocorticoid Drugs	229	(6)
Hydrocortisone	229	(1)
Cortisone	229	(3)
Prednisone	232	(1)
Prednisolone	232	(1)
Methylpredinsolone	232	(1)
Dexamethasone	232	(1)
Triamcinolone	233	(1)
Beclomethasone Dipropionate	233	(1)
Betamethasone	234	(1)
Flunisolide	234	(1)
Budesonide	234	(1)
Fluticasone	235	(1)
Summary	235	(4)
Agents That Affect Mucus and Cough	239	(20)
Agents That Affect Mucus	240	(7)
Hydrating Agents and Diluents: Bland Aerosols	240	(1)
Expectorants	241	(3)
Mucolytics	244	(2)
Secondary Mucokinetic Drugs	246	(1)
Agents That Inhibit Cough	247	(12)
Centrally Acting Drugs	247	(3)
Other Centrally Acting Agents	250	(1)
Local Anesthetics	251	(1)
Aromatics and Aromatic Mixtures	252	(1)
Secondary Antitussive Agents	252	(7)
Antihistamines and Other Mediator Modifying Drugs	259	(30)
H1-Receptor Antagonists	260	(11)
Chemistry	260	(1)
Pharmacologic Properties	260	(3)
Pharmacokinetics	263	(2)
Clinical Use	265	(1)
Individual Agents	266	(5)
Mediator Modifying Compounds	271	(5)
Sodium Cromoglycate	271	(4)
Nedocromil	275	(1)
Ketotifen	275	(1)
Specific Mediators and Their Antagonists	276	(5)
Leukotrienes	276	(3)
Prostaglandins	279	(1)
Platelet Activating Factor	280	(1)
Summary	281	(8)
Antimicrobial Agents	289	(38)
Principles of Antimicrobial Therapy	289	(16)
Identification of the Infecting Organism	290	(1)
Stains and Cultures of Secretions	290	(3)
Modes of Action of Antimicrobials	293	(8)
Microbial Resistance	301	(2)
Superinfections	303	(1)
Routes of Administration of Antimicrobials	303	(1)
Combination of Antibiotics	304	(1)
Specific Classes of Antibiotics and Their Clinical Applications	305	(18)
Antibacterial Agents	305	(10)
Antiparasitic Agents	315	(1)
Antituberculous Agents	316	(3)
Antifungal Agents	319	(1)
Antiviral Agents	320	(3)
Summary	323	(4)
New, Emerging, and Experimental Therapies	327	(24)
New Therapies in Respiratory Care	327	(12)
Pharmacologic Therapy of Pulmonary Hypertension	327	(3)
Alpha1-Proteinase Inhibitor	330	(4)
Surfactant Therapy	334	(2)
Smoking Cessation Therapy	336	(3)
Emerging and Experimental Therapies	339	(12)
Expansion of Classes of Drugs	339	(1)
Novel Therapies and Their Biologic Basis	340	(11)
PART III CLINICAL PHARMACOLOGY AND APPLIED RESEARCH	351	(90)
Respiratory Function: Assessing the Response to Therapy	353	(42)
Definition and Description of Obstructive Airway Disease	354	(5)
Asthma	354	(1)
Chronic Bronchitis	355	(1)
Emphysema	356	(1)
Bronchiectasis	357	(1)
Upper Airway Obstruction	358	(1)
Hereditary Obstructive Lung Disease	359	(1)
The Course of Airway Obstruction	359	(2)
Interstitial Lung Disease	361	(1)
Respiratory Symptoms	362	(1)
Anatomic and Physiologic Considerations	363	(5)
Flow in Tubes	363	(1)
Reynolds Number	364	(1)
Dimensions of the Tube	364	(1)
Branching and Narrowing Points in Tubes	364	(1)
Surface of the Tube	364	(1)
Compliance of the Tube and Transbronchial Pressure	365	(1)
Airway Anatomy	365	(3)
Lung Function Tests	368	(8)
Static Lung Volumes	368	(1)
Dynamic Lung Volumes	368	(4)
Relation Between Pressure and Flow	372	(3)
Diffusing Capacity	375	(1)
Nasal Function Tests	376	(7)
Nasal Airflow	377	(1)
Rhinomanometry	378	(3)
Acoustic Rhinomanometry	381	(1)
Peak Nasal Flow Rate	382	(1)
Rhinoscopy	382	(1)
Nasal Blood Flow	383	(1)
Bronchial Provocation Testing	383	(2)
Histamine and Methacholine	383	(1)
Exercise and Cold	384	(1)
Specific Airway Challenge	385	(1)
Monitoring the Results of Therapy	385	(5)
The Decompensated Patient	385	(2)
The Stable Patient	387	(2)
Interstitial Lung Disease	389	(1)
Other Tests of Respiratory Function	390	(5)
Airway Challenge Testing	395	(22)
General Concepts and Utility	396	(2)
Clinical Indications and Use of Testing	396	(1)
Physiologic Basis for Hyperresponsiveness	396	(2)
General Safety Considerations	398	(1)
Factors That Influence the Response	398	(1)
Methods of Testing	399	(4)
Delivery of Aerosols that Provoke Bronchospasm	399	(2)
Measurement of Response	401	(1)
Analysis and Expression of Response	402	(1)
Bronchial Challenge with Methacholine	403	(1)
Chemistry	404	(1)
Preparations	404	(1)
Administration of the Test	404	(1)
Airway Challenge with Other Agents	404	(3)
Histamine and Other Mediators	404	(1)
Exercise and Isocapnic Hyperventilation	405	(1)
Nonisotonic Aerosols	406	(1)
Challenge with Environmental Contaminants	406	(1)
Other Methods of Provocation	407	(10)
Provoking Cough	407	(1)
Nasal Provocation	408	(9)
Critical Care Pharmacology	417	(24)
The Normal Cardiocirculatory System	418	(3)
Preload	418	(2)
Afterload	420	(1)
Contractility	421	(1)
Cardiocirculatory Failure	421	(1)
Pulmonary Edema	422	(1)
Cardiac Arrhythmias	423	(5)
General Approach to the Care of the Patient in Cardiocirculatory Failure	428	(1)
Specific Measures for Different States of Shock	429	(1)
Hypovolemic Shock	429	(1)
Cardiogenic Shock	429	(1)
Septic Shock	429	(1)
Pharmacologic Agents	430	(11)
Preload Correction	430	(2)
Afterload Reduction: Vasodilators	432	(1)
Vasopressors and Inotropic Agents	433	(3)
Pharmacologic Therapy for Cardiac Arrhythmia	436	(5)
APPENDICES	441	(4)
Medical Abbreviations Commonly Used in Respiratory Care	442	(1)
Some Useful Equivalents	442	(1)
Multiples and Submultiples of the Metric System	443	(1)
Describing Solutions: Percentage Concentrations, Ratios, and Weight in Volume Equivalents	443	(1)
Compendium of Respiratory Care Drugs Administered by Inhalation	444	(1)
Index	445