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Rau Reading

Rau Reading. Guideline in Reading . Reminder. You are responsible for the lecture material and all reading material. Please study accordingly QUIZ 1 on pharmacology will cover Ch . 1-3, 5-7 in the reading QUIZ 2 on pharmacology will include lecture and reading 8-14

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Rau Reading

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  1. Rau Reading Guideline in Reading

  2. Reminder • You are responsible for the lecture material and all reading material. • Please study accordingly • QUIZ 1 on pharmacology will cover Ch. 1-3, 5-7 in the reading • QUIZ 2 on pharmacology will include lecture and reading 8-14 • Pharmacology exam will cover all respiratory pharm

  3. Grades • 5Quizzes 100 points (20 each) • 4 Exams 400 points (100 each) • 1Presentations 40 points • 4 Homeworks20 points (5 each) • 1 final exam 200 points • I WILL DROP 1-2 QUIZZES • Total: 760 points

  4. Chapter 1. Basic Concepts • Skip: • Page 6 animal studies and investigational drug approval, new drug application

  5. Chapter 1. • Know/Read: • Key terms page 2 • Naming drugs page 4 • Orphan drugs (definition) page 6 • Prescription (what constitutes a proper prescription) page 6-7 • Over the counter drugs (definition) page 7 • Pharmacology overview page 8-10

  6. Chapter 2: Principles of Drug Action • Skip: • Volume distribution pg 16 • Plasma time curves and half life page 18-19 • Lung Availability/total systemic availability ratio page 21 • Potency versus maximal effect page 27 • Therapeutic index page 27

  7. Ch. 2 • Read/Know (all material not skipped) • In particular: • Key terms • Drug administration phase • Including routes of administration; enteral, parenteral, transdermal, topical, inhalation • The pharmacokinetic phase • Definition, absorption (factors affecting it), distribution (may skip volume distribution) • Metabolism (biotransformation, first pass effect) • Elimination (plasma clearance)

  8. Ch. 2 • Read/Know (all material not skipped) • In particular: • Pharmacokinetics of inhaled aerosol drugs page (Local vs systemic effect, aerosols in pulmonary disease; skip lung availabilty) • The pharmacodynamic phase • Drug receptors, receptor activation, ion channels, G-protiens, agonists/antagonists, drug interactions, drug responsiveness

  9. Ch. 2 • Read/Know (all material not skipped) • In particular: • Pharmacogenetics

  10. Chapter 3 Administration of Aerosolized Agents • Skip: • Measurement of particle size distributions • Lung Deposition and loss patterns with traditional aerosol devices

  11. Chapter 3 • Read/Know: • Key terms • Physical principles of inhaled aerosol drugs • Aerosol particle size distributions MMAD in particular • Particle size and lung disposition • Particle size and therapeutic effect page • Mechanisms of deposition (inertial impaction, gravitational settling, diffusion) • Effect of temperature and humidity

  12. Chapter 3 • Read/Know: • Aerosol devices for drug delivery • Ultrasonic • SPAG • SVN • Dead volume, filling volume/treatment time, effect of flow rate, type of power gas, type of solution • Metered dose inhalers • Technical description, correct use of MDI, factors affecting inhaler performance, breath actuated inhalers, HFA • MDI inhaler reservoir devices • Electrostatic charge

  13. Chapter 3 • Read/Know: • Dry powder inhalers page 54-55 • Clinical Application of aerosol delivery page 55-56 • Administration by IPPB, face mask and endotracheal tube page 60

  14. Chapter 5 The Central and Peripheral Nervous System • Skip: • NOTHING ALL GOOD MATERIAL

  15. Chapter 5 The Central and Peripheral Nervous System • Know/Review: • Key terms pg 81 • The nervous system pg 81-85 • Neurotransmitters, parasympathetic and sympathetic regulation, efferent/afferent nerve fibers • Parasympathetic branch page 85-87 • Muscarinic and nicotinic receptors

  16. Chapter 5 The Central and Peripheral Nervous System • Know/Review: • Cholinergic agents page 87-88 • Direct and indirect acting • Anticholingergic agents page 89 • Atropine, parasympatholytic effects • Sympathetic Branch page 90-94 • Adrenergic neurtotransmitter function, enzyme inactivation, receptor types, TABLE 5-5, Beta receptors, alpha receptors; you can skip dopaminergic receptors

  17. Chapter 5 The Central and Peripheral Nervous System • Know/Review: • Sympathomimetic adrenergic and sympatholytic antiadrenergic agents (page 94) Table 5-6 • Neural control of lung function • Airway smooth muscle, lung blood vessels, mucus glands • Parasympathetic innervation (muscarinic receptors; M1-3) • May skip Non adrenergic inhibitory nerves page 99-101

  18. Chapter 6: Adrenergic Bronchodilators • Skip: • Any chemical structure/line graphs • Keyhole theory page 107 • Resorcinol agents page 109 • Bitolterol page 110-111 • Oral and parenteral routes page 121-122 • Skip page 126-127

  19. Chapter 6 • Know/read: • Key terms page 104 • Clinical indications page 104-115 • Short acting, long acting, racemic epi indication • Specific adrenergic agents • Catecholamines, stereoisomers (basic concept), TABLE 6-1, Saligen agents, Pirbuterol, Levalbuterol • Long Acting bronchodilators; salmeterol, formoterol, arformeterol, antiinflammatory effects, clinical use

  20. Chapter 6 • Know/read: • MODE of ACTION page 116-120 • Beta receptor and alpha receptor activation, alpha 1 activation, Salmertol, formoterol and arfometerol mode of action pg 119-120 • Routes of administration page 120-121 • Continuous nebulization, inhalation route • Adverse side effects page 122-126 • Tremor, cardiac, tolerance, loss of bronchoprotection, CNS effects MAY SKIP THE REST

  21. Chapter 7 Anticholinergics • Skip: • Clinical pharmacology page 135-136 • Vagally mediated reflex bronchoconstriction page 139-140

  22. Ch. 7 • Know/read: • Key terms page 133 • Clinical indication page 133 • Specific agents page 133-135 • TABLE 7-1 • Pharmacological effects of anticholinergics page 137 • Tertiary ammonium compounds, quaternary compounds

  23. Ch. 7 • Know/read: • Mode of action page 138-143 • Muscarinic receptor subtypes TABLE 7-4 • Adverse effects page 142-143 • BOX 7-1 • Clinical Application page 143-146 • COPD • Asthma • Combination • Respiratory care assessment page 147

  24. Chapter 8. Xanthines • Skip: • All chemical structures • Structure activity relations page 153 • Antagonism of Adenosine page 154 • Titrating theophylline doses page 155-156 • Factors affecting theophylline activity page 157

  25. Ch. 8 • Know/Read: • Key Terms page 151 • Clinical indications page 151-152 • Asthma, COPD, apnea of prematurity • Specific Xanthine agents page 152 • General properties page 152-153 • Inhibition of Phosphodiesterase page 153 • Theophylline side effects page 156-157 • Clinical uses page 158-159 • Asthma, COPD, muscle strength, central ventilatory drive, cardiovascular, antiinflammatory, apnea of prematurity

  26. Chapter 9. Mucus Controlling Drugs • Skip: • Table 9-2 • Source of airway secretions (you know this already) page 164 • Nature of mucus secretion/structure and composition of mucus page 168-171 (NOT ALL OF IT SEE NEXT SLIDE) • Physical properties of mucus page 172-174 • F-actin depolymerizing drugs page 177-178 • Expectorants EXCEPT ONES LISTED IN FOLLOWING SLIDE page 178

  27. Chapter 9. Mucus Controlling Drugs • Skip: • Mucokinetic agents (review bronchodilator effect on cilia but skip the rest) page 179 • Mucoregulator medications page 179 • Other mucoactive agents page 180 • Gene therapy page 180-181 • Review page 181-183 but we have already gone over in class • Future agents page 183-184

  28. Ch. 9 • Know/read: • Key terms page 163 • Clinical indication page 164 • Factors affecting mucocilliary transport page 168 • Food intake and mucus production page 168 • Nature of mucus secretion page 168-172 • Mucus composition, mucus in disease states (chronic bronchitis, asthma, bronchorrhea, plastic bronchitis, cystic fibrosis)

  29. Ch. 9 • Know/read: • Mucoactive agents page 174 • TABLE 9-4 pahe 174 • Mucolytics and mucocilliaryclearence page 175 • N-Acetylcysteine page 175-176 • Dornasealfa page 176-177 • Expectorants page 178 • Sodium Bicarbonate, Guaifenesin • RT assessment of mucoactive drug page 184

  30. Chapter 10. Surfactant Agents • Skip: • Lipids and Proteins page 195-196 • Future directions of surfactant page 200-201 • RT assessment page 201 (you will learn this with neonates) • Any specific detail on the administration of surfactant beyond endotracheal delivery

  31. Ch. 10 • Know/Read: • Key terms page 192 • Perspective page 192 • Application to the lung page 192 • Clinical indications for exogenous surfactant page 192-193 • Composition of pulmonary surfactant page 193 • TABLE 10-1 you don’t need to know the formulations

  32. Ch. 10 • Know/Read: • Production of Surfactant page 196 • Types of surfactant page 196-197 • Specific types page 198 • Survanta, Infasurf, Curosurf (don’t worry about the details for administration) • Mode of Action page 199-200 • Hazards page 200

  33. Chapter 11. Corticoid Steroids • Skip: • TABLE 11-2 • Any chemical structure • Any nasal steroids • BOX 11-2 • Topical steroids • Table 11-3

  34. Ch. 11 • Know/Read: • Key terms page 205 • Clinical indications page 205 • Physiology of corticoid steroids page 205-209 • TABLE 11-1 (skip azmacort and Aerobid) • Page 208 review • Diurnal cycle page 209 • Nature of inflammation page 209-212 • Aerosolized agents page 212-214; Skip Azmacort and Aerobid • KNOW DOSES ONLY FOR: QVAR, ADVAIR, FLOVENT, PULMICORT, SYMBICORT= ADULT DOSES

  35. Ch. 11 • Know/read: • Mode of action page 215 • Effect on WBC’s, beta receptors • Hazards and side effects page 217-219 • Both aerosolized and systemic • Topical side effect with aerosol administration • Clinical Application page 220 • Asthma, COPD

  36. Chapter 12: Non-Steroidal Antiasthma agents • Skip: • BOX 12-2 • Chemical structures • Cell sources of leukotrienes and biochemical pathways page 236-238 • Leukotriene production page 238 • CysLT receptors page 238-239 • Dosages for anti leukotrienes • Churg-Strauss Syndrome page 243 • RSV page 244

  37. Ch. 12 • Read/Know: • Key terms page 226 • Clinical indication page 227 • Mechanisms in inflammation in asthma page 227-228 • Immunological response page 228-230 • Cromolyn Sodium page 230-234 • Skip nasal drugs, clinical efficacy page 234 • Clinical application page 234 • Tilade page 235-236 • Skip clinical efficacy

  38. Ch. 12 • Read/Know: • Antileukotriene agents page 238 • SKIP ALL DOSAGES, CELL SOURCES AND BIOCHEMICAL PATHWAYS • Zileuton page 239 basic mode of action only • Accolate page 240 basic mode of action only • Singulair page 241 mode of action • Role of antileukotriene drugs in asthma page 241-243 • SKIP TABLE 12-2 AND BOX 12-3 • Monoclonal antibodies page 244 • Omalizumab (mode of action)

  39. Chapter 13. Antiinfective Agents • Skip: • Side effects with parenteral pentamidine page 255 • Aerosol therapy for prophylaxis of PCP page 256 • Other treatments for RSV page 261-262 • Clinical efficacy of Tobi page 264-265

  40. Ch. 13 • Know/Read: • Key terms page 252 • Description of PCP page 253-254 • Nebupent dosage not important (read though) page 254 • Administration of Nebupent page 254 • Nebulizer performance page 255 • Mode of action page 255 • Side effects of aerosolized nebupent only page 255 • Environmental contamination page 256

  41. Ch. 13 • Know/Read: • Ribavirin page 257 • Clinical use page 257 • SKIP NATURE OF VIRAL INFECTION you know this • RSV infection page 258 • SKIP dosage page 258 • Administration with SPAG page 258-259 • Mode of action page 259-260 • Side effects page 260 • Aerosolized Tobi page 262-263 • Skip parenteral use • Side effects of Tobi page 264 • Skip clinical efficacy Zanamivir page 265 (skip dosage and table 13-2) Basic mode of action and adverse effects

  42. Chapter 14 Antimicrobials • Read entire chapter but… • Don’t worry about specific names or dosages, just read to understand basic mechanisms and production and resistance of anti microbials, anti fungals and anti virals

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