Guideline in Reading
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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
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5 Quizzes
100 points (20 each)
4 Exams
400 points (100 each)
1 Presentations
40 points
4 Homeworks
20 points (5 each)
1 final exam
200 points
I WILL DROP 1-2 QUIZZES
Total:
760 points
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Skip:
Page 6 animal studies and investigational
drug approval, new drug application
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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
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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
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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)
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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, Gprotiens, agonists/antagonists, drug interactions, drug
responsiveness
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Read/Know (all material not skipped)
In particular:
◦ Pharmacogenetics
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Skip:
◦ Measurement of particle size distributions
◦ Lung Deposition and loss patterns with traditional
aerosol devices
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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
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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
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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
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Skip:
◦ NOTHING ALL GOOD MATERIAL
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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
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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
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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 99101
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Skip:
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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
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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
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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
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Skip:
◦ Clinical pharmacology page 135-136
◦ Vagally mediated reflex bronchoconstriction page
139-140
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Know/read:
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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
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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
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COPD
Asthma
Combination
Respiratory care assessment page 147
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Skip:
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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
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Know/Read:
◦ Key Terms page 151
◦ Clinical indications page 151-152
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 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
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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
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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
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Know/read:
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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)
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Know/read:
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Mucoactive agents page 174
TABLE 9-4 pahe 174
Mucolytics and mucocilliary clearence page 175
N-Acetylcysteine page 175-176
Dornase alfa page 176-177
Expectorants page 178
 Sodium Bicarbonate, Guaifenesin
◦ RT assessment of mucoactive drug page 184
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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
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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
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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
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Skip:
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TABLE 11-2
Any chemical structure
Any nasal steroids
BOX 11-2
Topical steroids
Table 11-3
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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
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Know/read:
◦ Mode of action page 215
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Effect on WBC’s, beta receptors
Hazards and side effects page 217-219
◦ Both aerosolized and systemic
◦ Topical side effect with aerosol administration
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Clinical Application page 220
◦ Asthma, COPD
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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
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Read/Know:
◦ Key terms page 226
◦ Clinical indication page 227
◦ Mechanisms in inflammation in asthma page 227228
◦ 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
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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)
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Skip:
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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
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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
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Know/Read:
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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
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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