Ms. Weber-Hardy’s E-Mail

MU Homepage

School of Health Related Professions

Cardiopulmonary Diagnostic Sciences

UNIT I:  GENERAL PRINCIPLES OF PHARMACOLOGY

OBJECTIVES:

1. List the five names an approved drug will have and give an example of each.
    
2. Indicate the official and unofficial sources of drug information and state the purpose of at least two sources.
    
3. List and define the three basic phases of drug action.
    
4. Define pulmonary pharmacology, pharmacodynamics, and pharmacokinetics.
    
5. Relate an agent's water or lipid solubility to its ability to be absorbed.
    
6. Describe the procedure for delivering aerosol topically to the lungs via MDI.
    
7. Explain what is meant by the term receptor and relate this term to structurally specific drugs.
    
8. Define the following terms:  drug affinity, agonist and antagonist.
    
9. Explain the terms agonist and antagonist in accordance with the receptor theory of drug actions (Affinity vs Efficacy).
    
10. Distinguish between potency and efficacy.
     
11. Relate the following:  therapeutic index, median lethal dose (LD₅₀), and median effective dose (ED₅₀).
12. Describe the following terms:  drug tolerance, tachyphylaxis, and drug toxicity.
     
13. In the context of drug interactions, describe the meaning of each of the following terms:  addition, synergism, potentiation, and antagonism.
     
14. Match the meaning with the correct abbreviation used in writing prescriptions.
     
15. Describe the factors that effect MDI particle size.
     
16. Explain how one would determine the extent to which a MDI canister was empty.
     
17. Relate the advantages of using an auxiliary spacer device with an MDI.
     
18. Describe the factors that will encourage aerosol particle deposition in the upper airway, rather than the small airways of the lung and explain when this would be desirable.

UNIT II:  CALCULATING DRUG DOSAGES

OBJECTIVES:

1. Convert freely from scientific to household equivalents.
2. Convert percentage strength to a ratio and a ratio to percentage strength.
    
3. Convert a given amount of g:ml to the amount of mg:ml.
    
4. When given a drug dosage problem, provide an appropriate equation to solve for an unknown variable.  The unknown variable may be:
1. -the percentage strength or ratio
2. -the solute or the total solution amount
3. -the desired dosage or desired concentration

UNIT III:  THE CENTRAL AND PERIPHERAL NERVOUS SYSTEM

OBJECTIVES:

1. Describe the two branches of the autonomic nervous system with regard to the following:  structure; neurotransmitter substances; and origin.
    
2. Review the functions of the PNS in the body.
    
3. Review the functions of the SNS in the body.
    
4. Define the following terms associated with the autonomic nervous system:
1. parasympathomimetic (cholinergic)
2. parasympatholytic (anticholinergic)
3. sympathomimetic (adrenergic)
4. sympatholytic (antiadrenergic)
    
5. With regard to the PNS, discriminate between muscarinic and nicotinic effects.
    
6. Outline the rationale for administering antimuscarinic drugs for the purpose of airway dilation in asthma patients.
    
7. Relate the anticholinergic effects of atropine on the intracellular formation of 3, 5, GMP in airway smooth muscle.
    
8. Discuss the effects of atropine on the production of airway mucus and relate these to the overall clinical usefulness of the drug.
    
9. Explain the rationale for using aerosolized methacholine for inhalation challenge testing in the diagnosis of reactive airways disease.
    
10. Distinguish between direct-acting and indirect-acting parasympathomimetic drugs and give an example of each.
     
11. Regarding indirect-acting parasympathomimetics, define what is meant by reversible inhibitors, and give an example of a drug in this category.
     
12. List six purposes of administering a parasympatholytic drug.
     
13. Describe the effects produced by stimulation of the three neuroeffector sites of the SNS (Alpha, Beta₁ and Beta₂).
     
14. State the mechanism of action at the cellular level by which smooth muscle relaxation occurs.
     
15. Describe in detail the comprehensive view of autonomic effects mediated through cyclic AMP and cyclic GMP.

UNIT IV:  SYMPATHOMIMETIC BRONCHODILATORS

OBJECTIVES:

1. Describe the basic chemical structure of the catecholamines.
    
2. Discuss the relationship between duration and specificity with regard to chemical structure of the catecholamines.
    
3. List the advantages and disadvantages of delivering a bronchodilator via aerosol.
    
4. Relate tachyphylaxis with the prolonged use of adrenergic agents.
    
5. List and discuss three problems associated with metered dose inhalers (MDI).
    
6. Discuss the physiologic and pharmacologic mechanisms associated with a paradoxical fall in arterial oxygen tension as seen in some asthmatic patients after aerosol administration.
    
7. For each of the following bronchodilators, identify their:  drug category; strength; dosage; mode of action; and hazards associated with administration.
1. Isoproterenol
2. Isoetherine
3. Metaproterenol
4. Terbutaline Sulfate
5. Albuterol
6. Pirbuturol
7. Bitolterol
8. Salmeterol
    
8. For the agents listed above note:
1. The time required for the onset of a desired effect.
2. The time required to reach peak desired effect.
3. Duration of action.
    
9. For each agent listed in #7 note:
1. The trade name.
2. The available methods of administration.
    
10. Describe the significance of pinkish discoloration that may occur with some catecholamine solutions that are suitable for administration by small-volume nebulizer.
     
11. Relate the use of beta adrenergic bronchodilators to their adverse side effects.
     
12. Explain why it is important for one to know whether or not one's patient is allergic to sulfites.

UNIT V:  PARASYMPATHOLYTIC AND XANTHINE BRONCHODILATORS

OBJECTIVES:

1. Describe why the bronchodilating effects of a parasympatholytic agent are not as profound in the face of normal bronchomoter tone than is produced in the presence of hyperactive bronchomotor tone.
    
2. Relate the parasympatholytic effects of atropine to the intracellular formation of cyclic GMP in airway smooth muscle.
    
3. Describe in detail the role of the parasympathetic system in bronchoconstriction, with regard to the vagal reflex arc.
    
4. List the stimulants which, after coming into contact with the epithelial receptors in the upper airways, can lead to bronchoconstriction.
    
5. Give the dosage range for aerosolized atropine as used for the relief of bronchospasm.
    
6. Describe the clinical symptomatology of atropine toxicity, and identify the patient population that is at highest risk.
    
7. Discuss the potential clinical usefulness of Ipratropium bromide and the advantages it offers over atropine as a bronchodilating agent.
    
8. Give the effective dosage range for Ipratropium bromide when administered as an aerosol, and describe the precautions taken when administered via MDI.
    
9. List three methylxanthines and give their dietary origin.
    
10. Describe the rationale and mode of action of theophylline as an airway smooth muscle-relaxing agent.
     
11. Relate the plasma theophylline concentration to the degree of airway smooth muscle relaxation.
     
12. List the optimal serum therapeutic range for theophylline.
     
13. List eight effects of xanthine administration.
     
14. Outline the effects and relative potencies of the xanthines on the following:
1. skeletal muscle
2. cardia muscle
3. renal
4. central nervous system
    
15. Describe the effect that smoking tobacco has on the rate of metabolizing theophylline.
     
16. Relate other factors that can effect the plasma theophylline level for a particular individual.
     
17. Describe adenosine inhibition as a possible explanation of the bronchodilating effects of theophylline.

UNIT VI:  CORTICOSTEROIDS IN RESPIRATORY CARE
OBJECTIVES:

1. Differentiate anatomically and functionally between the adrenal cortex and medulla.
    
2. Describe the physiologic effects of endogenous mineralocorticoids and endogenous glucocorticoids.
    
3. Describe the characteristics a corticosteroid possesses for the therapeutic management of bronchial asthma.
    
4. Discuss the relationship between glucocorticoids and the regulation of airway smooth muscle.
    
5. List two possible glucocorticoid effects leading to bronchodilation.
    
6. Describe the anti-inflammatory properties of corticosteroids relative to the following:  a) maintenance of microcirculation; b) stabilization of cell membranes; c) neutrophil chemotaxis; d) margination; and e) macrophage mobility.
7. Discuss the potential therapeutic risk of infections by opportunistic organisms in patients receiving glucocorticoid therapy as related to the anti-inflammatory and immuno-suppressive qualities of corticosteroids.
    
8. Characterize the physical appearance and clinical symptoms of a patient with iatrogenic Cushing's Syndrome.
    
9. Explain the relationship of the hypothalamus, pituitary, and adrenal cortex in the regulation of corticosteroids under homeostatic conditions.
    
10. Explain why prolonged steroid therapy must be gradually withdrawn.
     
11. List nine glucocorticoids that are commonly administered for the control of asthmatic symptoms.
     
12. List three of the most effective (in terms of anti-asthmatic activity) steroids available for administration via the inhalation route.

UNIT VII: ANTIALLERGICS AND THE ALLERGIC RESPONSE

OBJECTIVES:

1. Distinguish extrinsic from intrinsic asthma.
    
2. Describe how cellular and humoral immunity play a role in the allergic response.
    
3. Summarize the antigen - antibody reaction on the mast cell and relate how this can initiate an asthma attack.
    
4. Describe the sequence of events involved in becoming sensitized to an antigen.
    
5. Indicate the role cromolyn sodium and nedocromil sodium play controlling asthma.
    
6. Indicate the usual dosage and side effects of cromolyn sodium and nedocromil sodium.
    
7. List the indication and mode of action for anti-leukotrienes.

UNIT VIII:  MUCOLYTICS & COUGH/COLD REMEDIES

OBJECTIVES:
 

List five diseases that are associated with thickened, tenacious bronchial mucous.
 

1. Review the sources and anatomy of bronchial mucous.
    
2. Describe the role water plays in mucous viscosity.
    
3. Define mucolysis and indicate five clinical means of achieving it.
    
4. Relate the clinical significance of topical hydration.
    
5. Define the following:
1. rheology
2. viscosity
3. elasticity
    
6. Indicate the roles that mucous viscosity and elasticity play in effective mucous transport.
    
7. Distinguish the effects of systemic and topical hydration on bronchial mucous.
    
8. Describe acetylcysteine's mode of action and the net result on mucous rheology.
    
9. Describe the mode of action for decongestants, antihistamines, expectorants and antitussives.
    
10. Indicate whether cough and cold remedies are best purchased separately by class or in combination with drugs from other classes.

UNIT IX:  NEUROMUSCULAR BLOCKERS

OBJECTIVES:

1. Describe the physiology of the neuromuscular junction with regard to the following:
1. myelinated nerve fibers
2. neuron motor end plate
3. acetylcholine
4. synaptic cleft
5. cholinesterase
6. depolarization
7. repolarization
    
2. State two mechanisms that cause "blockage" of the normal stimulation of skeletal muscle.
    
3. Describe the clinical effects of nondepolarizing neuromuscular blocking agents.
    
4. Describe the clinical effects of depolarizing neuromuscular blocking agents.
    
5. Discuss the potential use of neuromuscular blocking agents with the mechanically ventilated patient.
    
6. For each of the following drugs, identify their: strength; dosage; mode of action; and potential hazards.
1. Turbocurarine Chloride
2. Pancuronium Bromide
3. Vecuronium
4. Succinylcholine Chloride
5. Decamethonium
6. Atracurium
    
7. Explain why administration of analgesics and sedatives are recommended when neuromuscular blockers are utilized.
    
8. Describe the mode of action of the parasympathomimetics that are used to reverse the paralysis induced by the non-depolarizing agents.
    
9. Describe the particular advantage using Tracrium provides to the clinician when faced with a need to paralyze a patient with hepatic or renal failure.
    
10. List the side effects associated with vagolysis and histamine release and relate them to the use of Curare, Pavulon, Norcuron and Tracrium.

UNIT X:  CNS DEPRESSANTS AND RESPIRATORY STIMULANTS

OBJECTIVES:

1. Describe three classes of drugs that can depress ventilation.
    
2. Indicate the significance of the dosage of a CNS depressant to CNS functions.
    
3. Differentiate a sedative from a hypnotic.
    
4. Pertaining to barbiturates, discuss the following:
1. duration of action
2. drug tolerance
3. renal excretion and pH
4. barbiturate intoxication
    
5. List two nonbarbiturate hypnotics and describe their mode of action.
    
6. Define the effects anti-anxiety tranquilizers (benzodiazepines) have and describe what these drugs are used for.
    
7. Define antipsychotic drugs and list the two categories found in this group.  List two drugs for each category and describe it's effect.
    
8. Explain the term "analgesic" and list the two major groups of drugs in this category.
    
9. List four therapeutic uses of narcotic analgesics.
    
10. Describe the function of narcotic antagonists and list two drugs which fit this category.
     
11. List two non-narcotic analgesics and describe their mode of action.
     
12. List two drug groups which stimulate respiration and describe their clinical use.
     
13. Explain why respiratory stimulants aren't used more frequently.
     
14. Distinguish the desired effects that the Salicylates and Aniline Derivatives produce.

UNIT XI:  CARDIOVASCULAR AGENTS

OBJECTIVES:

1. Describe the relationship between mean arterial pressure and one's cardiac output and peripheral vascular resistance.
    
2. Outline the factors that influence cardiac output (C.O.).
    
3. Outline the factors that influence peripheral vascular resistance (PVR).
    
4. Explain the influence C.O. and PVR have on mean arterial pressure (MAP).
    
5. Define the following terms:
1. Chronotropic
2. Inotropic
3. Preload
4. Afterload
    
6. Relate CVP and PCWP values to the heart's preload.
    
7. Describe the relationship between various cardiovascular diseases and the effects on preload and afterload.
    
8. List three categories of drugs which affect the heart, and describe the mode of action of each class.
    
9. List three categories of drugs which influence the circulatory vessels, and describe their mechanism of action.
    
10. Match the drugs in the following categories with their correct mode of action on the cardiovascular system:
1. cardiac glycosides
2. antiarrhythmic drugs
3. antihypertensive drugs
4. vasoconstricting agents
    
11. List the class of drugs which have an effect on blood viscosity, and discuss their mode of action.
     
12. List the eleven drugs commonly used during CPR and describe their use.
     
13. Explain what a “fluid challenge” is, how it is done and why it is done.
     
14. Match the various wave forms which make up a single heart beat on an ECG (EKG): p, QRS, T; with the appropriate function of the specific areas of the heart.

UNIT XII:  DIURETIC AGENTS

OBJECTIVES:

1. Define the term "diuretic" and describe the purpose of diuretic agents.
    
2. Describe normal nephron function and list four important activities it performs.
    
3. Describe the effects the use of diuretics may have in maintaining acid-base balance.
    
4. List two mechanisms by which diuretics inhibit water reabsorption.
    
5. List three clinical uses of diuretics.
    
6. Discuss what is meant by the term "high ceiling diuretics" and give an example of this type of diuretic.
    
7. Indicate why tea, alcoholic beverages and colas are not recommended as sources of hydration for patients with tenacious sputum.
    
8. Distinguish high ceiling and potassium sparing diuretics in regard to the area of the loop of Henle (descending or ascending) where they exert their effect.
    
9. Name a life threatening side effect which must be monitored to catch and treat while administering diuretics; especially high-ceiling and thiazide diuretics.

UNIT XIII:  AEROSOLIZED ANTIBIOTICS AND ANTIVIRALS

OBJECTIVES:

1. Explain how one goes about diagnosing an infection.
    
2. Indicate which systemic side-effects are avoided by administering antibiotics by aerosol.
    
3. For what specific instances are aerosolized antibiotics indicated?
    
4. What immediate or delayed negative effects are possible as a result of aerosolized antibiotic administration?
    
5. For what disease is the antiviral Ribavirin administered and how is it administered?
    
6. For what patient group is RSV most dangerous?
    
7. Indicate why pregnant staff persons should not come in contact with ribavirin.
    
8. Describe the ventilator system used to deliver ribavirin and indicate why it is necessary.
    
9. Distinguish the technique involved in administering aerosolized pentamidine from the aerosol administration of a bronchodilator.
    
10. Outline the precautions one should take when a patient is to receive aerosolized ribavirin or pentamidine.

UNIT XIV:  SURFACTANT AGENTS

OBJECTIVES:

1. Define a detergent and list some examples.
    
2. Explain the relationship between surface tension, radius and pressure according to LaPlace's Law.
    
3. List the disadvantages of using ethyl alcohol for cardiogenic pulmonary edema.
    
4. List the indications of exogenous surfactant administration.
    
5. Explain how surfactant is administered to a patient.
    
6. List and explain the occurrence of five possible complications of surfactant therapy.

UNIT XV:  DRUG THERAPY IN NEONATES AND CHILDREN AND SELECTIVE RESPIRATORY DISEASE AGENTS

OBJECTIVES:

1. List a minimum of 4 factors that may affect drug therapy in young people. 
    
2. List a minimum of 2 sources that a RCP will check prior to the administration of any drug.
    
3. Explain the importance of the above objective # 2.
    
4. Add the BSA rule of pediatric drug calculations to your Dana Oakes' Clinical Practitioners Pocket Guide to Respiratory Care .
    
5. Explain the use of alpha1-proteinase inhibitor.  (Who should receive this drug, how is it administered and how often, what are the side effects?)
    
6. List 3 FDA approved ways to administer nicotine replacement therapy and their side effects.
    
7. Explain how nicotine effects each of the the specific parts of the nervous system.  Explain those parts of the nervous system which make the nicotine consuming individual feel good and addicted to the product and those which are considered to negatively effect the body physiologically.
    
8. Explain in detail how you would advise a person who wants to quit smoking, include the optimal way to use nicotine replacement therapy and how long it should be used for.
    
9. Explain how the nicotine replacement products should be handled and disposed of.
    
10. Explain 2 indications for NO, how it is administered, and what side effects to monitor for.