CHAPTER 1

Introduction
To
Respiratory
Care
Pharmacology
 Introduction
• Respiratory Care
Pharmacology represents
the application of
pharmacology to the
treatment of pulmonary
disorders, and more
broadly, critical care.
 Pharmacology and the Study of Drugs
• Human organism – regulated by chemical
agents such as hormones, kinins, and
cathecholamines
• “DRUG” – is any chemical that alters the
organism’s functions or processes, e.g. oxygen,
alcohol, LSD, heparin, epinephrine, or vitamins.
• PHARMACOLOGY – the study of drugs,
including their origin, properties and
interactions with living organism.
 Pharmacology can be subdivided to more
specialized topics:
• PHARMACY – the preparation and dispensing of drugs
• PHARMACOGNOSY – the identification of sources of
drugs, from plants and animals
• PHARMACOGENETICS – the study of the
interrelationship of genetic differences and drug
effects
• THERAPEUTICS – the art of treating disease with drugs
• TOXICOLOGY – the study of toxic substances and their
pharmacologic actions, including antidotes and poison
control
 NAMING DRUGS
• CHEMICAL NAME – the name indicating the
drug’s chemical structure.
• CODE NAME – name assigned by a
manufacturer to an experimental chemical
that shows potential as a drug
• GENERIC NAME – name assigned to a
chemical by the United States Adopted Name
(USAN) Council when chemical appears to
have therapeutic use and the manufactures
wishes to market the drug
 NAMING DRUGS

• OFFICIAL NAME – in the event that an

experimental drug becomes fully approved for
general use and is admitted to the USP-NF, the
generic name becomes the official name
• TRADE NAME – this is the brand name given
by a particular manufacturer and is also
known as the propriety name
– Code Name : ICI 204,219
– Chemical Name: 4-(5-cyclopentyloxy
carbonylamino-1-methyl- indol-
3-ylmethyl)- 3-methoxy- N-o-
tolysulfonylbenzamide
– Official Name: zafirlukast
– Generic Name: zafirlukast
– Trade Name: Accolate (Zeneca
Pharmaceuticals)
 BRIEF HISTORY:
Legislation Affecting Drug
• 1906 – first Food and Drugs Act passed by Congress;
the United States Pharmacopeia (USP) and the
National Formulary (NF) are given official status
• 1919 – the Harrison Narcotic Act is passed to control
the importation, sale, and distribution of opium and
its derivatives, as well as other narcotic analgesics
• 1938 – the Food, Drug, and Cosmetic Act becomes
law. – protect the public health and protect
physicians from irresponsible drug manufacturers.
Act is enforced by the FDA (Food and Drug
Administration)
 BRIEF HISTORY:
Legislation Affecting Drug (cont.)
• 1952 – the Durham-Humphrey Amendment
defines the drugs that may be sold by the
pharmacist only by prescription
• 1962 – the Kefauver-Harris Law is passed as
an amendment to the Food , Drug, and
Cosmetic Act of 1938. Act requires proof of
safety and efficacy of all drugs introduced
since 1938. Drugs in use prior to that have not
been reviewed but are under study.
 BRIEF HISTORY:
Legislation Affecting Drug (cont.)
• 1971 – the Controlled Substance Act becomes effective; this
act lists requirements for the control, sale, and dispensation
of narcotics and dangerous drugs.
• Schedule 1-5 defines drugs of decreasing potential for abuse,
increasing medical use, and decreasing physical dependence
• Sched 1 – Heroin, Marijuana, LSD, peyote and mescaline
• Sched 2 – Opium, morphine, codeine, cocaine,
amphetamines
• Sched 3 – Glutethimide, paregoric, and barbituates
• Sched 4 – Phenobarbital, barbital, chloral hydrate,
meprobamate, and paraldehyde
• Sched 5 – Narcotics containing nonnarcotics in mixture form,
such as cough preparation
SOURCES OF DRUG INFORMATION
• United States Pharmacopeia and National Formulary –
giving drug standards in the United States
• United States Pharmacopeia(USP) – established in
1820 as a private medical effort; given official status in
1960
• National Formulary(NF) – published in 1888
• Physician’s Desk Reference (PDR) – is prepared by
manufacturers of drugs. This annual volume provides
useful information.
• Hospital Formulary – is published by the American
Society of Hospital Pharmacist
 SOURCES OF DRUGS
• Naturally occurring drugs - Egyptian papyrus
records, ancient Chinese and Central American
civilization
• Animal: thyroid hormone, insulin
• Plants: khellin (Ammi visnaga), atropine
(belladonna alkaloid), digitalis (foxglobe), reserpine
(rauwolfia serpentines), eucalyptus, pine, anise
• Minerals: copper sulfate, magnesium sulfate
(epsom salts), mineral oil (liquid hydrocarbons
• Synthetic derivatives
 Major Steps in the Process of Marketing a
Drug in the United States
• Isolation and identification of the chemical
• Animal studies
– General effects and special effects
– Toxicology study
• Investigational New Drug (IND) Approval
– Phase 1 – small number, healthy subjects
– Phase 2 – small number, subjects with disease
– Phase 3 – large multicenter studies
• New Drug Application (NDA)
– Reporting system for first 6 months
 The Thalidomide Story
• 1950 – released outside the United States
• Prescribed to pregnant women to prevent or lessen
morning sickness and to aid in sleeping
• Drug causes severe birth deformities
• Currently, thalidomide is used worldwide for the
treatment of leprosy, reverse weight loss seen in
tuberculosis and AIDS, slow viral HIV
• Investigators at Rockefeller University found that it
reduces production of cytokine tumor necrosis
factor alpha (TNFα) by immune cells that causes
tissue wasting, fevers and night sweats
 Orphan Drugs
• Is a drug or biological product of the diagnosis
or treatment of a rare disease
• Rare is defined as a disease that affects fewer
than 200,000 persons
• A drug may be designated as orphan if used for
a disease that affects more than 200,000
persons but there is no reasonable expectation
of recovering the cost of drug development
 The Prescription
• Written order for a drug, along with any
specific instructions for compounding,
dispensing and taking the drug
• Written by physician, osteopath, dentist,
veterinarians and others but not chiropractors
and opticians.
RxPatient
symbolTRANSCRIPTION
INSCRIPTION
SUBSCRIPTION
– “recipe”
Name,
Physician or “take
Address, Date
Signature thou”
Name
“Sig”-write.
Direction
and
SUPERSCRIPTION
Quantitry
toIntstruction
the pharmacist
of Drug
to px
 Over-the-Counter (OTC) Drugs
• Drugs available to the general population
without a prescription
• The strength and the dose may be lower than
with a prescription formulation, OTC drugs can
be hazardous in normal amounts if their
effects are not understood and they can be
taken in large quantities, thereby increasing
the risk
 Generic Substitution
• A physician can indicate to the pharmacist that
generic substitution is permitted in the filling
of the prescription
• Any manufacturer’s version of the prescribed
drug
• Intended to save money
RESPIRATORY CARE PHARMACOLOGY-
AN OVERVIEW
Aerosolized Agents Given by Inhalation
• Aerosol dose are smaller than those used for the
same purpose and are given systematically
• Side effects are usually fewer and less severe with
aerosol delivery than with oral or parenteral
delivery
• Onset of action is rapid
• Drug delivery is targeted to the respiratory system
• Inhalation is painless, relatively safe, and may be
convenient depending on the specific delivery
device used
Related Drug Groups in Respiratory Care
• ANTIINFECTIVES – antibiotics, antituberculosis, antivirals
• NEUROMUSCULAR BLOCKING AGENTS – curariform
agents
• CENTRAL NERVOUS SYSTEM AGENTS – analgesics,
sedatives/hypnotic
• ANTIARRHYTHMIC AGENTS – cardiac glycosides,
lidocaine
• ANTIHYPERTENSIVE AND ANTIANGINAL AGENTS – beta
blocking agents
• ANTICOAGULANTS AND THROMBOTIC AGENTS – heparin
• DIURETICS – thiazides or furosemides
 Aerosolized Agents GROUPS
• Adrenergic agents
– Beta-adrenergic: relaxation of smooth muscle
and bronchodilation, reduce Raw and
improve ventilatory flow rates in airway
obstruction such as COPD, asthma, CF, acute
bronchitis
– Alpha adrenergic: Epinephrine- topical
vasoconstriction and decongestion
• Epinephrine, Isoproterenol, Isoetharine,
Terbutaline, Metaproterenol, Albuterol,
Pirbuterol, Bitolterol, Salmeterol…
 Aerosolized Agents GROUPS
• Anticholinergic agents
– Relaxation of cholinergic-induced
bronchoconstriction to improve ventilatory
flow rates in COPD and asthma
• Ipratropium bromide
 Aerosolized Agents GROUPS
• Mucoactive agents
– Modification of the properties of respiratory
tract mucus; current agents lower viscosity
and promote clearance secretions
• Acetylcysteine
• Dornase alfa
 Aerosolized Agents GROUPS
• Corticosteroids
– Reduce and control the inflammatory
response in the airway usually associated
with asthma (lower respiratory tract) or
with seasonal or chronic rhinitis (upper
respiratory tract)
• Dexamethasone, Beclometasone dipropionate,
Triamcinolone acetonide, Flunisolide,
Fluticasone propionate, Budesonide
 Aerosolized Agents GROUPS
• Antiasthmatic agents
– To prevent the onset and development of
the asthmatic response, through inhibition
of chemical mediators of inflammation
• Cromolyn sodium, Nedocromil sodium,
Zafirlukast, Zileuton
 Aerosolized Agents GROUPS
• Antiinfective agents
– To inhibit or eradicate specific infective
agents such as Pneumocystis carinii or
respiratory syncytial virus
• Pentamidine, Ribavirin
 Aerosolized Agents GROUPS
• Exogenous surfactants
– Approved clinical dose is by direct
intratracheal instillation, for the purpose of
restoring a more normal lung compliance in
respiratory distress syndrome of the
newborn
• Colfosceril palmitate, Beractant
 Assignment

1. Make a list of abbreviations and symbols with

their meanings used in prescriptions (hand
written or printed copy) and attach it to your
Tickler notebook.
2. In a short bond paper, discuss the generics
act of 1988 / republic act no. 6675 and its
importance in the field of medical practice.