Airway and Ventilation

I.	Respiratory Anatomy
A.	Upper airway
1.   conducting zone (structures)
B.	Lower airway
1.	respiratory zone (structures)
C.	Functional units
1.	alveoli
2.	exchange of gases
D.	Ventilation
1.	muscles of respiration
2.	pressure changes, active vs passive processes
a.  gas laws

II.	Respiratory Physiology
A.	Control of respiration
1.	brain stem respiratory centers
a.   baroreceptors, chemoreceptors, glossopharyngeal nerve
2.	stimulus
a.	accumulation of CO2
1)	 PaCO2 =  pH   ventilation
2)	 PaCO2 =  pH   ventilation

III.	Respiratory Pharmacology
A.	General Pharm review
1.	terminology (see attached appendix A)
a.	suffixes
1)	-mimetics (stimulate or mimic)
2)	–lytics (inhibit)
2.	medical control
3.	six rights of medication administration
4.	regulations (FDA)- handout info
5.	drug nomenclature
6.	drug forms
7.	target tissues
a.	sympathetic receptors
1)	adrenergic
2)	dopaminergic
a.	parasympathetic receptors
1)	cholinergic 

B.	Respiratory meds (mostly sympathomimetics)
1.	oxygen
2.	epinephrine
3.	albuterol
4.	racemic epinephrine
5.	terbutaline
6.	isoetharine
7.	metaproterenol
8.	aminophylline
9.	atropine
10.	ipratropium
11.	magnesium sulfate
12.	methylprednisolone
13.	hydrocortisone
14.	neuromuscular blockers

C.	Respiratory conditions (one example)
1.	asthma
a.	chronic inflammatory disorder of the airways (susceptible individuals)
b.	major characteristic  reversible lower airway obstruction (from edema,
mucus and smooth muscle spasm)
c.	obstruction narrows smaller airways, natural dilation with inspiration allows
air in – contraction of airways and obstruction combine to prevent air from escaping (traps air = hypoxemia, hypercarbia  respiratory distress)
d.	triggers (inducers) – allergens, cold air, exercise, foods, irritants, certain
medications (often cannot be identified)
e.	exposure (pathophysiology)
1)	Phase 1:  trigger causes HISTAMINE release (causes bronchial 
   contraction, peribronchial capillary leakage = 	BRONCHIAL 
   CONSTRICTION + BRONCHIAL EDEMA); restricts expiratory 
   airflow  typical “asthma attack”
DURATION:  1-2 hours or  by MDI
2)	Phase 2:  up to 6-8 post exposure; characterized by INFLAMMATION of
                    bronchiole as cells of IMMUNE SYSTEM (neutrophils,
                    eosinophils, lymphocytes) invade respiratory mucosa =  
                    edema and bronchial swelling   expiratory airflow
		DOES NOT respond well to inhaled  agonists  requires 
                    Anti-inflammatory drugs  CORTICOSTEROIDS

APPENDIX A

Pharm Terminology:

ANTAGONISM:	opposition between 2 or more medications
BOLUS:	  single, oftentimes large dose of medication
CONTRAINDICATIONS:  medical or physiological conditions present that would make it harmful 
  to administer a med of otherwise known therapeutic value
CUMULATIVE ACTION:  occurs when a drug is administered in several doses, causing an  effect
  (usually due to a quantitative build-up of the drug in the blood)
DEPRESSANT:  med that  or lessens a body function or activity
HABITUATION:  physical or psychological dependence on a drug
HYPERSENSITIVITY:  reaction to a substance that is normally more profound than seen in a 
  population not sensitive to the substance (e.g. allergic reaction to PCN)
IDIOSYNCRASY:  individual reaction to a drug that is unusually different from that seen in the 
  rest of the population
INDICATION:  the medical condition(s) in which the drug has proven to be of therapeutic value
PHARMACOKINETICS:  study of basic processes that determine the duration of intensity of a 
  drug’s effect
PHARMACODYNAMICS:  study of mechanisms by which specific drug dosages act to produce 
  biochemical or physiological changes in the body