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The information in this course is primarily a synthesis of materials found in the following references
1. Egan’s Fundamentals of Respiratory Care, editors C. Scanlan, C Spearman, & R. Sheldon, Mosby, 7th ed., 1999.
2. Clinical Assessment of Respiratory Care, by Wilkins, Mosby, 4th ed., 2000.
3. Respiratory Care Pharmacy, by J. Rau, Mosby, 5th ed., 1998.
4. Respiratory Care Equipment, by S. McPherson, Mosby, 6th ed., 1999.
5. Clinical Pharmacy 2000, published by Gold Standard Media, 2000.
6. The Physician’s Desk Reference, 2000.
7. Del Mar’s Respiratory Care Drug Reference, by F. Hill, Del Mar, 1st ed, 1999.
8. Taber’s Cyclopedic Medical Dictionary, FA Davis, 2000.
9. Understanding Pharmacology, by S. Turley, Prentice Hall, 2nd ed., 1999.
10. Prentice Hall’s Health Professional’s Drug Guide 2001, by M. Shannon, B. Wilson, and C. Strang, 1st ed., 2001.
11. Principles of Pharmacology for Respiratory Care, by G. Bills and R. Soderberg, Del Mar, 2nd ed., 1998.
AARC Clinical Practice Guideline, “Selection of a Device for Delivery of Aerosol to the Lung Parenchyma,” RESPIRATORY CARE, July 1996, Vol.41, #7
Haas C, Weg, J, “Exogenous Surfactant Therapy”, RESPIRATORY CARE, May 1996.
Hess D. et al, “Use of Inhaled Nitric Oxide in Patients with ARDS”, RESPIRATORY CARE, May 1996.
McLaughlin, AJ and Levine, SR, Respiratory Care Drug Reference, Aspen Publishers, 1997.
Svedmyr N., “Clinical Advantages of the Aerosol Route of Drug Administration”, RESPIRATORY CARE, September 1991.
Witek T, Schachter E. PHARMACOLOGY AND THERAPEUTICS IN RESPIRATORY CARE, 1994, W. B. Saunders Co.
1. Oxygen. Although a PO2 of 64 mm Hg on room air with a saturation of 90% appears to be satisfactory, this is achieved by a labored pattern of respiration, with tachypnea (R = 22/min), and is accompanied by an increased blood pressure (170/112 mm Hg) and a tachycardia (120 beats/min). In addition, he is mildly anemic. Relieving his hypoxemia, and thereby reducing his WOB and myocardial work, may prevent the need for ventilatory support.
2. Yes. Ipratropium bromide is the drug of choice in COPD, including an acute exacerbation. However, a dose of 2 inhalations from the MDI may be insufficient, and should be titrated to 6-8 actuations, with a reservoir device because he is tachypneic and may have trouble coordinating breathing and actuation. A larger dose of ipratropium can be administered if the SVN solution of 500 mcg is administered.
3. A beta2 agonist, such as albuterol, pirbuterol or terbutaline should be administered by MDI with a reservoir. This should be administered at the same time as the ipratropium. In addition, this patient may well benefit from theophylline.
4. Theophylline has a weak bronchodilating effect in the airway which may help reverse his airway obstruction, and it has been shown to reduce dyspnea.
5. Question the patient on the use of theophylline prior to admission. If he does recall regular use of the drug, or any prior use, a theophylline blood level should be checked as soon as possible.
6. Optimal results, with minimal side effects will be obtained with a blood level of 10-12 mcg/ml in most patients.
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