CONTENTS UNIT ONE Basic Concepts and Principles UNIT THREE Critical Care, Cardiovascular, in Pharmacology, 1 and Polysomnography Agents, 298 1 Introduction to Respiratory Care Pharmacology, 2 18 Skeletal Muscle Relaxants (Neuromuscular Blocking 2 Principles of Drug Action, 11 Agents), 299 3 Administration of Aerosolized Agents, 31 19 Diuretic Agents, 313 4 Calculating Drug Doses, 65 20 Drugs Affecting the Central Nervous System, 325 5 Central and Peripheral Nervous Systems, 76 21 Vasopressors, Inotropes, and Antiarrhythmic Agents, 343 UNIT TWO Drugs Used to Treat the 22 Drugs Affecting Circulation: Antihypertensives, Respiratory System, 95 Antianginals, Antithrombotics, 367 6 Adrenergic (Sympathomimetic) Bronchodilators, 96 23 Sleep and Sleep Pharmacology, 399 7 Anticholinergic (Parasympatholytic) Bronchodilators, 119 Appendix A: Units and Systems of Measurement, 417 Appendix B: Acceptable Mixtures of Most Commonly 8 Xanthines, 135 Prescribed Respiratory Care Drugs, 421 9 Mucus-Controlling Drug Therapy, 145 Glossary of Selected Terms, 422 10 Surfactant Agents, 171 11 Corticosteroids in Respiratory Care, 181 12 Nonsteroidal Antiasthma Agents, 200 13 Aerosolized Antiinfective Agents, 217 14 Antimicrobial Agents, 236 15 Cold and Cough Agents, 263 16 Selected Agents of Pulmonary Value, 272 17 Neonatal and Pediatric Aerosolized Drug Therapy, 285 YOU’VE JUST PURCHASED MORE THAN A TEXTBOOK ACTIVATE THE COMPLETE LEARNING EXPERIENCE THAT COMES WITH YOUR BOOK BY REGISTERING AT http://evolve.elsevier.com/Gardenhire/Rau/respiratory/ Once you register, you will have access to your FREE STUDY TOOLS: • General Resources • Flashcards • Prepare for Class, Clinical, or Lab • Audio glossary • S tudent lecture notes • Content Updates • Additional Resources • Clinical Scenario Answer Keys • Self Assessment Question Answer Keys • Weblinks • Answer Keys for the Workbook for Rau’s Respiratory Care Pharmacology, eighth edition REGISTER TODAY! This page intentionally left blank DOUGLAS S. GARDENHIRE, EdD, RRT-NPS Director of Clinical Education Division of Respiratory Therapy School of Health Professions Georgia State University Atlanta, Georgia 3251 Riverport Lane St. Louis, Missouri 63043 RAU’S RESPIRATORY CARE PHARMACOLOGY, EIGHTH EDITION ISBN: 978-0-323-07528-2 Copyright © 2012, 2008, 2002, 1998, 1994, 1989, 1984, 1978 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). Notices Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary. Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility. With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. Library of Congress Cataloging-in-Publication Data Gardenhire, Douglas S. Rau’s respiratory care pharmacology. -- 8th ed. / Douglas S. Gardenhire. p. ; cm. Includes bibliographical references and index. ISBN 978-0-323-07528-2 (pbk. : alk. paper) 1. Respiratory agents. 2. Respiratory therapy. I. Rau, Joseph L. Respiratory care pharmacology. II. Title. III. Title: Respiratory care pharmacology. [DNLM: 1. Respiratory Therapy. 2. Bronchodilator Agents--pharmacology. WB 342] RM388.R383 2012 615.8’36--dc23 2011017256 Managing Editor: Billie Sharp Senior Developmental Editor: Kathleen Sartori Publishing Services Manager: Julie Eddy Senior Project Manager: Laura Loveall Project Manager: Janaki Srinivasan Designer: Kim Denando Printed in China Last digit is the print number: 9 8 7 6 5 4 3 2 1 To all persons that support the pursuit of education, education is life. This page intentionally left blank CONTRIBUTORS Prasad Abraham, PharmD, BCPS Leah Crow, PharmD, BCPS Marian A. James, PharmD Critical Care Clinical Pharmacy Clinical Pharmacist Specialist—Internal Geriatric Pharmacotherapy Resident Specialist Medicine Kingsbrook Jewish Medical Center Department of Pharmacy and Drug Department of Pharmacy Brooklyn, New York Information Kingsbrook Jewish Medical Center Chapter 22: Drugs Affecting Circulation: Grady Health System Brooklyn, New York Antihypertensives, Antianginals, Anti- Atlanta, Georgia Chapter 22: Drugs Affecting Circulation: thrombotics Chapter 18: Skeletal Muscle Relaxants Antihypertensives, Antianginals, Anti- (Neuromuscular Blocking Agents) thrombotics Saira C. Khalique, PharmD Clinical Pharmacy Specialist—Critical Antonia Alafris, BS, PharmD, CGP Michael J. Decker, PhD, RN, RRT, Care Medicine Associate Director of Pharmacotherapy D ABSM Department of Pharmacy Services Associate Professor Kingsbrook Jewish Medical Center Pharmacy Residency Programs Byrdine F. Lewis Chair Clinical Assistant Professor of Pharmacy Kingsbrook Jewish Medical Center Byrdine F. Lewis School of Nursing Practice Brooklyn, New York Georgia State University Arnold & Marie Schwartz College of Chapter 22: Drugs Affecting Circulation: Atlanta, Georgia Pharmacy and Health Sciences Antihypertensives, Antianginals, Anti- Chapter 23: Sleep and Sleep Pharmacology Long Island University thrombotics Brooklyn, New York Lorena M. Fernandez-Restrepo, MD Chapter 21: Vasopressors, Inotropes, and Arzu Ari, PhD, RRT, PT, CPFT Pediatric Resident (PGY-3) Antiarrhythmic Agents Associate Professor Department of Pediatrics Division of Respiratory Therapy The University of Texas Health Science Amanda Lin, PharmD School of Health Professions Center at San Antonio Clinical Pharmacist Specialist—Geriatric Georgia State University San Antonio, Texas Pharmacotherapy Atlanta, Georgia Chapter 19: Diuretic Agents Department of Pharmacy Services Chapter 3: Administration of Aerosol- Kingsbrook Jewish Medical Center ized Agents James B. Fink, PhD, RRT, FAARC, Brooklyn, New York FCCP Chapter 22: Drugs Affecting Circulation: Henry Cohen, PharmD, MS, FCCM, Associate Professor Antihypertensives, Antianginals, Anti- BCPP, CGP Division of Respiratory Therapy thrombotics Professor of Pharmacy Practice School of Health Professions Arnold & Marie Schwartz College of Georgia State University Michael Liu, PharmD Pharmacy and Health Sciences Atlanta, Georgia Critical Care Pharmacotherapy Resident Long Island University Chapter 9: Mucus-Controlling Drug (PGY-2) Chief Pharmacotherapy Officer Therapy Department of Pharmacy Director of Pharmacy Residency Pro- Kingsbrook Jewish Medical Center grams (PGY-1 and PGY-2) Markus O. Henke, MD Clinical Assistant Professor of Pharmacy Department of Pharmacy Services Department of Pulmonary Medicine Practice Kingsbrook Jewish Medical Center Internal Medicine Arnold & Marie Schwartz College of Brooklyn, New York Philipps University Marburg Pharmacy and Health Sciences Editor-in-Chief Marburg, Germany Long Island University Journal of Pharmacy Practice Chapter 9: Mucus-Controlling Drug Brooklyn, New York Sage Publishing Therapy Chapter 21: Vasopressors, Inotropes, and Thousand Oaks, California Antiarrhythmic Agents Chapter 21: Vasopressors, Inotropes, and Sandra Hinski, MS, RRT-NPS Antiarrhythmic Agents Faculty, Respiratory Care Division Chapter 22: Drugs Affecting Circulation: Gateway Community College Antihypertensives, Antianginals, Anti- Phoenix, Arizona thrombotics vii viii CONTRIBUTORS Bishoy Luka, PharmD, BCNSP Susan L. Pendland, MS, PharmD Bruce K. Rubin, MEngr, MD, MBA, Clinical Assistant Director of Pharmacy Clinical Staff Pharmacist FRCPC Department of Pharmacy Services St. Joseph Berea Hospital Jessie Ball duPont Professor and Chair Queens Hospital Center Adjunct Associate Professor Department of Pediatrics Jamaica, New York University of Illinois at Chicago College Professor of Biomedical Engineering Chapter 21: Vasopressors, Inotropes, and of Pharmacy Virginia Commonwealth University Antiarrhythmic Agents Chicago, Illinois School of Medicine Community-Based Faculty Member Richmond, Virginia Catherine A. Millares, PharmD, University of Kentucky College of Chapter 9: Mucus-Controlling Drug Therapy CGP, BCPS Pharmacy Coordinator of Geriatric Pharmaco- Lexington, Kentucky Christopher A. Schriever, PharmD, MS therapy Chapter 14: Antimicrobial Agents Clinical Assistant Professor Kingsbrook Jewish Medical Center University of Illinois—Chicago Clinical Associate Professor of Phar- Ruben D. Restrepo, MD, RRT, College of Pharmacy, Rockford Campus macy Practice FAARC Rockford, Illinois Arnold & Marie Schwartz College of Distinguished Teaching Professor Chapter 14: Antimicrobial Agents Pharmacy University of Texas Health Science Cen- Brooklyn, New York ter at San Antonio Christopher M. Sinton, PhD Chapter 22: Drugs Affecting Circulation: San Antonio, Texas Department of Internal Medicine Antihypertensives, Antianginals, Anti- Chapter 17: Neonatal and Pediatric University of Texas Southwestern Med- thrombotics Aerosolized Drug Therapy ical Center at Dallas Chapter 19: Diuretic Agents Dallas, Texas S. R. Pandi-Perumal, MSc Chapter 23: Sleep and Sleep Pharmacology President and CEO Somnogen, Inc. Toronto, Ontario, Canada Chapter 23: Sleep and Sleep Pharmacology