Cardiopulmonary Pharmacology

Course Description

RET2350 – Cardiopulmonary Pharmacology is a 3-credit course on the drugs used to treat cardiac and respiratory disease: how they work, what they are for, how they are delivered, what they do wrong, and what a respiratory therapist must know to administer them safely and to recognize when they are failing.

Pharmacology occupies a particular place in respiratory care because the therapist is frequently the person who administers the drug and evaluates the response in the same encounter. A bronchodilator is given, and the therapist auscultates, measures peak flow or observes work of breathing, and decides whether it worked — often within minutes. That immediacy makes the pharmacology practical rather than theoretical, and it makes recognizing adverse effects a bedside skill rather than a chart review.

Content covers pharmacology principles — pharmacokinetics (absorption, distribution, metabolism, excretion), pharmacodynamics, receptor theory, dose-response, and drug interactions; routes of administration with emphasis on the inhaled route and its advantages; drug calculations — dosage, concentration, and dilution; the autonomic nervous system — sympathetic and parasympathetic control of the airway, which underlies most respiratory drugs; adrenergic bronchodilators — short- and long-acting beta agonists, selectivity, and adverse effects; anticholinergic bronchodilators; corticosteroids — inhaled and systemic, and the local and systemic adverse effects; anti-asthmatic and anti-inflammatory agents — leukotriene modifiers, mast cell stabilizers, and biologics; mucolytics and expectorants; surfactants; inhaled antimicrobials; cardiovascular agents — antiarrhythmics, inotropes, vasopressors, antihypertensives, diuretics, and anticoagulants; drugs used in advanced life support; sedatives, analgesics, and neuromuscular blocking agents — critical in mechanically ventilated patients; vasoactive inhaled agents including nitric oxide; drug delivery in the ventilated patient; and patient assessment and education related to drug therapy.

Offered at Florida institutions with CoARC-accredited respiratory care programs.

Learning Outcomes

Required Outcomes

• Describe pharmacokinetic and pharmacodynamic principles.
• Explain receptor theory and dose-response relationships.
• Compare routes of administration and explain the advantages of the inhaled route.
• Calculate drug dosages, concentrations, and dilutions accurately.
• Describe autonomic control of airway smooth muscle and secretions.
• Describe short-acting beta agonists including indications and adverse effects.
• Describe long-acting beta agonists and their appropriate use.
• Explain beta-2 selectivity and the consequences of loss of selectivity at high dose.
• Describe anticholinergic bronchodilators and their role.
• Describe inhaled and systemic corticosteroids and their adverse effect profiles.
• Describe leukotriene modifiers, mast cell stabilizers, and biologic agents.
• Describe mucolytics and expectorants and evaluate the evidence for them.
• Describe surfactant preparations and their administration.
• Describe inhaled antimicrobial agents and their indications.
• Describe cardiovascular drug classes and their cardiopulmonary effects.
• Describe drugs used in advanced cardiac life support and their indications.
• Describe sedatives, analgesics, and neuromuscular blocking agents used in ventilated patients.
• Explain the critical distinction between sedation and paralysis.
• Describe inhaled vasoactive agents including nitric oxide.
• Describe drug delivery considerations in mechanically ventilated patients.
• Assess patient response to drug therapy and document it.
• Recognize adverse drug reactions and respond appropriately.
• Educate patients about their respiratory medications and correct device technique.

Optional Outcomes

• Analyze a case requiring drug therapy selection and justification.
• Describe pediatric and neonatal dosing considerations.
• Describe medication reconciliation and adherence assessment.
• Describe pharmacoeconomics and formulary considerations.
• Describe emerging respiratory therapeutics.
• Complete NBRC pharmacology-focused examination review.

Major Topics

Required Topics

• Pharmacology principles — kinetics, dynamics, and terminology.
• Receptors and dose-response — agonists, antagonists, and potency.
• Routes of administration — and why inhalation is preferred.
• Drug calculations — dosage, dilution, and concentration.
• Autonomic pharmacology — sympathetic and parasympathetic airway control.
• Short-acting beta agonists — rescue therapy and adverse effects.
• Long-acting beta agonists — maintenance use and cautions.
• Beta selectivity — and cardiac effects at high dose.
• Anticholinergics — short and long acting.
• Combination therapy — and its rationale.
• Inhaled corticosteroids — role, adverse effects, and rinsing.
• Systemic corticosteroids — indications and toxicity.
• Anti-asthmatic agents — leukotriene modifiers and biologics.
• Mucolytics and expectorants — agents and the evidence.
• Surfactants — preparations and neonatal administration.
• Inhaled antimicrobials — indications and delivery.
• Antiarrhythmics — classes and cardiopulmonary implications.
• Inotropes and vasopressors — hemodynamic effects.
• Antihypertensives and diuretics — and respiratory relevance.
• Anticoagulants and thrombolytics — and pulmonary embolism.
• ACLS pharmacology — the resuscitation formulary.
• Sedation and analgesia — agents, scales, and goals.
• Neuromuscular blockade — agents, monitoring, and the paralysis-sedation distinction.
• Inhaled vasoactive agents — nitric oxide and prostacyclins.
• Delivery during mechanical ventilation — circuit placement and dosing.
• Assessment and education — evaluating response and teaching patients.

Optional Topics

• Case-based therapy selection.
• Pediatric and neonatal dosing.
• Medication reconciliation and adherence.
• Pharmacoeconomics and formulary.
• Emerging respiratory therapeutics.
• NBRC pharmacology review.

Resources & Tools

• Rau's Respiratory Care Pharmacology (Gardenhire), Elsevier — the standard text in this field and closely matched to NBRC content.
• Egan's Fundamentals of Respiratory Care — the program reference; its pharmacology chapters support this course.
• AARC Clinical Practice Guidelines — free; aerosol delivery and bronchodilator guidance grounded in evidence.
• GOLD (Global Initiative for Chronic Obstructive Lung Disease) and GINA (Global Initiative for Asthma) reports — free, updated annually, and the authoritative statements on how these drugs are actually used in practice. Read the current version, not a textbook summary.
• NBRC content outlines — free; pharmacology appears throughout the TMC examination.
• DailyMed (NIH) — free; the actual FDA-approved labeling for any drug, which is the authoritative source for dosing and adverse effects.
• A drug reference app — carry one; looking things up is professional practice, not weakness.
• Flashcards or spaced repetition — this course carries a large memorization load and spacing beats cramming decisively.

Career Pathways

• Respiratory Therapist (SOC 29-1126) — where this content is applied every shift.
• Critical Care Therapist — ventilated patients, sedation, and vasoactive agents.
• Neonatal and Pediatric Therapist — surfactant and weight-based dosing.
• Emergency Department Therapist — resuscitation pharmacology.
• Pulmonary Rehabilitation and Asthma Educator — the AE-C credential; patient education is largely medication education.
• Home Care Therapist — adherence and device technique.
• Clinical Specialist or Educator — hospital-based.
• Pharmaceutical or Device Clinical Specialist — manufacturers recruit experienced therapists.
• Transport Therapist — ground and air critical care.

Special Information

Learn drugs by class and mechanism, not as a list

The study method that determines whether this course is manageable. There are many individual agents and comparatively few mechanisms. A student who knows that beta-2 agonists relax airway smooth muscle, that selectivity is lost at high dose producing tachycardia and tremor, and that duration determines rescue versus maintenance use can reason about any agent in the class — including one introduced after they graduate.

The productive structure for each class: mechanism, indication, route and onset, adverse effects, and what you assess to know it worked. That last item is the respiratory therapist's distinctive contribution and is what examinations actually test — not the drug's name but what you do after giving it.

⚠ The inhaled route is the field's central pharmacologic advantage — and its weak point

Worth understanding as a principle rather than a detail. Delivering a drug directly to the airway achieves therapeutic effect at a small fraction of the systemic dose, with correspondingly fewer systemic adverse effects — which is why respiratory pharmacology looks the way it does.

The vulnerability is that delivery is technique-dependent. Particle size determines deposition; breathing pattern determines where the drug lands; a poorly used inhaler deposits most of the dose in the oropharynx. In ventilated patients, circuit position, humidity, and timing with inspiration all change delivered dose substantially. The therapist's job is therefore not merely to administer but to ensure the drug arrives — and a large share of apparent treatment failure is delivery failure rather than pharmacologic failure.

⚠ Paralysis is not sedation — and confusing them is a patient-harm event

The most serious single point in the cardiovascular and critical care portion of this course. Neuromuscular blocking agents prevent movement; they provide no sedation, no analgesia, and no amnesia. A paralyzed patient who is inadequately sedated is awake, aware, unable to move or signal, and frequently in pain — an experience patients who have had it describe as terrifying, and one associated with lasting psychological harm.

The professional obligations are absolute: sedation and analgesia must be established and maintained before and during paralysis; sedation depth must be monitored and cannot be judged from movement; and a respiratory therapist who notices that a paralytic is running without adequate sedation must say so immediately. This is a recognized never-event category, and it is one where a therapist at the bedside is well positioned to catch the error.

Steroid mouth rinsing, and other small things that matter

A collection of practical points that patients are rarely told and therapists should be teaching:

• Rinse and spit after inhaled corticosteroids — it substantially reduces oral candidiasis and dysphonia, and most patients are never told.
• Bronchodilator before airway clearance or other inhaled therapy where indicated — order of administration matters.
• Rescue versus maintenance — patients confuse their inhalers constantly, and a patient using a long-acting maintenance inhaler as a rescue medication is both untreated and at risk. Increasing rescue inhaler use is a warning sign of deteriorating control, not a solution.
• Spacers — they improve delivery and reduce oropharyngeal deposition, and are underused.

These are low-cost, high-value interventions, and they are squarely within the therapist's role.

Evidence matters here, and some traditional therapies do not hold up

Worth knowing so a student can practice thoughtfully. Respiratory care has historically included therapies whose evidence base is weaker than their usage suggests — certain mucolytics, routine bland aerosol, and some airway clearance applications among them — and the profession has moved toward protocol-driven, evidence-based practice partly to address this.

The professionally valuable stance is to know both what is ordered and what the evidence supports, and to be able to discuss it. GOLD and GINA are updated annually, are free, and are the authoritative statements on COPD and asthma pharmacotherapy; a therapist who reads the current version knows more about appropriate therapy than a textbook edition can convey. Therapist-driven protocols exist precisely because respiratory therapists who reason from evidence produce better outcomes than order-following does.

Pharmacology is heavily represented on the boards

Practical examination advice. Pharmacology appears throughout the NBRC TMC examination and in clinical simulation, usually not as recall questions but embedded in scenarios — a patient with these findings receiving this drug, what do you do. That format rewards the mechanism-and-assessment structure described above and punishes rote memorization of drug names.

Begin structured review during this course rather than after it, and use the NBRC content outline to target study. Programs with strong pass rates typically start comprehensive review well before the final term, and pharmacology is one of the areas where early, spaced study pays off most because the material is cumulative and detailed.

Numbering and program context

Florida carries respiratory pharmacology as RET2350 and related numbers, with RET4354 (Advanced Pharmacology) appearing in bachelor's completion programs. It typically follows cardiopulmonary anatomy and physiology (RET1485C) and the fundamentals courses, and supports mechanical ventilation (RET1264C/RET1265C), life support (RET2244C), and the clinical practice sequence. Note that this course carries no laboratory — there is no C suffix — which distinguishes it from most of the RET sequence. SCNS equivalency applies to the same number at the same level, never across numbers, and respiratory coursework rarely transfers mid-sequence because clinical competencies track a specific CoARC-accredited plan.