Advanced Pharmacology

Course Description

Advanced Pharmacology extends cardiopulmonary pharmacology to the drug classes, mechanisms, and clinical decisions encountered by an experienced respiratory therapist — particularly in critical care, where patients receive multiple interacting agents and where the therapist's assessment informs how they are titrated.

Within the SCNS taxonomy, RET is the Respiratory Care prefix. Daytona State's course index lists RET4354 under the title "Advanced Pharmacology", and its 4000-level number places it in the upper-division bachelor of applied science sequence.

⚠⚠ The catalog detail page for this course could not be retrieved

Daytona State's course index confirms this course number and title, but the catalog page carrying its description, credit value, prerequisites, and terms of offering did not resolve at the time this guide was written. The outcomes and topics below are therefore indicative rather than transcribed from a published outline, derived from the course title, its 4000-level placement, and its relationship to the live lower-division RET2350 (Cardiopulmonary Pharmacology, 3 credits / 45 hours). The credit value and contact hours shown here follow that course and the prefix's lecture convention, and are an estimate.

⚠ Confirm the syllabus, credit value, prerequisites, and terms of offering with the programme before relying on any of this.

Pharmacology is where respiratory therapists most directly affect a patient's physiology, and in critical care the interactions matter as much as the individual agents. A sedated, ventilated patient may be receiving sedatives, analgesics, neuromuscular blockers, vasoactive agents, and bronchodilators simultaneously — and the therapist assessing that patient's readiness to wean needs to understand what each of those is doing to the respiratory drive they are measuring.

Daytona State does not publish a lecture and laboratory split for its RET courses. The prefix runs at three conventions: unsuffixed lecture courses at 15 contact hours per credit (RET1295 and RET2350 at 3 credits and 45 hours, RET2483 at 2 credits and 30), C-suffixed courses at 20 (RET1025C, RET1026C, RET1264C and RET1450C all at 3 credits and 60 hours), and clinical practice at 60 (RET1874 at 4 credits and 240 hours, RET1875 at 3 and 180). This course is unsuffixed and lecture-based, and is priced at the lecture convention.

Learning Outcomes

Required Outcomes

• Describe pharmacokinetics and pharmacodynamics as applied to critical care.
• Describe drug absorption, distribution, metabolism, and excretion in the critically ill.
• Describe how organ dysfunction alters drug handling.
• Describe aerosol drug delivery and the factors affecting deposition.
• Compare delivery devices and their efficiency.
• Describe bronchodilators, their classes, and their mechanisms.
• Describe anti-inflammatory agents used in airway disease.
• Describe mucoactive agents and their appropriate use.
• Describe agents used in pulmonary hypertension.
• Describe surfactant preparations and their administration.
• Describe sedatives and analgesics used in mechanical ventilation.
• Describe the effect of sedation on respiratory drive and weaning.
• Describe neuromuscular blocking agents and their monitoring.
• Describe the hazards of neuromuscular blockade and the safeguards required.
• Describe vasoactive and inotropic agents at an awareness level.
• Describe medications used in advanced life support.
• Describe antimicrobial considerations relevant to respiratory infection.
• Describe anticoagulation relevant to pulmonary embolism.
• Identify clinically significant drug interactions.
• Recognise adverse drug reactions and respond appropriately.
• Describe high-alert medications and the controls applied to them.
• Perform dosage calculations accurately.
• Describe the therapist's role and its limits in medication administration.
• Document medication administration and patient response accurately.

Optional Outcomes

• Describe inhaled antimicrobial and specialty agents.
• Describe emerging biologic therapies in airway disease.
• Describe medication use in neonatal and paediatric patients.
• Describe pharmacogenomics at an awareness level.
• Describe protocol-driven therapy and its evidence.
• Describe medication stewardship and cost considerations.

Major Topics

Required Topics

• Pharmacokinetics and pharmacodynamics in critical care
• Drug handling in the critically ill
• Organ dysfunction and drug handling
• Aerosol delivery and deposition
• Delivery device comparison
• Bronchodilators
• Anti-inflammatory agents
• Mucoactive agents
• Pulmonary hypertension agents
• Surfactant
• Sedatives and analgesics in ventilation
• Sedation, respiratory drive, and weaning
• Neuromuscular blocking agents
• Hazards of neuromuscular blockade
• Vasoactive and inotropic agents
• Advanced life support medications
• Antimicrobials in respiratory infection
• Anticoagulation
• Drug interactions
• Adverse drug reactions
• High-alert medications
• Dosage calculation
• Scope and limits in administration
• Documentation

Optional Topics

• Inhaled antimicrobials and specialty agents
• Biologic therapies
• Neonatal and paediatric medication
• Pharmacogenomics
• Protocol-driven therapy
• Medication stewardship

Resources & Tools

• Egan's Fundamentals of Respiratory Care — the standard text of the profession and the one to keep.
• Pilbeam's Mechanical Ventilation — the standard ventilation reference.
• NBRC (nbrc.org) — free examination content outlines and eligibility rules; read the eligibility page before enrolling anywhere.
• CoARC (coarc.com) — free accreditation lookup and programme outcome data, including credentialing success rates.
• AARC (aarc.org) — the American Association for Respiratory Care; clinical practice guidelines and inexpensive student membership.
• Florida Board of Respiratory Care (floridasrespiratorycare.gov) — free; the authority on Florida licensure.
• American Heart Association — BLS, ACLS, and PALS provider courses; hold current certification before you need it for a job application.
• Your clinical preceptors — the most valuable resource in the programme; ask why, not just how.
• Rau's Respiratory Care Pharmacology — the standard pharmacology text for this profession.
• Institute for Safe Medication Practices (ismp.org) — free; its high-alert medication lists and error reports are the best available material on how medication harm actually happens.

Career Pathways

• Respiratory therapist — SOC 29-1126.
• Hospital adult critical care — the largest employment setting and the highest acuity.
• Emergency department and rapid response.
• Neonatal and paediatric intensive care — a demanding speciality with its own credential.
• Pulmonary function laboratory and diagnostics.
• Sleep medicine and polysomnography — a related pathway with its own credential.
• Cardiopulmonary rehabilitation.
• Home care and long-term ventilator management — a growing sector.
• Transport and flight respiratory care — higher acuity and higher pay.
• Patient and community education — asthma, COPD, and smoking cessation programmes.
• Clinical education and programme instruction, and management, after experience.
• Continue to a bachelor's or master's — increasingly expected for leadership and education roles.

Special Information

⚠⚠ Neuromuscular blockade — the error class that terrifies clinicians, correctly

• A neuromuscular blocking agent paralyses the patient without sedating them. Given to a conscious or inadequately sedated patient, it produces complete paralysis with full awareness and the inability to breathe or signal — among the most distressing harms in medicine.
• These agents are high-alert medications with specific storage, labelling, and independent double-check requirements, and those controls exist because of documented fatal errors.
• ⚠ Sedation must be established and maintained before and throughout paralysis, and it must be assessed by a method that does not rely on movement — because a paralysed patient cannot demonstrate distress.
• A paralysed patient is entirely dependent on the ventilator. Disconnection, tube displacement, or equipment failure is immediately fatal, and alarms must never be silenced without addressing the cause.
• Monitor depth of blockade where the protocol requires it, and understand what the monitoring is telling you.
• Know the reversal agents and their limitations.
• Never assume a paralysed patient is unaware. Speak to them, explain, and treat them as conscious unless sedation is verified.
• Report any concern about inadequate sedation immediately — this is exactly the situation where speaking up matters most.

⚠ Delivery device and technique determine how much drug reaches the lung

• An aerosolised drug is only as effective as its deposition, and a large fraction of a nominal dose routinely never reaches the airway at all.
• Device, interface, particle size, breathing pattern, and technique all change deposition substantially — which means the same prescription delivers very different doses depending on how it is given.
• In ventilated patients, circuit position, humidity, and the endotracheal tube itself all affect delivery, and settings can be adjusted to improve it.
• Check technique in spontaneously breathing patients every time. Poor inhaler technique is extremely common and it is invisible unless you look.
• A spacer improves delivery substantially with a metered-dose inhaler, and many patients have never been given one or shown how to use it.
• Assess the response, not just the administration. The clinical question is whether the patient improved, not whether the treatment was given.
• Document what was delivered, how, and what happened.
• ⚠ Escalate rather than repeating an ineffective treatment. A patient not responding to bronchodilator needs reassessment, not another identical dose.

⚠⚠ Respiratory care is a high-acuity role — the interventions are immediately life-sustaining

• Respiratory therapists manage airways, ventilators, and oxygen delivery for patients who cannot breathe adequately for themselves. The margin between a correct and an incorrect intervention is measured in minutes.
• You will be called to emergencies. Codes, rapid responses, and intubations are part of the role, and the respiratory therapist is frequently the airway person in the room.
• Ventilator settings are prescribed within a plan of care, and the therapist's assessment informs them. Know your institution's protocols and the limits of what you may adjust independently.
• ⚠ Oxygen is a drug. It is prescribed, it has indications and hazards, and too much can be as harmful as too little in specific patient groups. Titrating without understanding why is dangerous.
• Escalate rather than wait. A deteriorating patient needs the physician now, and hesitating to call is a recurring contributor to poor outcomes.
• Document assessments, settings, and responses accurately and contemporaneously; the ventilator record is a clinical and legal document.
• Infection control is central — you work with airways and secretions, and ventilator-associated pneumonia is a measured, preventable harm.
• Speak up about safety concerns, including to senior clinicians. The therapist is frequently the person who notices the airway problem first.

⚠⚠ Credentialing and licensure — verify before you enrol

• The recognised credentials are the CRT and RRT, awarded by the National Board for Respiratory Care (NBRC). The RRT is the standard for hospital employment, and many employers will not hire at the CRT level.
• ⚠⚠ Eligibility to sit those examinations requires graduation from a programme accredited by CoARC (the Commission on Accreditation for Respiratory Care). Confirm a programme's accreditation before enrolling — the same trap already recorded here for CAPTE, CAAHEP, and ACOTE, and equally unrecoverable afterwards.
• Florida licenses respiratory therapists under Chapter 468, Part V, Florida Statutes, through the Department of Health's Board of Respiratory Care. Licensure follows credentialing, and practising without a licence is an offence.
• Specialty credentials exist — neonatal/paediatric, sleep, pulmonary function, and adult critical care among them — and they raise both capability and pay.
• Life support certifications are separate and expected: BLS always, and ACLS, PALS, and NRP depending on the setting. Many employers require them at hire or within a defined period.
• Licences renew with continuing education on a defined cycle.
• Background screening and health clearance are required for clinical placement and for licensure, and a criminal record can end this pathway before it starts — raise any concern early and privately.
• ⚠ Rule 11 applies. Verify accreditation, examination eligibility, and licensure requirements with CoARC, the NBRC, and the Florida Board rather than relying on this guide.

How Florida course levels affect transfer

The first digit of an SCNS number denotes the year of offering, not transferability. Courses at the 1000 and 2000 levels transfer transparently between Florida public institutions, and 3000 to 4000 is unproblematic since both are upper division. The boundary that actually matters is 2000 to 3000, where lower-division credit generally cannot satisfy an upper-division requirement — and it is live here, since Daytona State offers both associate-level and bachelor of applied science coursework in this prefix.

⚠ The credit value and contact hours shown for RET4354 are an estimate, derived from the live RET2350 (Cardiopulmonary Pharmacology, 3 credits / 45 hours) and the prefix's lecture convention. Daytona State's catalog detail page for this course could not be retrieved, so its description, prerequisites, and terms of offering are unconfirmed.

Confirm all of it with the programme. See this repository's RET2350 guide for the lower-division pharmacology course.