Asthma

and Respiratory Drugs

→ Asthma: reversible airway obstruction d/t hyper-reactivity, airway inflammation, mucous plugs, and smooth mm. hypertrophy
→ Observe for exacerbation of asthma, COPD, and peptic ulcer after giving cholinomimetic agents
→ Asthma medications for exacerbation! ASTHMA: Albuterol, Steroids, Theophylline, Humidifier O2, Mg2+, Anticholinergics
→ COPD treatment!COPD: Corticosteroids, oxygen, prevention control, dilators
→ Drugs that may cause pulm fibrosis! amiodarone, busulfan, bleomycin, carmustine, methotrexate, nitrofurantoin
Drug Name Class Description MOA Uses Adverse Effects Other

Short Acting β2 -DOC for acute relief of bronchospasm

Albuterol
agonist -Prevent exercise-induced bronchoconstriction Tremors
Pirbuterol
↑cAMP!relaxation of bronchial for 2-4hrs Tachycardia high doses:
Terbutaline nonspecific ß
Rapid onset smooth muscle!bronchodilation -Acute COPD/asthma attacks Arrhythmia
ß2 Adrenergic
-Long term control and prevention of sxs in
Hyperglycemia Genetic
Bronchodilators

Agonists Long Acting β2 Inhalation minimizes systemic polymorphism in β2

moderate-severe asthma/COPD when used in
Salmeterol agonist side effects (poorly absorbed via Tolerance w/ excessive use receptors! risk of
combo w/ inhalational corticosteroids
Formoterol the lungs) worsening asthma,
-Prevent exercise-induced bronchoconstriction
Slow onset Paradoxical bronchospasm exacerbations,
for 12-24hrs
death
-Asthma -Dry mouth Poor systemic
Short acting Competitively Blocks PSN!
Ipratropium M3 Muscarinic -Prevents vagal mediated bronchoconstriction -Caution in pts with glaucoma, absorption
inhalant ↓bronchoconstriction &
Antagonists and drug induced bronchospasm BPH and bladder neck
↓mucous secretion
Tiotropium Long acting COPD obstruction Duration: several hrs
Inhibits PDE Inhibit phosphodiesterase! Tremor, Insomnia, GI distress CYP inducers
Asthma; limited role d/t small therapeutic
Theophylline Methylxanthine ↑cAMP! bronchodilation Hypokalemia ↓effect
window
Aminophylline derivatives Blocks adenosine Hyperglycemia CYP inhibitors
Prophylactic against nocturnal attacks!
receptor Oral slow release lasts 12hrs Seizures & arrhythmias ↑effect
Beclomethasone Inhibit PLA2!↓ arachidonic DOC for prophylaxis of asthma Cough
Inhaled steroid Prevent remodeling
Fluticasone acid!↓ synthesis of -Acute exacerbation: oral glucocorticoids Oral thrush
use in the txt of of respiratory tract
Budesonide leukotrienes, cytokines, and -dexamethasone and prednisolone in status Dysphonia
chronic asthma
Flunisolide prostaglandins asthmaticus (Severe refractory asthma) Pharyngeal candidiasis
Corticosteroids
Anti-Inflammatory Agents

↓need for β2
-TXT chronic rhinitis (beclomethasone and
Abnormal glucose metabolism agonist
Dexamethasone IV steroids Bind to glucocorticoid response flunisolide)!effects not seen for 2 wks
↑appetite, weight gain, HTN,
Prednisolone (systemic) elements (GREs) in the -Dexamethasone before birth for prophylaxis of
adrenal suppression ↑ β2 responsiveness
nucleus!↓inflammation RDS
Inhibits 5-
Zileuton Oral administration!block Elevated liver enzymes
lipoxygenase -Prevent exercise-induced asthma up to 24hrs in Not beneficial in
Leukotriene synthesis of LTs or block LT
50% of patients Vasculitis and systemic acute
Zafirlukast Inhibitors LTD4 receptor receptors!↓inflammation and
-Prevent antigen and aspirin induced asthma eosinophilia resembling bronchospasm
Montelukast antagonist ↓bronchoconstriction
Churg-Strauss (rare)
Binds to IgE on sensitized mast -Prophylactic mgmt. of severe refractory asthma
Expensive;
Omalizumab Antibody cells!prevent activation and when inhaled corticosteroids are inadequate (pts Anaphylaxis
parenteral
release of LTs + other mediators older than12)
Infrequent laryngeal edema
Unknown!↓release of Ophthalmic, nasopharyngeal and Cough Inhaled aerosol
Cromolyn Release Possibly mast cell
mediators from mast cells gastrointestinal allergy Wheezing lasting 3-6hours
Nedocromil inhibitors stabilizers
Not for acute attacks Rarely used for prophylaxis of asthma Nedocromil!unpleasant
taste
Codeine Act via G-proteins!depress CNS Acute debilitating cough (Wakes up from sleep)
Opioids Cough Lasts 30min-1hr
Dextromethorphan cough center ↓cough reflex
medications!
Cough and Rhinitis

N-acetylcysteine Mgmt. of acetaminophen OD

Mucolytic agent antitussives Breaks disulfide bonds in mucus
(NAC) CF
Hay fever, angioedema, motion sickness, oral
Diphenhydramine Sedation and anticholinergic
1st generation OTC sleep aide, parenteral for dystonias Lasts 6-8hrs
Chlorpheniramine Competitive H1 effects
Allergic rhinitis
H1 antagonist inhibitors!blocks histamine
Loratadine
release Hay fever, angioedema Oral admin.
Fexofenadine 2nd generation
Allergic rhinitis Lasts 12-24hrs
Cetirizine
Decongestant HTN Oral, inhalant, or
Phenylephrine α-agonist Nonspecific Binds to α1 and α2 receptors Mydriasis Stroke parenteral
Neurogenic hypotension MI Lasts 15min-1hr