PHARMACOLOGY – DRUGS ACTING ON THE RESPIRATORY SYSTEM

SELECT PROTOTYPE MEDICATION: Albuterol

 OTHER MEDICATIONS
 Formoterol
 Levalbuterol
 Salmeterol
 Terbutaline

PURPOSE: expected pharmacological action  Beta2 adrenergic agonists act by selectively activating the beta2 receptors in the bronchial smooth
muscle, resulting in bronchodilation. As a result of this:

 Bronchospasm is relieved.
 Histamine release is inhibited.
 Ciliary motility is increased.

THERAPEUTIC USES

DRUG ROUTE THERAPEUTIC USES

Albuterol, - Inhaled, short-acting - Inhaled, short-acting prevention of asthma episode (exercise-induced)
levalbuterol - Oral, long-acting Inhaled, short-acting treatment for bronchospasm and asthma
(albuterol) - Oral, long-acting, long-term control of asthma
Formoterol, Inhaled, long-acting Long-term control of asthma
salmeterol
Terbutaline Oral, long-acting Long-term control of asthma
COMPLICATIONS: Tachycardia, angia, tremors

 Know the dosage schedule (if the medication is to be taken on a fixed or asneeded schedule).

Methylxanthines

SELECT PROTOTYPE MEDICATION: Theophylline

PURPOSE  EXPECTED PHARMACOLOGICAL ACTION

 Relaxation of bronchial smooth muscle, resulting in bronchodilation

 Once the first-line medication for asthma, now used infrequently because newer medications are safer and more effective

THERAPEUTIC USES: Oral theophylline is used for long-term control of chronic asthma or COPD.

ROUTE OF ADMINISTRATION: Oral or IV (emergency use only)

COMPLICATIONS

 Mild toxicity reaction can include GI distress and restlessness.

 More severe reactions can occur with higher therapeutic levels and can include dysrhythmias and seizures.
 Inhaled Anticholinergics

SELECT PROTOTYPE MEDICATION: Ipratropium

OTHER MEDICATIONS: Tiotropium

PURPOSE

EXPECTED PHARMACOLOGICAL ACTION: Block muscarinic receptors of the bronchi, resulting in bronchodilation

THERAPEUTIC USES

 Relieve bronchospasm associated with COPD

 Allergen-induced and exercise-induced bronchospasm
 Ipratropium is FDA approved only for bronchospasm associated with COPD, though is often used off-label for asthma and is part of the
evidence-based guidelines for asthma management
 ROUTE OF ADMINISTRATION: Inhalation

COMPLICATIONS

 Local anticholinergic effects

 Dry mouth, hoarseness

Glucocorticoids

SELECT PROTOTYPE MEDICATIONS

Inhalation: beclomethasone

Oral: prednisone

Others:

 Inhalation:
o Budesonide
o Budesonide and formoterol
o Fluticasone and salmeterol
o Fluticasone
o Mometasone and formoterol
 Oral: prednisolone
 IV: Hydrocortisone, Methylprednisolone

EXPECTED PHARMACOLOGICAL ACTION

Prevent inflammation, suppress airway mucus production, and promote responsiveness of beta2 receptors in the bronchial tree

Reduction in airway mucosa edema

 The use of glucocorticoids does not provide immediate effects, but rather promotes decreased frequency and severity of exacerbations and acute
attacks.

THERAPEUTIC USES

 Short-term IV agents are used for status asthmaticus.

 Inhaled agents are used for long-term prophylaxis of asthma.
 Short-term oral therapy is used to treat manifestations following an acute asthma episode.
 Long-term oral therapy is used to treat chronic, severe asthma.
 Promote lung maturity and decrease respiratory distress in fetuses at risk for preterm birth

COMPLICATIONS

 BECLOMETHASONE  Difficulty speaking, hoarseness, and candidiasis

Prednisone

Prednisone when used for 10 days or more can result in:

 Suppression of adrenal gland function

 Bone Loss
 Hyperglycemia And Glycosuria
  Peptic Ulcer Disease
 Infection
 Disturbances of fluid and electrolytes
 Additional adverse effects

Leukotriene Modifiers

SELECT PROTOTYPE MEDICATION: Montelukast

Others: Zileuton, Zafirlukast

EXPECTED PHARMACOLOGICAL ACTION  Leukotriene modifiers suppress the effects of leukotrienes, thereby reducing inflammation,
bronchoconstriction, airway edema, and mucus production.

THERAPEUTIC USES: Long-term therapy of asthma in adults and children, and to prevent exercise-induced bronchospasm

 Montelukast is used in children as young as 12 months of age.

 Zafirlukast is used in children age 5 years and up.
 Zileuton is used in adolescents and adults.

ROUTE OF ADMINISTRATION: Oral

COMPLICATIONS

 Depression, suicidal ideation

 Liver injury with use of zileuton and zafirlukast
 UPPER RESPIRATORY DISORDERS

The medications in this section work on the CNS, nasal passages, or other parts of the respiratory system to treat the effects of allergic or nonallergic
rhinitis or coughs from the common cold, influenza, and other disorders. Antihistamines, often prescribed for allergic rhinitis, are also used to treat
nausea, motion sickness, allergic reactions, and insomnia. Medications in this section are frequently combined for increased effectiveness. For
example, an antitussive is combined with an expectorant to reduce a cough.

Antitussives: Opioids

SELECT PROTOTYPE MEDICATION: Codeine

OTHER MEDICATION: Hydrocodone

EXPECTED PHARMACOLOGICAL ACTION  Codeine suppresses cough through its action on the central nervous system to increase cough
threshold.

THERAPEUTIC USES: Codeine is used for chronic nonproductive cough to decrease the frequency and intensity.

COMPLICATIONS

 CNS effects
 Dizziness, lightheadedness, drowsiness, respiratory depression
 GI distress (nausea, vomiting, constipation)
 Opioid use disorder

Antitussives: Non-opioids

SELECT PROTOTYPE MEDICATION: Dextromethorphan (found in many different products for cough)

Others: Benzonatate, Diphenhydramine

PURPOSE

EXPECTED PHARMACOLOGICAL ACTION: Dextromethorphan suppresses cough through its action on the CNS. Although not an opioid, it is
derived from opioids.

THERAPEUTIC USES

 Cough suppression
 Can reduce pain when combined with an opioid

COMPLICATIONS  This medication has few adverse effects. Some mild nausea, dizziness, and sedation can occur. There is some potential for
abuse as the medication can instill euphoria in high doses.

Expectorants

SELECT PROTOTYPE MEDICATION: Guaifenesin

Guaifenesin is an expectorant and has mucolytic properties, so clients should take this medication with a full glass of water.

EXPECTED PHARMACOLOGICAL ACTION: Guaifenesin promotes increased cough production by increasing and thinning mucous secretions.
These actions allow clients to decrease chest congestion by coughing out secretions.

THERAPEUTIC USES: Although guaifenesin is available as an expectorant alone, it is often combined with antitussives (either opioid or non-
opioid) or a decongestant for treating manifestations of colds, allergic or nonallergic rhinitis, or for cough caused by lower respiratory disorders.

COMPLICATIONS

 GI upset
 Drowsiness, dizziness
 Allergic reaction (rash)

Mucolytics

SELECT PROTOTYPE MEDICATION: Acetylcysteine

Others: Hypertonic saline

EXPECTED PHARMACOLOGICAL ACTION: Mucolytics thin and enhance the flow of secretions in the respiratory passages.

THERAPEUTIC USES
 o Mucolytics are used in clients who have acute and chronic pulmonary disorders exacerbated by large amounts of secretions.
o Mucolytics are used in clients who have cystic fibrosis.
o Acetylcysteine is the antidote for acetaminophen poisoning.

COMPLICATIONS

 Aspiration and bronchospasm when administered orally

 Dizziness, drowsiness, hypotension, tachycardia
 Hepatotoxicity.

Decongestants

SELECT PROTOTYPE MEDICATION: Phenylephrine

Others: Ephedrine, Naphazoline, Pseudoephedrine

EXPECTED PHARMACOLOGICAL ACTION: Sympathomimetic decongestants stimulate alpha1-adrenergic receptors, causing reduction in the
inflammation of the nasal membranes.

THERAPEUTIC USES

o This medication can be used to treat allergic or nonallergic rhinitis by relieving nasal stuffiness.
o Acts as a decongestant for clients who have sinusitis and the common cold.

COMPLICATIONS

 Rebound congestion
 CNS stimulation
 Vasoconstriction

Antihistamines

SELECT PROTOTYPE MEDICATIONS

1st generation H1 antagonists

 Diphenhydramine
 Promethazine
 Dimenhydrinate

2nd generation H1 antagonists

 Loratadine
 Cetirizine
 Fexofenadine
 Desloratadine

Intranasal antihistamines

 Azelastine
 Olopatadine

EXPECTED PHARMACOLOGICAL ACTION  Antihistamine action is on the H1 receptors, which results in the blocking of histamine release in
the small blood vessels, capillaries, and nerves during allergic reactions. These medications relieve itching, sneezing, and rhinorrhea, but do not
relieve nasal congestion. First generation antihistamines produce cholinergic effects and drowsiness.

THERAPEUTIC USES

o Mild allergic reactions (seasonal allergic rhinitis, urticaria, mild transfusion reaction)
o Anaphylaxis (hypotension, acute laryngeal edema, bronchospasm)
o Motion sickness
o Insomnia
o Often used in combination with sympathomimetics to provide a nasal decongestant effect

COMPLICATIONS

 Sedation
 Anticholinergic effects
 Gastrointestinal discomfort
  Acute toxicity, excitation, hallucinations, incoordination, and seizures in children
 Respiratory depression and local tissue injury at intravenous site

Nasal Glucocorticoids

SELECT PROTOTYPE MEDICATION: Mometasone

Others: Fluticasone, Triamcinolone, Budesonide

EXPECTED PHARMACOLOGICAL ACTION: Nasal glucocorticoids decrease inflammation associated with allergic rhinitis. They are the first line
of treatment for nasal congestion. By decreasing nasal congestion, they also help with sinusitis in addition to allergic rhinitis.

THERAPEUTIC USE: To reduce the effects of allergic rhinitis including sneezing, nasal itching, runny nose.

COMPLICATIONS: Sore throat, nosebleed, headache, burning in the nose