Respiratory Pharmacology

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Albuterol

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PROVENTIL/VENTOLILN
.5 ml/2.5 mg!!
β2 specif adrenergic (SMM) bronchodilator.
Avaiable as oral and aerosol preparation.
Onset/15 min peak effect 30-60 min with 4-6 hour duration.
Indications - bronchodilator for acute and chronic asthma, bronchitis, emphysema.
SE, nervousness, termor, headache, insomnia, weakness, dizziness, tachycardia, palpitations.

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Ipratropium Bromide

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ATROVENT
anticholinergic (PSlytic) bronchodilator
Approved specifically for COPD maintenance, chronic bronchitis, emphysema.
MDI 2pfs/qid
SVN .2 mg/ml
nasal spray .03%/.06%
Onset 15min, peak 1-2hrs, duration 4-6hrs
SE, drowsiness, sedation, dry mouth.
A derivative of atropine which is not recommended for inhalation as a bronchodilator because of greater side effects.

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Ipratropium/Albuterol

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COMBIVENT anticholinergic (PSLYTIC) bronchodilator
Used for maintenance in stable COPD
Dosage, MDI 18microg ipra, 90microg albut
SVN/DuoNeb

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Cromolyn Sodium

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INTAL Nonsteroidal antiasthmatic, antiallergic & Mast cell stabilizer
Blocks release of chemical mediators of inflammation.
Dosage MDI 800 microg
SVN 20 mg/amp or 20mg/vial
Nasalcrom spray 40mg/ml (allergic rhinitis)
SE, safe, dermatitis, myositis and gastr in few pts
Inhaled because of low oral absorption.
Indications - prevent asthma attacks esp. in cold and exercise induced asthma. most protective in kids with chronic unstable asthma.
SE, seen in less than 5% of pts. sore thraot, cough, dry mouth most common.

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Pirbuterol

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MAXAIR adrenergic agent
Beta 2 specif.
MDI 2 puffs, 0.2 mg/puff

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Epinephrine

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ADRENALIN adrenergic agent
SVN .25-0.5ml
MDI primatene mist .2 mg puff
Stimulates both α (vasoconstriction - esp skin, mucosa and kidneys) and β (bronchodilatation) receptors. β2 stimulation may also decrease mast cell secretions. Not effective orally, rapidly absorded IM or SQ.
Occurs naturally in adrenal medulla
Rapid onset/short duration
Metabolized by COMT
Indications - acute asthmatic attacks,
SE, anxiety, termor, palpitations, tachycardia, headache, diaphoresis.

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Isoproterenol

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ISUPREL adrenergic agent
Properties - stimulates β receptors.
SVN .25-.5ml of 1:200 (0.5%)
MISTOMETER 2 puffs, 103 microg/puff
Rapidly absorded after inhalation.
Indications - relieves respiratory distress in severe asthmatic attacks but rarely used now that there's more selective agents.
SE, acute toxicity less than with epi. tachycardia, headache, nausea, dizziness, diaphoresis.
Tolerance can occur

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Metaproterenol

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ALUPENT adrenergic agent β2 spec.
0.3 ml SVN MDi 2-3 Puffs, duration up to 4 hours.
Indications - bronchodilator in treatment of asthma, reversible bronchospasm.
SE, tachycardia, hypertension, nervousness, termor, caution in pts with coronary artery disease, CHF, tolerance less like compared to inhaled isoproterenol

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Prednisone/Prednisolone

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Class - corticosteroids. reduce inflammation and edema and potentiate the bronchodilating effects of adrenergic agonists. inactivate NF-kB the transcription factor that induces the production of TNF-α.
Indications - severe chronic and acute bronchospasm.
SE, Tox - suppression of growth, osteoporosis, aggravation of diabetes, aseptic bone necrosis, adrenocortical suppresions.

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Salmeterol

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Properties - β2 selective. longer actinging.
Indications - asthma prophylaxis.

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Terbutaline

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Properties - β2 selective when given orally but causes cardio effects similar to isoproterenol when given SQ. resistant to COMT methylation.
Indications - only β2 agonist used parenterally for tx of status asthmaticus.
SE, Tox - oral causes tremor. dizziness, nervousness, fatigue, tinnitus, palpitations rare. SQ causes same effects as epi.

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Theophylline

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Properties - inhibits phosphodiesterase --> increased cAMP. relaxes bronchial smooth muscles --> increased VC, potent CNS stimulant, imporves diaphragmatic contractility. positive inotropic action. increases water and electrolyte excretion. oral, rectal, or parental. distributed into all compartments, 60% pro bound.
Met/Excr- liver met, t1/2 = 8 hrs.
Indications - bronchodilator in asthma and COPD, improve diaphragmatic function in COPD, reduceds prolonged apnea in preterm infants.
SE, Tox - oral causes headache, nervousness, dizziness, n/v, epigastric pain. iv causes cardiac arrhythmias (blocks adenosine receptors which then increases AV nodal conduction), hypotension, cardiac arrest and seizures.
in children, CNS stimulation, diuresis, fevers.
monitor serumm levels (tox at >20 mg/L, benefit at 7-10).
Drug Interactions - barbituates, phenytoin, smoking increase its met. allopurinol, propranolol, cimetidine, erthromycine, influences vaccine decrease its met.

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Zafirlukast

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Blocks LTD4 leukotriene receptors. LTD4 is a receptors function in bronchoconstriction, vasoconstriction, contraction of smooth muscle and increased vascular permeability.

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Zileuton

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ZYFLO/anit-leukotriene
MOA/inhibits 5-LO enzyme, therefore blocks synthesis of leukotrienes. use with corticosteroids.
Indications - prophylaxis and chronic trtmnt of asthma. Dosage 600 mg tablet
SE, diarrhea, headache, increased risk of infections.

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Montelukast

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SINGULAIR/anti-leukotriene MOA/inhibits early and late phase bronchoconstriction caused by antigen. Dosage 10/4/5 mg tab w/wout food. SE, headache, flu, abdominal pain