Transcript Respiratory Drugs - Acupuncture and Massage College

Respiratory Drugs
Felix Hernandez, M.D.
Bronchodilators
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Sympathomimetics
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Albuterol (Ventolin)
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MOA: beta-2 agonist which causes bronchodilation
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Indications: DOC for the treatment of acute asthma symptoms
and prevent exercise induced asthma.
Side Effects: vasodilation, tachycardia, CNS stimulation.
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Has a faster onset of action than albuterol (5m INH, 15-30m PO)
Terbutaline
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Inhalation preparations have less side effects
Metaproterenol
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Onset of action <15m inhaled, <30m PO  3-4h, 5-8h
Can be given SC with an intermediate onset of 5-15m
PO and INH onset is the same as albuterol
Levalbuterol (Xopenex)
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Less side effects than albuterol
Onset <5m, duration of action 5-8h
Bronchodilators
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Salmeterol
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MOA: long acting beta-2 agonist
Indications: chronic treatment of asthma or
bronchospasm in adults.
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Is not used for acute exacerbations
Side Effects: nasopharyngitis, headache, cough
Onset  INH 20m, duration 12h
Epinephrine (Primatene Mist)
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MOA: beta-2 bronchdilation, alpha-1 vasoconstriction and
decreased secretions
Indications: emergent use for sever
bronchoconstriction/vasodilation seen in anaphylaxis
Side Effects: tachycardia, CNS stimulation
SC works immediately with a short duration of action
Contraindications: HTN, hyperthyroid, Cerebrovascular
insufficiency, glaucoma
Bronchodilators
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Isoproterenol (Isuprel)
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MOA: Beta-1 and Beta-2 agonist
Indications: same as epinephrine
Side effects: same as epinephrine
Can be given inhaled, IV or sublingual
Contraindications: Tachycardia
Withdrawal can induce reflex bronchoconstriction
Ipratropium (Atrovent)
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MOA: muscarinic antagonist which reverses AcH induced
bronchconstriction
Indications: bronchospasm associated with COPD in
adults
Side effects: very few systemic anticholinergic s/sx
because it poorly crosses into the systemic circulation
Contraindications: glaucoma, prostatic hypertrophy
Has an additive effect with adrenergic agonists
Methylxanthines
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Theophylline
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MOA: mechanism of bronchodilation is unknown
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Indications: used for maintenance therapy in moderate to
severe asthma
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At toxic doses it causes bronchoconstriction
Has a slow onset so it isn’t effective in treating acute attacks
Is replaced by ipratropium bromide for non-asthmatic COPD
Side Effects: insomnia, tachycardia, neuromuscular
irritability. They are dose related
Contraindications: seizure disorder, cardiovascular
disorder, PUD
Sympathomimetics increase the risk of heart and CNS
toxicity.
OCP increases its half-life and toxicity
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Systemic
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MOA: decrease inflammation and edema in respiratory
tract. Enhance the activity of sympathomimetics in
hypoxic and acidotic states
Indications: asthma which can not be controlled by
sympathomimetics alone
Side Effects: sodium/water retention, osteoporosis, PUD,
avascular necrosis of the femoral head
Should be discontinued ASAP
Inhaled
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Corticosteroids
MOA: same as systemic
Indications: same as systemic
Side Effects: don’t induce systemic toxicity. Their action is
mostly in the lungs. They have an increased risk of oral
thrush (Candida albicans infection)
Drugs: Beclomethasone (Beclovent), Triamcinolone
(Azmacort), Dexamethasone (Decadron)
Inflammatory Cell Stabilizers
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Cromolyn (Intal)
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MOA: prevents the release of inflammatory
mediators (histamine) form mast cells,
macrophages, neutrophils, and eosinophils
Indications: prophylaxis of asthma attacks
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Is not useful against an ongoing attack
Side effects: minimal, MC is throat irritation
Effective prophylaxis requires several weeks of
therapy
May allow a reduction in bronchodilator or
corticosteroid dose
Leukotriene Receptor Anatagonist
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Zafirlukast (Accolate) and Montelukast (Singulair)
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MOA: competitive antagonist of leukotriene receptors.
Inhibits bronchoconstriction and inflammation
Indications: prophylaxis and chronic asthma treatment
Side Effects: headache and GI distress.
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Increased respiratory infections in older patients
Not used to reverse bronchospasm in an acute attack
Zileuton
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MOA: inhibits 5-lipoxygenase, an enzyme required for the
synthesis of leukotrienes
Indications: same as kasts
Side Effects: headache, GI s/sx, liver enzyme elevation
(Inhibits P450)
Surfactant
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MOA: decreases surface tension in the lungs,
permitting alveoli to open easier.
Indications: used to reduce the incidence of
infant respiratory distress syndrome (usually
due to surfactant deficiency)
Side Effects: oxygen desaturation,
bradycardia with a risk of pulmonary
hemorrhage during administration
Dornase Alfa (DNase/Pulmozyme)
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MOA: a DNase that cleaves DNA strands
Indications: given to CF patients to decrease
the viscosity of bronchial secretions
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The viscosity is due to strands of DNA from lysed
inflammatory cells
Reduces the frequency of respiratory infections
N-Acetylcysteine (Mucomyst)
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MOA: mucolytic agent that reduces the
viscosity of mucous by cleaving protein
complexes
Indications: patients with chronic
bronchopulmonary disease
Intranasal Steroids
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Drugs:
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Beclomethasone
Budesonide (Rhinocort)
Triamcinolone (Nasacort)
Fluticasone (Flonase)
Mometasone (Nasonex)
MOA: inhibit inflammatory cells in the nasal
mucosa thus reducing the symptoms of
rhinitis
Side effects: may increase the risk of thrush
and prevent healing of damaged nasal
mucosa
GI Drugs
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H2 Blockers
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Antacids
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Cimetidine
Ranitidine
Famotidine
Aluminum salts
Calcium carbonate
Magnesium Salts
Sodium Citrate
Misc. Drugs
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Sucralfate
Metoclopramide
Omeprazole
Lansoprazole
Esomeprazole
Pantoprazole
Misoprostol
GI Drugs
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Antidiarrheal
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Opiates
Diphenoxylate
 Loperamide
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Absorbents
Bismuth Subsalicylate
 Kaolin/Pectin
 Cholestyramine
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Inflammatory Bowel Agents
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Mesalamine
Sulfasalazine
Laxatives and Cathartics
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Bulk Forming Agents
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Stimulant Laxatives
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Psyllium
Bisacodyl
Others
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Milk of Magnesia
Castor Oil
Polyethylene glycol
Lactulose
Docusate