Beta-adrenergic agonists mechanism of action
Bronchodilator that acts on B-2 receptors on respiratory smooth muscle cells to cause relaxation and bronchodilation
Beta adrenergic agonists- route of admin
- inhalation (rapid acting)
- metered-dose inhalers (MDI), dry powder inhalers, nebulizers
Beta adrenergic agonists side effects
Airway irritation, nervousness, restlessness, tremor, increased HR
Xanthine derivatives -mechanism of action
Bronchodilator; CNS stimulant for reversible airway obstruction (bronchitis, emphysema), works on smooth muscle to dilate but also anti-inflammatory (inhibits phosphordiesterase enzyme)
Xanthine derivatives- admin
Orally
Xanthine derivatives side effects
- theophylline toxicity- nausea, confusion, irritability, seizures, arrhythmia as
- serious life threatening effects
- avoid long term use
- not used frequently anymore
Anti-cholinergics mechanism of action
Bronchodilator; blocks muscarinic cholinergic receptors to prevent acetylcholine-induced bronchoconstriction
Anti-cholinergics - use/ admin
- drug of choice for COPD, chronic bronchitis
- inhaled for respiratory disorders
Anti-cholinergics side effects
Dry mouth, constipation, urinary retention, confusion, blurred vision (less likely w/ inhaled)
Lukotriene inhibitors use
Anti inflammatory; used w/ glucocorticoids for optimal COPD / asthma management
Lukotriene Inhibitors mechanism of action
Inhibit lipooxygenase enzyme to dec. airway inflammation
Leukotriene inhibitors side effects
Mild liver impairment
Cromones- use/ admin
- used prophylactically to prevent asthma, esp in children
- nasal spray/nebulizer
Cromones- mechanism of action
Anti-inflammatory; inhibit inflammatory mediators from pulmonary mast cells
Cromones side effects
Free of serious effects, infrequently used
Glucocorticoids use
-most effective for controlling asthma
Glucocorticoids mechanism of action
Anti-inflammatory; inhibits pro inflammatory proteins and promotion of anti-inflammatory proteins, inhibit migration of neutrophils and monocytes
Glucocorticoids side effects
- decreased if inhaled (ex. Thrush), avoid prolonged oral use
- thrush, catabolic effect on tissues (osteoporosis, skin/muscle wasting), aggravation of diabetes mellitus, HTN
Antitussives use
Short term for suppressing coughing, used w/ acetaminophen
Questionable efficacy
Decongestants- MOA
Alpha 1 adrenergic agonists that stimulate nasal vasoconstriction
Decongestants side effects
CNS excitation (HA, dizziness, nervousness, HTN, palpitations) -rebound congestion when used long term
Acetylcysteine use
Expectorant/mucolyticis used with other decongestants or antihistamines A
Acetylcysteine MOA
Breaks disulfide bonds of mucoproteins, less viscous
Guaifenesin MOA
Expectorant; increases production of pulmonary secretions, encouraging ejection
Guaifenesin side effect
GI upset
Antihistamine MOA
Blocks H1 receptors to decrease nasal congestion, mucosal irritation, discharge (rhinitis, sinusitis) and conjunctivitis
Antihistamine side effects
Can cross BBB- sedation
COPD
Obstructive pulm disease- flow impacted, difficulty exhaling (air trapped in lungs)
COPD management
Prevent airway restriction, maintain patency= anticholinergics/beta-adrenergic blockers
Short term: oral glucocorticoids
Meds for exercise induced asthma
- long acting beta agonist with rapid acting agonist
- combined preparations (glucocorticoid + bronchodilator)
- rescue inhaler as backup