Respiratory Drugs (Skills Lab Spring 2025)

Albuterol Therapeutic Class?

β2-adrenergic agonist (Antiasthmatic)

Albuterol Sulfate; Ipratropium Bromide Therapeutic Class?

Β2 agonist/Anticholinergic (Antiasthmatic)

Azelastine Therapeutic Class?

Antihistamine (Anti Allergy)

Benzonatate Therapeutic Class?

Non-Opioid Antitussive/CNS suppressant

Common FDA Indications for Albuterol

Asthma (acute exacerbation), asthma (bronchospasm), exercise-induced asthma prevention, chronic obstructive pulmonary disease (acute symptom relief), chronic obstructive pulmonary disease (acute exacerbation).

MOA of Albuterol

Albuterol is a selective β2-adrenergic agonist that increases cyclic AMP levels resulting in bronchial smooth muscle relaxation.

ADR (>10%) for Albuterol

Nausea, pharyngitis, rhinitis, throat irritation, upper respiratory tract infections, tremor, nervousness.

Key Counseling Points for Albuterol

Instruct patient on inhaler technique, wash the mouthpiece weekly, contact prescriber if more albuterol is needed, do not use more frequently than recommended. Hold breath for 10 seconds to reach deeper into the lungs and DPI does not require shaking/priming but does require deep inhalation.

Common FDA Indications for Albuterol Sulfate; Ipratropium Bromide

Chronic obstructive pulmonary disease.

MOA of Albuterol Sulfate; Ipratropium Bromide

Albuterol produces bronchodilation (selective B2-adrenergic agonist) while Ipratropium is a competitive antagonist of acetylcholine at peripheral muscarinic receptors.

ADR (>10%) for Albuterol Sulfate; Ipratropium Bromide

Bronchitis, upper respiratory tract infections.

Key Counseling Points for Albuterol Sulfate; Ipratropium Bromide

Instruct patient on inhaler technique, wash mouthpiece daily, store inhaler at room temperature, use entire vial of inhalation solution immediately after opening.

Common FDA Indications for Azelastine

Perennial allergic rhinitis, vasomotor rhinitis.

MOA of Azelastine

Azelastine is a selective H1-receptor antagonist that blocks histamine release and inhibits other mediators of allergic reactions.

ADR (>10%) for Azelastine

Bitter taste in mouth, headache, somnolence, rhinitis.

Key Counseling Points for Azelastine

Avoid spraying in eyes, avoid alcohol use, review proper instillation technique, blow nose prior to using.

FDA Indications for Benzonatate

Cough.

MOA of Benzonatate

Acts peripherally by anesthetizing stretch receptors in the respiratory passages, reducing the cough reflex.

Box warning for Benzonatate

No specific warnings related to boxed warnings for the drug.

No pregnancy warning for Benzonatate

No specific warnings related to pregnancy for the drug.

ADR (>10%) for Benzonatate

If capsules are broken or chewed, oral and pharyngeal numbness may occur.

Key Counseling Points for Benzonatate

Do not chew or crush capsules or allow capsules to dissolve in mouth as oropharyngeal anesthesia will occur, plus the liquid in the capsule has an incredibly foul taste.

Administer with food or milk if GI upset occurs.

Accidental ingestion of as few as 1-2 capsules by children <2 y of age has been fatal.

The drug appearance (round, clear liquid-filled capsules) may be attractive to children, so particular care should be taken to keep out of reach.

Budesonide; Formoterol Brand Name?

Symbicort

Common FDA Indications for Symbicort

Asthma and COPD.

MOA of Budesonide and Formoterol

Budesonide is an anti-inflammatory with potent glucocorticoid and weak mineralocorticoid activity.

Formoterol is a long-acting selective β2-adrenergic agonist that produces bronchodilation.

BOX WARNING for Symbicort

Asthma deaths; pediatrics, increased risk of hospitalization.

ADR (>10%) for Symbicort

Upper respiratory tract infections.

Key Counseling Points for Symbicort

Advise patient on proper inhalation technique.

If >1 inhalation is prescribed, wait 1 min after initial inhalation and shake the inhaler again before the next inhalation.

After administration, rinse mouth with water and spit, and wash face to minimize risk of developing oral candidiasis.

Wash the mouthpiece and air-dry thoroughly at least once a week.

Cetirizine Brand and Therapeutic Class?

Zyrtec is a 2nd-Gen Antihistamine available by prescription and over-the-counter.

Common FDA Indications for Cetirizine

Perennial or seasonal allergic rhinitis and chronic urticaria (hives).

MOA of Cetirizine

Cetirizine is a low-sedating, long-acting H1-receptor antagonist that inhibits the interaction of histamine with H1 receptors.

ADR (>10%) for Cetirizine

Drowsiness.

Key Counseling Points for Cetirizine

Patients should avoid activities requiring mental alertness or coordination until drug effects are known, as the drug may cause dizziness or sedative effects.

Fluticasone Brand + Therapeutic Class?

Flonase (OTC)is an intranasal adrenal glucocorticosteroid for anti-allergy and Flovent (Rx) is an inhaled adrenal corticosteroid for antiasthmatic.

Common FDA Indications for Fluticasone (Nasal)

Allergic rhinitis, nonallergic rhinitis, and nasal polyps.

Common FDA Indications for Fluticasone (Inhale)

Asthma.

MOA of Fluticasone (Nasal)

Fluticasone has anti-inflammatory, antipruritic, and vasoconstrictive properties.

MOA of Fluticasone (Inhale)

Fluticasone is a synthetic trifluorinated corticosteroid with anti-inflammatory effects.

ADR (>10%) for Fluticasone (Nasal)

Headache, nasal irritation, and burning.

ADR (>10%) for Fluticasone (Inhale)

Pharyngeal candidiasis.

Key Counseling Points for Fluticasone (Nasal)

Advise patients on the proper administration technique for this product.

Instruct patients to monitor for signs of toxicity, especially adrenal insufficiency.

Inform patient there may be a scent associated with this product.

Relief and/or adverse effects may not occur for several days after initiation.

Fluticasone Counseling Points?

Administration Techniques for Each Inhaled Products Prescribed

Rinse Mouth with H20 after each use to prevent oral infection.

Monitor for signs of toxicity, especially adrenal insufficiency, oral candidiasis, and worsening pulmonary function.

Provide package insert and other education materials and educate both adults and children on proper administration, usage, and storage.

Repeat training or demonstration at regular checkups.

Fluticasone Propionate; Salmeterol Xinafoate Brand + Therapeutic Class?

Advair Diskus; Inhaled Corticosteroid + Long-Acting β2-Adrenergic Agonist Combo (Antiasthmatic).

Common FDA Indications for Advair

Asthma, COPD.

MOA of Fluticasone

Fluticasone is a synthetic trifluorinated corticosteroid with anti-inflammatory effects, a human glucocorticoid receptor agonist that inhibits multiple cell types and mediator production or secretion involved in asthma and COPD.

MOA of Salmeterol

Salmeterol is a long-acting β2-adrenergic agonist that stimulates intracellular adenylyl cyclase in catalyzing the conversion of adenosine triphosphate (ATP) to cyclic-3',5'-adenosine monophosphate (cyclic AMP).

Box Warning for Advair

Increased asthma-related deaths.

ADR (>10%) for Advair

Headache, Pharyngitis, upper respiratory infection, difficulty speaking.

Key Counseling Points for Advair

Proper administration technique for specific inhaled product prescribed, rinse mouth with water after each use to prevent oral infections, monitor for signs of toxicity.

Fluticasone; Vilanterol Brand + Therapeutic Class?

Breo; Inhaled Corticosteroid/Ultra-long acting Beta 2 agonist combo (antiasthmatic).

Common FDA Indications for Breo

Asthma maintenance, chronic bronchitis, chronic obstructive pulmonary disease (COPD), emphysema.

MOA of Fluticasone in Breo

Fluticasone is an anti-inflammatory corticosteroid; its mechanism in COPD symptoms is unknown.

MOA of Vilanterol

Vilanterol is a selective agonist at beta2-receptors, causing relaxation of bronchial smooth muscle and bronchodilation.

Box Warning and Pregnancy Warning for Breo?

None

ADR (>10%) for Breo

None.

Key Counseling Points for Breo

FLUTICASONE; VILANTEROL treats asthma and COPD; it is a combination of an inhaled steroid and a bronchodilator.

Usage Instructions for Breo (Counseling)

This medication is inhaled through the mouth; rinse your mouth with water after use; take it as directed on the prescription label at the same time every day.

Acute Attack Warning for Breo (Counseling Points for Breo)

NEVER use this medication for an acute asthma attack; use a short-acting rescue inhaler instead.

Worsening Symptoms Warning for Breo (Counseling Points for Breo)

This medication can worsen breathing or cause wheezing right after use; have a short-acting inhaler for acute attacks nearby.

Side Effects that You Should Warn to Care Team ASAP?

Allergic Rx, heart rhythm changes, increase in BP, low adrenal gland function, muscle pain/cramps, thrush, and wheezing/trouble breathing that is worse after use.

Hydroxyzine Therapeutic Class

An antihistamine (H1 Antagonist) used for anxiety, pruritus, and sedation.

MOA of Hydroxyzine

Rapid-acting agent with probable action of suppressing activity in key locations of the subcortical area of the CNS.

Levocetirizine Theruapeutic Class?

An antihistamine used for idiopathic urticaria and allergic rhinitis.

MOA of Levocetirizine

Low-sedating, long-acting H1-receptor antagonist that prevents allergic response.

Loratadine

An antihistamine used for allergic rhinitis and urticaria.

MOA of Loratadine

Low-sedating, long-acting H1-receptor antagonist that prevents allergic responses.

Montelukast Therapeutic Class

A leukotriene receptor antagonist used for asthma and allergic rhinitis.

MOA of Montelukast

Inhibits physiologic actions of leukotriene by binding with leukotriene receptors.

Tiotropium Therapeutic Class?

An anticholinergic bronchodilator used for COPD and asthma.

MOA of Tiotropium

Long-acting antimuscarinic agent that leads to bronchodilation by inhibiting M3-receptors.

Xerostomia and Upper RTI is a ADR seen in?

A side effect of Tiotropium

Key Counseling Points for Hydroxyzine

Patients should avoid activities requiring mental alertness or coordination until drug effects are known.

Key Counseling Points for Levocetirizine

Patients should avoid activities requiring mental alertness or coordination until drug effects are known.

Key Counseling Points for Loratadine

Avoid allergic triggers and use scheduled doses instead of prn.

Key Counseling Points for Montelukast

Not indicated for acute asthma attacks; report increased use of short-acting inhaled bronchodilators.

Key Counseling Points for Tiotropium

Not indicated for acute bronchospasm; capsules are for inhalation only.

Behavior and mood-related effects are BBW for What Drug?

Box warning associated with Montelukast.

ADR (>10%) for Levocetirizine

Diarrhea in children.

ADR (>10%) for Loratadine

Headache.

ADR (>10%) for Tiotropium

Xerostomia and upper respiratory infection.

Time for full benefit of Loratadine (Counseling Point)

Symptoms should improve after 3-4 days but may require at least 14 days for full benefit.

Activities to avoid with Hydroxyzine (Counseling Point)

Activities requiring mental alertness or coordination.

Activities to avoid with Levocetirizine (Counseling Point)

Activities requiring mental alertness or coordination.