Top 200 Drugs Section 3: Respiratory Agents

severe reactions are called

anaphylaxis

Anaphylaxis

involves multiple systems in the body, sudden drop in blood pressure, tightening of airways

Histamine

chemical in the body found in almost all our cells, involved in the immune response and sets off events that lead to inflammation

The word antihistamine typically refers to

H1 - blockers or H2 - blockers (stomach)

H1 - blockers

diphenhydramine (Benadryl)

fexofenadine (Allegra)

Benadryl

diphenhydramine

Allegra

fexofenadine

H2 - blockers (stomach)

rantidine (Zantac) and famotidine (Pepcid)

Zantac

rantidine

Pepcid

famotidine

What are antihistamines for

usually for runny noses, itchy and water eyes, scratchy throats and a cough

What can you not use antihistamines for

stuffy nose

Antihistamines side effects

dry eyes and dry mouth

First generation antihistamines

older agents, usually dosed q4-6 prn, higher incidence of side effects

Second generation antihistamines

dosed QD - loratadine, cetirizine

Third generation antihistamines

dosed QD - desloratadine, fexofenadine

Meclizine

used for tinnitus and dizziness, found in OTC motion sickness tablets

Promethazine

anti-emetic

Hydroxyzine

used for sleep and anxiety

Allegra-D

fexofenadine + psuedophedrine

Clarinex

desloratadine

Claritin

loratadine

Claritin-D

loratadine + psuedophedrine

Zyrtec

cetirizine

Zyrtec-D

cetirizine + pseudoephedrine

Antivert

meclizine

Atarax

hydroxyzine hydrochloride

Vistaril

hydroxyzine pamoate

What is also used to treat allergy symptoms

steroids and leukotriene antagonists

Nasocort AQ

triamcinolone

Singulair

montelukast

Topical steroids (nasal sprays)

flonase, nasonex, nasocort AQ

Nasal steroids

doses are small and have a limited application to a local area, so minimal drug is absorbed into bloodstream

Leukotrienes

chemicals that are involved in the allergic response pathway

How do leukotriene antagonists work

block these chemicals from binding and help turn off the pathway

Leukotriene antagonists

taken orally, treat allergic rhinitis in patients as young as 6 months old, and treats asthma in patients 12 yrs and older

Singulair is taken

once daily at bedtime

Decongestants

reduces inflammation and allows air to flow more freely, can be given topically or systemically

Decongestants side effects

increased BP, sleeplessness, dizziness, heart palpitations

Why is pseudoephedrine restricted to behind the counter

it is a precursor to meth

Topical decongestants can cause tachyphylaxis which means

a rapid decrease in response to a drug

Sudafed

psuedoephedrine

Sudafed-PE

phenylephrine

Antitussives

suppress the cough reflex, used to treat a DRY cough

Why is stopping a cough harmful

it is the way for the body to rid itself of irritants

Robitussin/Delsym

dextromethorphan

Who are antitussives not recommended for

children under 4

Codeine containing coughsyrups are CV and are

sold behind the counter in some states

Expectorant

used to treat a wet cough (productive cough)

What is the only expectorant approved for use in the US

guaifenesin

How does expectorant work

thins mucous secretions, making them easier to get out

Mucinex/Robitussin

guaifenesin

What is expectorant often combined with

anti-tussives of little clinical value since they cancel eachother out)

Robitussin DM

guaifenesin + dextromethorphan (syrup)

Robitussin AC

guaifenesin + codeine (syrup)

Mucinex DM

guaifenesin + dextromethorphan (tablets)

What is asthma

chronic, inflammation of the airways (bronchi)

COPD

patients can have chronic bronchitis, emphysema, or both

Chronic bronchitis

airway muscles tighten and the narrow passages fill w mucous

Emphysema

air sacs get stretched out like a deflated balloon and the old air doesn’t fully come out. new air can’t come in

Medications used to treat COPD and asthma

Steroids - used on a daily basis for controlling symptoms (patients must rinse mouth w water after steroid inhalers to avoid thrush)

Pulmicort (inhaled)

budesonide

Flovent HFA (inhaled)

fluticasone

Flonase

fluticasone

Nasonex

mometasone

Nasacort AQ

triamcinolone

Rhinocort

budesonide

Bronchodilators

relax smooth muscle that surrounds airways making is easier to breathe

How are bronchodilators given

by MDI (metered dose inhaler) or nebulizer

Types of bronchodilators

beta agonists and anticholinergics

Beta agonist bronchodilator

Short acting “rescue inhaler”:

q4-6 prn

rapid heart rate

Long acting:

used in combo w steroid (beta agonist opens airways to enhance effects of steroid)

every 12 hrs

Proventil HFA/Ventolin HFA/ProAir HFA

albuterol

Xopenex

levalbuterol

Anticholinergics

often combined w albuterol to increase effectiveness

SPIRIVA

disk-haler for daily maintenance use, dosed QD

Atrovent

ipratropium

Spiriva

tiotropium

Advair

fluticasone + salmeterol

Combivent

albuterol + ipratropium

Symbicort

budesonide + formoterol