Respiratory Tract Drugs

wheezing lung sounds

asthma, COPD, anaphylaxis

high pitch lung sounds

obstruction

low pitch crackling lung sounds

fluid in lungs/pneumonia

fine crackling lung sounds

fluid with air bubbles in lungs/fibrosis

emphysema

dysfunction of alveoli; low O₂ exchange/dead lung space

bronchodilator classes (4)

Beta₂-Agonists (albuterol)

Anticholinergic (ipratropium)

Methylxanthine (theophylline)

Epinephrine

Beta₂-Agonist drugs + MOA + uses

short acting: albuterol; long acting: -terol suffix

MOA- activate Beta₂ andrenergic receptors to dilate bronchi

uses- short-term: acute asthma attacks/bronchospasms PRN

long-term: fixed schedule for COPD

albuterol contraindications

do not take with beta-blockers or NSAIDs

albuterol adverse effects

tachycardia, angina, muscle tremors, anxiety, insomnia

epinephrine uses

acute anaphylaxis

therapeutic effect within 5 mins

anticholinergic prototype drug + MOA + uses

ipratropium (-tropium suffix)

MOA- block mucus receptors in bronchi; ↓bronchoconstriction/mucus secretion

uses- COPD (off label for asthma)

ipratropium adverse effects

cough, nervousness, N/D, GI upset

ipratropium contraindications

glaucoma

-not as effective as albuterol; nebulizer route

methylxanthine prototype drug + MOA + use

theophylline

MOA- relaxes bronchi smooth muscle

use- severe COPD/bronchitis as 2nd line if other drugs aren’t working (not used often)

theophylline adverse effects

seizures, tachycardia, dysrhythmia

theophylline contraindications

avoid caffeine, ciprofloxacin, cimetidine

TOXIC ABOVE 20mcg/mL (if toxic level reached → stop med and contact provider)

anti-inflammatory respiration drugs

Selected glucocorticoids (beclomethasone)

Leukotriene inhibitors (montelukast)

Mast cell stabilizers (cromolyn)

selected glucocorticoid drugs

beclomethasone (inhaled)

PO: prednisone, methylprednisolone

(-sone suffix)

steroid MOA + uses

MOA- reduce inflammation/edema

uses- chronic asthma; suppress immune system

-scheduled use; NOT PRN

steroid adverse effects + considerations

↑ risk of infections (rinse mouth), ↑ blood glucose (administer insulin) hoarseness, delayed growth, ↓adrenal function

leukotriene modifiers

montelukast

MOA- ↓brochoconstriction/ edema/mucus secretion

- 2nd-line therapy when steroids are contraindicated

BBW- NEUROPSYCHIATRIC EVENTS

mast cell stabilizers

cromolyn sodium (nebulizer)

MOA- calm down mast cells to prevent histamine release

-not effective for acute attacks

URI antihistamines

diphenhydramine (-dine suffix)

MOA- relieve sneezing, rhinorrhea, nasal itching (NOT nasal congestion)

-PO Histamine₁-receptor antagonist

1st gen sedation side effect

URI glucocortoids

beclomethasone IN route

MOA- suppresses congestion rhinorrhea, sneezing, nasal itching, erythema

adverse effects- dry nasal mucosa, headache, buring/itching, sore throat, nosebleeds

NOT long term

sympathomimetics (decongestants) drugs + MOA

pseudoephedrine PO

oxymetazoline nasal spray to stop nosebleeds (vessel constriction)

MOA- ↓nasal constriction by activating alpha₁-andrenergic receptors → vasoconstriction, decreased swelling/drainage

sympathomimetics adverse effects

rebound congestion (topical sprays for only 3-5 days)

CNS stimulation- produce euphoric high (abuse potential)

CV- widespread vasoconstriction (risk for pt with HTN/CV disease)

immunosuppressant monoclonal antibodies

omalizumab (-mab suffix: Mono AntiBody)

MOA- inhibits IgE binding to receptors on mast cells/basophils, ↓ allergic response

BBW- anaphylaxis on 1st injection; anaphylaxis >1 year post initial dose

-live medication

opioid antitussives

codeine, hydrocodone

MOA: numb lung stretch receptors; used for dry cough

AE: sedation, resp depression, death

nonopioid antitussives

dextromethorphan, benzonatate

MOA: numb lung stretch receptors; used for dry cough

AE: N/D, rash, difficulty breathing

expectorant

guaifenesin

MOA: ↑ productive cough by stimulating resp tract secretions

-stay hydrated, monitor airway, elevate HOB

mucolytic anti contestants

acetylcysteine (acetaminophen antidote)

MOA: makes mucus more watery/productive

-stay hydrated, monitor airway, elevate HOB