PHARM: RESPIRATORY SYSTEM

H1 antagonists: -ine (diphenhydramine)

INDICATED: allergy, anaphylaxis, sedation—blocks H1 receptors; decreasing flushing, edema, secretions, pain & itching

• MONITOR for drowsiness, anticholinergic effects, paradoxical excitation (also seen in OD)

• NO ETOH, take at night and avoid driving, take with food to decrease GI effects

glucocorticoids

INDICATED: asthma, COPD—decreases inflammatory response

1.) inhaled: budesonide, ciclesonide, flunisolide, fluticasone

• SE: oral candidiasis; rinse/gargle after use

• NOT for acute attacks, take on a schedule and 5 min after SABA if having acute attack

2.) PO: methylprednisone, prednisolone, prednisone

• systemic use in acute attacks

• use less than 10 days; long term use has a risk of adrenal suppression , osteoporosis, hyperglycemia, PUD, and growth suppression

• stress dose may be needed in times of high stress if used chronically

• NEVER D/C abruptly

leukotriene receptor antagonists: -lukast (zafirlukast, montelukast)

INDICATED: asthma—decrease leukotrienes; decreased smooth muscle contraction, bronchoconstriction, edema, and mucous

• used for LONG TERM, NOT to abort attack

• hepatotoxic

• rare but potential for neuropsychiatric effects (depression, anxiety, hallucinations) & churg-strauss syndrome (vasculitis)

monoclonal antibodies: -mab (omalizumab, dupilumab)

INDICATED: allergy related asthma or when other options have failed—decreased IgE, limiting the ability to initiate an inflammatory response

• SQ injection site rxns

• CV/malignancy problems

• possible anaphylaxis; MONITOR for first 2h after first 3 doses & 30 min after each subsequent dose

B2 adrenergic agonists

INDICATED: asthma, COPD—binds to B2 receptors in the lungs causing brochodilation

1.) SABA: albuterol, levalbuterol

2.) LABA: salmeterol, arfomoterol

• SE: tachycardia, angina, tremor

• can mask s/sx of hyPOglycemia

• CAUTION with glaucoma; increases IOP

• when using two inhalers, SABA first and 1 min interval in between

methylxanthines: aminophylline, theophylline

INDICATED: asthma—relaxes muscle; bronchodilation

• narrow therapeutic index; MONITOR lvls; do not double dose if missed dose

  • TOXICTITY: arrhythmias, seizures, hypotension, N/V

• caffeine=intensifies

• tobacco/marijuana=increases theophylline clearance; decreasing effects

anticholinergics: ipatropium, tiotropium, glycopyronium bromide, aclidinium bromide

INDICATED: asthma, COPD—block muscarinic receptors in the bronchi (blocking parasympathetic); bronchodilation

• can be used to abort ongoing attacks

• available in combos with SABAs

• MONITOR for anticholinergic SE

decongestants: phenylphrine, pseudophedrine

INDICATED: congestion—activating receptors in the nasal blood vessels; vasoconstriction & decreasing edema of mucous membranes

• PO or topical

  • PO: more systemic results; restlessness, irritable, anxiety, insomnia, lasts longer

  • topical: faster and more effective, risk for rebound congestion; do NOT use >3-5 consecutive days

antitussives

INDICATED: cough— decreased cough threshold therefore decreasing triggering of cough response

1.) opioid: codeine, hydrocodone

• risk for physical dependence (schedule V)

  • MONITOR for respiratory depression

2.) non-opioid: dextromethorphan

expectorants: guaifenesin

INDICATED: excess mucous (ex. cystic fibrosis)—stimulates flow of respiratory secretions=productive cough

• do NOT give with antitussives; helping get things flowing; WANT to get this out

mucolytic: hypertonic saline, acetylcysteine

INDICATED: excess mucous—breaks up thick mucous making it easier to expel

• do NOT give with antitussive

• rare AE of bronchospasms