Respiratory Pharmacology - Video Notes Flashcards

Albuterol (Proventil, Ventolin, ProAir)

• Class: bronchodilator (SABA) short acting
• Action: β₂ adrenergic agonist (rescue) – stimulates β₂, relaxation of bronchial smooth muscles
• Delivery / Doses:
  • SVN: $2.5\ \text{mg}/3\ \text{mL}$
  • MDI: $2{-}4\ \text{puffs}$
• Indications: Asthma, COPD
• Most common side effects: tachycardia, tremor, palpitations, hypokalemia, anxiety

Levalbuterol (Xopenex)

• Class: bronchodilator (SABA) short acting
• Action: β₂ adrenergic agonist (rescue)
• Delivery / Doses:
  • SVN: $0.63{-}1.25\ \text{mg}$
  • MDI: $2{-}4\ \text{puffs}$
• Indications: Asthma, COPD
• Most common side effects: tachycardia, tremor, palpitations, hypokalemia, anxiety

Racemic Epinephrine (Vaponephrine)

• Class: bronchodilator, vasoconstrictor, ultra-short–acting
• Action: α, β-adrenergic agonist
• Delivery / Doses:
  • SVN: $0.5\ \text{mL of } 2.25\%/3\ \text{mL NS}$ (directly instill)
• Indications: Acute bronchospasm, laryngeal edema, stridor, croup, bleeding (bronchoscopy)
• Common side effects: tachycardia, arrhythmias, hypertension, peripheral vasoconstriction, hyperkalemia

Salmeterol (Serevent)

• Class: bronchodilator, LABA (long acting β₂ agonist) – long term control
• Action: maintenance relaxation of smooth muscles in the airways
• Delivery / Doses: DPI: $50\ \mu\text{g} \ \text{bid}$
• Indications: Asthma, COPD
• Not for acute episodes
• Common side effects: tachycardia, tremor, palpitations, hypokalemia, anxiety
• Notes: recommended with a corticosteroid

Formoterol (Foradil, Perforomist)

• Class: bronchodilator, LABA – long term control
• Action: maintenance relaxation of smooth muscles in the airways
• Delivery / Doses:
  • DPI: $12\ \mu\text{g} \text{ bid}$
  • SVN: $20\ \mu\text{g} \text{ bid}$
• Indications: Asthma, COPD
• Not for acute episodes
• Common side effects: tachycardia, tremor, palpitations, hypokalemia, anxiety
• Notes: recommended with a corticosteroid

Arformoterol (Brovana)

• Class: bronchodilator, LABA – long acting
• Action: maintenance relaxation of smooth muscles in the airways
• Delivery / Doses: SVN: $15\ \mu\text{g} \text{ bid}$
• Indications: Asthma, COPD
• Not for acute episodes
• Common side effects: tachycardia, tremor, palpitations, hypokalemia, anxiety
• Notes: recommended with a corticosteroid

Tiotropium (Spiriva)

• Class: long-acting anticholinergic (LAMA)
• Action: bronchodilator – block cholinergic constriction of bronchial smooth muscles, prevent bronchoconstriction
• Delivery / Doses: DPI: $2.5\ \mu\text{g} \text{ once daily}$
• Indications: COPD, asthma
• Not for acute asthma exacerbation
• Common side effects: dry mouth, sore throat, sinus infection, headache, cough

Ipratropium bromide (Atrovent)

• Class: short-acting anticholinergic (SAMA)
• Action: bronchodilator – block cholinergic constriction of bronchial smooth muscles, prevent bronchoconstriction
• Delivery / Doses:
  • SVN: $500\ \mu\text{g}$
  • MDI: $2\ \text{puffs}$ (QID)
• Indications: COPD, asthma; rescue therapy in COPD
• Common side effects: headache, dizziness, stuffy nose, dry mouth, cough

Albuterol / ipratropium (Combivent, DuoNeb)

• Class: short-acting combination bronchodilator
• Action: β₂ adrenergic agonist + anticholinergic – stimulate β₂ and block cholinergic constriction
• Delivery / Doses:
  • MDI: $2\ \text{puffs} \ (QID)$
  • SVN: $2.5\ \text{mg}/0.5\ \text{mg} \ (QID)$
• Indications: COPD, asthma
• Common side effects: tachycardia, tremor, palpitations, hypokalemia, anxiety

Fluticasone / Salmeterol (Advair)

• Class: corticosteroid / LABA combination
• Action: anti-inflammatory + long-acting β₂ agonist; maintenance therapy
• Delivery / Doses: DPI: $1\ \text{puff}$; MDI: $2\ \text{puffs}$
• Indications: COPD, asthma
• Not for acute episodes
• Common side effects: thrush, hoarseness, dizziness, cough

Budesonide / Formoterol (Symbicort)

• Class: corticosteroid / LABA combination
• Action: anti-inflammatory + long-acting β₂ agonist
• Delivery / Doses: MDI: $2\ <br /> \text{puffs}$
• Indications: Asthma, COPD
• Common side effects: headache, thrush, sore throat, hoarseness, cough, hypertension

Budesonide (Pulmicort)

• Class: corticosteroid
• Action: anti-inflammatory, reduce airway inflammation
• Delivery / Doses:
  • SVN: $0.25/2\ \text{mL} - 0.5/2\ \text{mL}$
  • DPI: $90{-}180\ \mu\text{g} \text{ bid}$
• Indications: Asthma, COPD
• Noting: Long term control
• Common side effects: thrush, sore throat, hoarseness, cough, hypertension

Fluticasone (Flovent)

• Class: corticosteroid
• Action: anti-inflammatory
• Delivery / Doses: MDI: $88{-}440\ \mu\text{g} \text{ BID}$
• Indications: Asthma
• Common side effects: thrush, sore throat, hoarseness, cough

Beclomethasone (Qvar, Vanceril)

• Class: corticosteroid
• Action: anti-inflammatory
• Delivery / Doses:
  • MDI: $250\ \mu\text{g}$
  • Nasal spray: $50\ \mu\text{g}$
  • DPI: $100/200\ \mu\text{g}$
• Indications: Asthma
• Common side effects: sore throat, stuffy nose, cough, sinus pain, vomiting, nausea, headache

Prednisone (Deltasone) / Deltasone (oral)

• Class: corticosteroid
• Action: potent anti-inflammatory
• Delivery / Doses:
  • Oral: $5{-}60\ \text{mg per day}$
  • Nasal / IV / Injection (listed in table)
• Indications: Asthma, Bronchitis, allergies
• Common side effects: nausea, vomiting, weakness, fatigue, decreased appetite, weight loss, diarrhea, abdominal pain, shock, high blood pressure, high blood sugar

Methylprednisolone (Solu-Medrol)

• Class: corticosteroid / glucocorticoid
• Action: potent anti-inflammatory
• Delivery / Doses: Injection (IV); Oral
• Indications: Asthma
• Common side effects: dizziness, lightheadedness, flushing, facial redness, nausea, nervousness, vomiting

Xanthines (Aminophylline, Theophylline, Methylxanthines)

• Class: bronchodilators
• Action: relax bronchial smooth muscles
• Delivery / Doses: IV, orally, rectally
• Indications: COPD, Asthma
• Common side effects: tachycardia, dysrhythmias, irritability, nausea, vomiting, anorexia

Dornase Alfa (Pulmozyme)

• Class: mucolytic
• Action: synthetic protein that breaks down DNA in pulmonary secretions (recombinant human DNase)
• Delivery / Doses: Inhalation SVN
• Indications: Cystic Fibrosis, pulmonary diseases
• Common side effects: increased difficulty breathing, chest pain, fever, bronchospasm, sore throat

Acetylcysteine (Mucomyst)

• Class: mucolytic
• Action: opens disulfide bonds in mucoproteins and lowers mucus viscosity
• Delivery / Doses: Inhalation SVN; concentration $10/20\%$
• Indications: Pulmonary diseases; Diagnostic use in bronchography; Acetaminophen overdose
• Common side effects: bronchoconstriction, bronchospasm, chest tightness, hemoptysis, rhinorrhea, stomatitis, vomiting

Hypertonic Saline

• Class: mucolytic (sterile saline >3%)
• Action: salt attracts water into airways, thinning mucus
• Delivery / Doses: Inhalation SVN
• Indications: Pulmonary diseases, CF
• Common side effects: increased cough, sore throat, chest tightness

Tobramycin (Tobi, Tobrex, Kitabis Pak, Bethkis, Nebcin)

• Class: antibiotic
• Action: treat gram-positive and gram-negative bacteria
• Delivery / Doses: Inhalation SVN; IV / Injection
• Indications: Bacterial infections of the pulmonary system
• Common side effects: headache, rash, nausea, vomiting, anemia, joint pain, shaking, temporary or permanent hearing loss, kidney damage

Colistin Sulfate (Polymyxin E) / Xylistin

• Class: antibiotic
• Action: treat gram-negative bacteria
• Delivery / Doses: Inhalation SVN; IV / Injection
• Indications: Bacterial infections
• Common side effects: kidney toxicity, neurotoxicity, bronchospasm

Key concepts and connections

• Inhaled therapies are designed for rapid local effect in the lungs with fewer systemic effects (e.g., SABA/LABA, SAMA/LAMA, ICS, mucolytics, antibiotics for airway infections).
• Short-acting agents (SABA, SAMA) are typically rescue or symptomatic therapies; long-acting agents (LABA, LAMA) are maintenance therapies and are often combined with corticosteroids for asthma or COPD control.
• Combination inhalers (ICS/LABA) pair anti-inflammatory action with bronchodilation for better control and reduce exacerbations.
• Some agents are not appropriate for acute episodes (e.g., salmeterol, formoterol, arformoterol) due to slower onset; these require concurrent rescue therapy.
• Devices vary by drug: SVN (nebulized), MDI (metered-dose inhaler), DPI (dry powder inhaler); device choice can affect onset, dosing accuracy, and patient adherence.
• Mucolytics (dornase alfa, acetylcysteine) modify secretions rather than bronchodilate and are used in diseases with thick mucus (e.g., cystic fibrosis).
• Antibiotics (tobramycin, colistin) are used for chronic airway infections in specific diseases and delivery routes (inhalation) can reduce systemic exposure; monitor for ototoxicity, nephrotoxicity, and bronchospasm.
• Adverse effects are common across classes and include cardiac effects (tachycardia, arrhythmias), nervous system effects (tremor, anxiety, dizziness), and local effects (thrush, hoarseness).
• Practical implications: choose therapy based on disease state (acute vs maintenance), monitor for side effects, and consider device compatibility and patient ability to use the device correctly.

Representative device and dosing reminders

• SABA/LABA timing: rescue use vs maintenance; LABAs should be used with corticosteroids when indicated.
• DPI vs MDI vs SVN: inhaler type affects dose delivery and requires patient technique; spacer devices may be used with MDIs to improve delivery.
• Corticosteroids (inhaled) can cause thrush and hoarseness; rinse mouth after use to mitigate.
• Antibiotics for inhalation therapy require careful monitoring of renal function and potential ototoxicity or bronchospasm depending on agent.

Notable numerical references (for quick recall)

• Albuterol SVN dose: $2.5\ \text{mg} / 3\ \text{mL}$
• Levalbuterol SVN dose: $0.63{-}1.25\ \text{mg}$
• Salmeterol dose: $50\ \mu\text{g}\,\text{bid}$
• Formoterol dose (DPI): $12\ \mu\text{g}\,\text{bid}$
• Arformoterol dose: $15\ \mu\text{g}\,\text{bid}$
• Tiotropium dose: $2.5\ \mu\text{g}\,\text{daily}$
• Pulmicort (budesonide) DPI: $90{-}180\ \mu\text{g}\,\text{bid}$
• Beclomethasone MDI: $250\ \mu\text{g}$
• Prednisone range: $5{-}60\ \text{mg/day}$
• Dornase alfa SVN: dosing not specified here; delivered via inhalation
• Hypertonic saline concentration: >$3\%$
• Tobramycin inhalation: dosing not specified here; multiple brands listed

If you need the notes reorganized (e.g., by drug class first, then by device), or want additional example scenarios (exams, clinical vignettes) added, tell me and I can adjust.