Beta₂ Adrenergic Agonists

Long or Short Acting

albuterol (Proventil, Ventolin)

Long Acting

Formoterol (Foradil Aerolizer)

Salmeterol (Serevent)

Terbutaline (Brethine)

bronchiodilation, antihistamine, increased ciliary motility

Adverse: tachycardia/angina (avoid caffeine, and report 20-30 beats > normal), tremors (beta₂ in skeletal m.) = decreased dosage

MAOIs/tricyclic antidepressents increase risk of tachycardia and angina

Methylxanthines

theophylline (Theolair, Theo-24)

(TR: 5-15 mcg, but adverse e. are unlikely under 20)

long-term control of chronic asthmas or COPD by relaxation of bronchial smooth muscle

mild toxicity - Gi distress-restlessness

severe toxicity - dysrhythmias, seizure

Avoid Caffeine

Phenobarbital/Phenytoin decrease lvls

Tagament/Cipro/floroquinolone antibx increase levls

Inhaled Anticholinergics

ipratropium (Atrovent)

tiotropium (Spiriva)

bronchiodilation by blocking muscarine receptors

local anticholinergic effects: dry mouth, hoarseness

Avoid if: peanut allergy, N-A glaucoma, benign prostatic hyperplasia

rinse mouth after, wait 5 min between inhaled meds

Glucocorticoids

beclomethasone (QVAR)

prednisone (Deltasone)

budesonide (Pulmicort Flexhaler, Symbicort), fluticasone (Advair, Flovent), mometasone, prednisolone, hydrocortisone, methylprednisone

prevent inflammation, suppres mucus production, promote beta₂ reponsivness

Adverse:

Inhaled:  candidiasis, hoarseness, difficulty speaking

Inhaled/Oral: bone loss, adrenal glad suppression

Oral: Hyperglycemia/glucosuria,

mypoathy/muscle weakness,

peptic ulcer disease,

infection,

 fluid retenention (weight gain, edema),

 hypokalemia (muscle weaknesss

don't take with a live virus vaccine, avoid NSAIDS, and potassium depleting diuretics

Leukotriene Modifiers

montelukast (Singulair)

zileuton (Zyflo)

zarfirlukast (Accolate)

 prevents effects of leukotrienes, thereby suppressing inflammation, bronchoconstriction, airway edema, mucus production

risk for liver injury, watch PT/INR (with coumadin), watch theopylline lvls

singulair- HS

zafirlukast 1h before, 2 h after food

zileuton - with or without

Antitussives - Opiods

codein, hydrocodone

for nonproductive cough

Adverse: CNS depression (dizziness, lightheadedness, drowsiness, respiratory depression), GI distress (N/V, constipation), Abuse Potential

Take with food, increase fluids, and dietary fiber

Avoid in: asthma, head trauma, alcoholism

Antitussives - Nonopiods

dextromethorphan

benzonatatte (tessalon)

diphenhydramine (Benadryl)

dirived from opiods, cough suppressant

mild side effects: nausea, dizziness, sedation, small potential for abuse

AVOID use with MAOIs

Expectorants

guaifenesin (Mucinex)

increased cough  production

Adverse: Gi upset, drowsiness, dizziness, allergic reaction

don't crush, but capsules can be opened

mucolytics

acetylcysteine (Mucomyst, Acetadote)

hypertonic saline

enhances flow of secretions (for CF), also antidote for acetameniphen

adverse: PO - aspiration, bronchospasms

Avoid If: risk for hemorrhage, PUD, liver dx, asthma

it smells like rotten eggs

Decongestants

phenylephrine (Neo-synephrine)

ephedrine

naphazoline (Privine)

Psudoephedrine (Sudafed)

relieving nasal stuffiness

adverse effects: rebound congestion (limit to 3-5 days)

CNS stimulation (agitation, nervousness, uneasiness)

Vasoconstriction (avoid if hypertensive or CAD)

Antihistamines

Diphenhydramine (Benadryl)

Promethazine (Phenergan)

Dimenhydrinate (Dramamine)

Loratadine (Claritin)

Cetirizine (Zyrtec)

Fexofenadine (Allegra)

Desloratadine (Clarinex)

blocks histamine release

sedation, anticholinergic, GI discomfort (N/V constipation)

toxicity - fever, tachycardia, dry mouth, urinary retention, pupil dilation, excitation, hallucinatin, incoordinaiton, seizures

avoid alcohol, and CNS depressing drugs

Nasal GLucocorticoids

Nasonex mometasone

Veramyst fluticasone

Triamcinolone (Nasacort)

Budesonide (Rhinocort Aqua)

decrease inflammation associated with allergic rhinitis

AE: sore throat, nosebleed, HA, burning in the nose

take at least 7 days to get relief