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1. Respiratory System
(General Key Points)
N203
ATI (Unit 8)
Respiratory System -

3. β2-Adrenergic Agonists
N203
ATI (Unit 8)
Respiratory System -

4. Expected Action:
Proto: albuterol (Proventil) — Others: formoterol (Foradil),
salmeterol (Serevent), terbutaline (Brethine)
· Selectively activate β2 receptors resulting in bronchodilation: bronchospasm is
relieved, histamine release is inhibited, and ciliary motility is 
Therapeutic Uses: · Albuterol: Inhaled, short-acting and oral, long-acting
· Formoterol, salmeterol: Inhaled, long-acting · Terbutaline: Oral, L-A
Adverse Effects: · Inhaled: Minimal adverse effects
· Oral: Tachycardia/angina d/t β1 in ♥ / tremors d/t β2 in skeletal muscle
Contraindications/Precautions: ♀ (C) · CI: tachydysrhythmias
Interactions: ·
· β-blockers like propanolol  negate effects of both
· TCAs and MAOIs   risk of tachycardia and angina
Education: · Inhale 3-5 sec, hold 10 sec, wait 60 sec for next dose
· Use inhaled β2-agonist before using inhaled glucocorticoid

5. Methylxanthines
N203
ATI (Unit 8)
Respiratory System -

6. Expected Action: Proto: Theophylline (Theolair)
· Theophylline relaxes bronchial smooth muscle  bronchodilation
Therapeutic Uses: · Long-term control of asthma
Adverse Effects: · Mild toxicityGI distress & restlessness. Severe reactions
· Severe reactions can occur at  therapeutic levels and include dysrhythmias and
seizures. Effects unlikely @ <20 mcg/mL. Activated charcoal  absorption,
lidocaine for dysrhythmias and diazepam for seizures.
Contraindications/Precautions: ♀ (C) ·
Interactions: · Caffeine:  CNS/♥ effects of theophylline. Also [theophylline]
· Phenobarbital, phenytoin:  [theophylline]
· Cimetidine, ciprofloxacin:  [theophylline]

7. Inhaled Anticholinergics
N203
ATI (Unit 8)
Respiratory System -

8. Expected Action: Proto: ipratropium (Atrovent) — Others: tiotropium (Spiriva)
· Block muscarinic receptors on bronchi  bronchodilation
Therapeutic Uses: · Relief of bronchospasms associated with COPD
· Relief of allergen-induced and exercise-induced asthma.
Adverse Effects: · Local anticholinergic effects
Contraindications/Precautions: ♀ (B) · CI: Peanut allergy
· Caution in narrow-angle glaucoma
Education: · Usual adult dose is 2 puffs (1 minute apart)
· If taking two inhaled medications, separate by at least 5 minutes.

9. Glucocorticoids
N203
ATI (Unit 8)
Respiratory System -

10. Expected
Action:
Proto: beclomethasone (QVAR) — Others: budesonide (Pulmicort),
fluticasone (Flovent), triamcinolone (Azmacort), prednisone (Deltasone)
· Prevent inflammation, suppress airway mucous production, and promote
responsiveness of β2-receptors in bronchial tree.
Therapeutic Uses: · Inhaled: Long-term asthma prophylaxis
· S-T, oral: Treat symptoms following acute asthma.
· L-T, oral: Treat chronic asthma · 1º adrenocortical insufficiency
· Promote lung maturity and  RDS in fetuses at risk for preterm birth.
Adverse Effects: · Inhaled: Dysphasia, candidiasis, bone loss
· Oral (≥10d):  adrenal gland function / bone loss / hyperglycemia / glucosuria /
/ infection / peptic ulcer disease / myopathy / fluid & electrolyte disturbances.
Contraindications/Precautions: ♀ (?) · CI: Live virus / systemic fungal infect.
Interactions: · Diuretics:  hypokalemia · NSAIDs:  GI ulceration
· Glucocorticoids counteract effects of insulin and oral hypoglycemics.
Education: · Oral are for short-term use, 3-10 days following acute attack

11. Mast Cell Stabilizers
N203
ATI (Unit 8)
Respiratory System -

12. Expected Action: Proto: Cromolyn (Intal) — Others: nedocromil (Tilade)
· Anti-inflammatory: Stabilize mast cells, inhibiting histamine release.
· Suppress inflammatory cells (e.g. eosinophils, macrophages)
Therapeutic Uses: · Management of chronic asthma
· Prophylaxis of exercise-induced and allergen-induced asthma attacks
· Allergic rhinitis by intranasal route
Adverse Effects: · Safest of all asthma meds / safe for kids
Contraindications/Precautions: ♀ (B)
· Propellant  CI: CAD, dysrhythmias, and status asthmaticus
Education: · Take 15 min before exercise
· Long-term prophylaxis may take several weeks

13. Leukotriene Modifiers
N203
ATI (Unit 8)
Respiratory System -

14. Expected Action:
Proto: montelukast (Singulair) — Others: zileuton (Zyflo),
zafirlukast (Accolate)
· Prevent effects of leukotrienes thus suppressing inflammation, airway edema,
bronchoconstriction, and mucus production.
Therapeutic Uses: · Long-term asthma therapy in folks ≥ 12 YO
Adverse Effects: · Liver injury ĉ zileuton and zafirlukast. (nausea, anorexia,
abdominal pain)
Contraindications/Precautions: ♀ (?) ·
Interactions: ·
· Zileuton / zafirlukast inhibit warfarin metabolism   [warfarin]
· Zileuton / zafirlukast inhibit theophylline metabolism   theophylline toxicity
Education: · Zileuton given without regard to food. Zafirlukast taken ŝ food

15. Antitussive – Opioids
N203
ATI (Unit 8)
Respiratory System -

16. Expected Action: Proto: codeine — Others: hydrocodone
· Suppresses cough center in the medulla oblongata.
Therapeutic Uses: · Chronic, non-productive cough
Adverse Effects: · GI distress (nausea, constipation) – take ĉ food,  fluid/fiber
· CNS sedation effects: Respiratory depression (<12/min) – naloxone
· Potential for abuse, schedule II.
Contraindications/Precautions: ♀ (C) ·
· CI: acute asthma, head trauma, liver/renal dysfunction, acute alcoholism

17. Mucolytics
N203
ATI (Unit 8)
Respiratory System -

18. Expected Action: Proto: acetylcysteine (Mucomyst) — Others: hypertonic saline
· Enhance flow of secretions in the respiratory passages
Therapeutic Uses: · Acute & chronic pulmonary disease ĉ  secretions
· Cystic fibrosis · Acetylcysteine is the antidote for acetaminophen poisoning
Adverse Effects: · Aspiration and bronchospasm
Contraindications/Precautions: ♀ (B) · CI: GI bleeding
· Caution: Peptic ulcers / esophageal varices / severe liver disease
Education: · Has smell of rotten eggs · Dilute in fruit juice
· IV: Loading dose, next dose over 4h, last dose over 16h.

19. Decongestants
N203
ATI (Unit 8)
Respiratory System -

20. Expected Action:
Proto: Phenylephrine
Others: Ephedrine, naphazoline, phenylpropanolamine
· Stimulate α1-adrenergic receptors   inflammation of nasal membranes
Therapeutic Uses: · Allergic rhinitis, sinusitis, and common cold
Adverse Effects: · Rebound congestion (Max 3-5 days, taper down use)
· CNS stimulation (rare ĉ topical) · Vasoconstriction
Contraindications/Precautions: ♀ (?) · CI: Chronic rhinitis
· Caution: CAD and hypertension
Education: · Oral do not lead to rebound congestion