This document discusses several classes of respiratory agents including bronchodilators, xanthine derivatives, corticosteroids, leukotriene inhibitors, mast cell stabilizers, mucolytic agents, and smoking cessation agents. It describes their mechanisms of action, indications, examples within each class, and important adverse effects and considerations for use.

1. RESPIRATORY AGENTS
Asthma-----inflammation in the lungs that causes airways
to constrict and yields wheezing, dysnea, and cough.
allergen may trigger release of histamine from mast cells.
bronchodilators---
moa----cause beta2 receptors on smooth muscle
to relax, decreases bronchospasm, more airflow.
beta1 in heart/kidney
beta2 in bronchus/uterus/eye/GI/liver
beta3 in adipose tissue
beta1 receptors have equal affinity for epi and norepi.
beta2 receptors prefer epinephrine.

2. RESPIRATORY AGENTS
Xanthine derivatives----xanthine comes from guanine and
precursor to uric acid, caffeine. Commonly used for their
effects as mild stimulants and as bronchodilators
moa---reverse bronchospasm associated with antigens
and irritants. improves contractility of diaphragm. MOA occur
through multiple molecular mechanisms of action,
including at least one unknown mechanism.
indications---lung disease that is unresponsive to other
medications.
consider-----watch xanthine blood levels(kidney stones)
may interact with antibiotics.
examples---
aminophylline
theophylline

3. RESPIRATORY AGENTS
indications----airway obstruction, COPD, bronchitis,
emphysema.
adverse reaction----CNS stimulation yields nervousness,
tremors, anxiety, tachycardia, arrhythmia
considerations----self overmedication. protect ipratropium
from light. keep salmeterol room temperature.
bronchodilator examples---
albuterol
epinephrine
formoterol fumarate
ipratropium
salmeterol
terbutaline

4. RESPIRATORY AGENTS
Leukotriene inhibitors
moa----block effect of leukotrienes. Leukotriene production
is usually accompanied by the production of histamine
and prostaglandins, which also act as inflammatory mediators.
trigger contractions in the smooth muscles lining the bronchioles
indications---prophyalxis and long-term asthma
adverse effect-----headache
consider-------must be over 6yoa for singulair
examples--
montgelukast/singulair
zafirukastr/accolate
zileuton/zyflo

5. RESPIRATORY AGENTS
Corticosteroids
moa---stimulate adenylate cyclase and inhibit
inflammatory cells. adenylate cyclase is enzyme on cell
membrane that synthesizes cyclic adenosine monophosphate
(cyclic AMP) from adenosine triphosphate (ATP)
The activation of 1, 2 and 3 receptor activates the enzymeβ β β
Adenylate cyclase. This in turn leads to the activation of the
secondary messenger Cyclic adenosine monophosphate and
induces smooth muscle relaxation by interfering with actin/myosin
inhaled reactions--oral candidiasis, irritation nasal mucosa,
hoarseness,dry mouth.
oral medications---female facial hair, male breast, edema,
buffalo hump, weight gain, bruising
consider---nightmares unless taper off the dosing.

6. RESPIRATORY AGENTS
corticosteroid examples---
prednisolone
triamconolone
prednisone
fluticasone
dexamethasone
methylprednisone
mometasone

7. RESPIRATORY AGENTS
mast cell stabilizers
mao---inhibit inflammatory cells
indications---prophylaxis, no use for acute attack
reactions----cromolyn may give unpleasant taste,
hoarsness, dry mouth, stuffy nose
consider----noncompliance… 4 doses/day
examples-
cromolyn
nedocromil
combo---fluticasone-salmeterol

8. RESPIRATORY AGENTS
emphysema----destruction of alveoli. from smoking, pollution,
occupational exposure, genetic
bronchitis----obstruction of airflow during expiration. from
smoke, dust, pollution, infection. cough produces green or
blood sputum. excessive mucus, 30ml/day
cystic fibrosis----thick, sticky mucus, frequent chest
infections, and coughing or shortness of breath with infections.
mucolytic agents---
moa--break down gylcoprotein, yields easier removal
adverse reaction---unpleasant odor and taste
examples-- acetylcysteine
domase alfa

9. RESPIRATORY AGENTS
tuberculosis----slow, progressive respiratory disease with
weight loss, fever, night sweats, malaise, less appetite.
asymptomatic medication is isoniazid for 12 months, maybe
several medications if symptomatic.
consider-----avoid alcohol
examples---
capreomycin
ciprofloxin
isoniazid
ofloxin
rifampin
streptomycin

10. RESPIRATORY AGENTS
smoking----increased heart disease, COPD, stroke.
asthma, impotence, infertility, CO concentration, shortness of
breath.
cessation agents
bupropion
nicotine
varenicline