This document summarizes drugs used to treat asthma, rhinitis, and cough. It discusses classes of drugs like bronchodilators, anti-inflammatory agents, decongestants, antihistamines, antitussives, expectorants and mucolytics. Specific drugs are provided within each class, along with their mechanisms and brand names. The document also covers the inflammatory response underlying asthma and approaches to treatment, including relaxing bronchial smooth muscle, inhibiting mediator release, and blocking mediator effects.

1. Pharmacology
Drugs used to treat:
Asthma
Rhinitis & Cough

2. Topics
• Bronchodilators • Decongestants
• Methylxanthines • Antihistamines
• Anticholinergics • Antitussives
• Anti-inflammatory • Expectorants &
Agents mucolytics
• Leukotriene
Antagonists
• Mast cell stabilizers

3. Asthma
• Inflammatory response to allergen
• Antibody binds with & ruptures mast cells
– Releases histamine, prostaglandins,
leukotrienes
• Two primary issues
– Bronchoconstriction
– Inflammation (mucous production)

4. Approaches to Treatment
• Relax bronchial smooth muscle
– ß2 agonists
– methylxanthines
– anticholinergics
• Inhibit release of mediators
– Glucocorticoids
– Mast cell stabilizers
• Block affects of mediators
– Leukotriene antagonists

5. Bronchodilators
ß2 agonists albuterol (Proventil®),
metaproterenol (Alupent®)
terbutaline (Breathair®)
Nonselective epinephrine (Adrenalin®)
Methylxanthines theophylline (TheoDur®)
aminophyllin, (Aminophylline®)
Anticholinergics ipratropium bromide (Atrovent®)

6. Antiinflammatory Agents
Glucocorticoids
inhaled beclomethasone (Beclovent®)
flucticasone (Flovent®)
oral prednisolone (Deltasone®)
injected methylprednisolone (Solu-Medrol®)
dexamethasone (Decadron®)
Mast cell Stabilizer cromolyn (Nasalcrom®, Intal®)
Leukotriene Antagonists zafirlukast (Accolate®)
zileuton (Zyflo®)

7. Colds and Allergies
• Nasal Inflammation
– Vasodilation & engorgement
• Itching, redness, rhinorrhea
– Mast/basophil degranulation

8. Nasal Decongestants
∀ ⇓ congestion via • phenylephrine (Neo-
vasodilation Synephrine®)
• Alpha1 stimulation • pseudoephedrine
– Topical administration (Sudafed®, Actifed®)
• A moment of silence
for:
– phenylpropanolamine
(AlkaSeltzer Cold®,
Contact®, Allerest®)

9. Antihistamines
• H1 receptors • Other histamine
– Vasodilation receptors
– Increased capillary – Sedation
permeability
– Bronchoconstriction
• H2 receptors
– Increase gastric acid
secretion (Zantac®),
etc)

10. Antihistamine Agents
• First generation • Second generation
– Sedation – No sedation
• chlorpheniramine – blood-brain barrier
(Chlor-Trimeton®) • Sniff, sniff:
• diphenhydramine – terfenadine (Seldane®)
(Benadry®) • fexofenadine
• clemastine (Tavist®) (Allegra®)
• promethazine • cetirizine (Zyrtec®)
(Phergan®) • loratadine (Claritin®)

11. Cough Suppressants
• Antitussives • Expectorants
– Decrease cough reflex – guaifenesin may work
– Opioids – others are doubtful
• codeine & hydrocodone • Mucolytics
– Non-opioids – Decreases viscocity
• dextromethorphan
– acetlycysteine
• benzonatate
(Tessalon®) (Mucomyst®)
– hypertonic saline