Lower Respiratory Tract Agents

Lower Respiratory Tract Agents Mechanism: Increase cyclic adenosine
monophosphate (cAMP), leading to

Lower Respiratory Tract Disorders
bronchodilation.
 COPD: Airway obstruction with
Nonselective Sympathomimetic
increased resistance to airflow.
Epinephrine (Adrenalin) alpha1, beta1,
 Restrictive Lung Disease:
and beta2 agonist.
Decreased lung capacity due to
fluid buildup or reduced lung  adm. SC. for acute bronchospasm
elasticity. and anaphylactic reactions.
COPD Mechanism of Action: Promotes
bronchodilation, elevates blood pressure,
1. Chronic Bronchitis: Long-term
and improves airway patency.
inflammation, excess mucus, and
airway obstruction.
2. Bronchiectasis: Bronchi and
SE and reaction:
bronchioles abnormally dilate;
secondary to infection. →Airway  Tremors
obstruction, tissue fibrosis, and  dizziness
mucus buildup.  hypertension
3. Emphysema: Alveoli are  tachycardia
damaged, leading to trapped air  angina Selective
and reduced gas exchange.
4. Asthma: Typically, reversible but Beta2-Adrenergic Agonists
may cause irreversible damage  Primarily treat bronchospasm in
with frequent attacks. - chronic asthma and COPD. Adm:
Inflammation and mucus secretion aerosol or PO (tablet)
block airways. →Wheezing,  Focused on beta2 receptors for
Chronic Cough, Shortness of fewer side effects compared to
Breath, Tightness in the Chest. epinephrine.
Restrictive Lung Disease

• Common Causes: Albuterol - Selective Beta2 Agonist
 Causes bronchodilation with
 Pulmonary Edema minimal side effects at standard
 Pulmonary Fibrosis doses.
 Pneumonitis
 Lung Tumors Adm: Commonly via INH; long duration of
 Thoracic deformities (e.g., action.
scoliosis)
 Thoracic wall disorders (e.g., SE:
myasthenia gravis)  Headache,
 Reduced lung capacity, difficulty in  possible blood glucose elevation,
deep breaths, rapid breathing  nervousness,
 tremor,
 increased pulse with high doses.
Sympathomimetics
 drugs mimic the effects of the
sympathetic nervous system.
Metaproterenol (Alupent)
 Primarily beta2 effects with some  bronchodilator, also stimulate the
beta1 activity. CNS and respiration, dilate
coronary and pulmonary vessels,
Adm: Can be inhaled (via MDI or and cause diuresis.
nebulizer) or PO Drugs:
Onset: Rapid action when inhaled (1  Aminophylline,
minute), slower with oral administration  theophylline,
(15 minutes) Isoproterenol (Isuprel)  caffeine.
Mechanism: Increase cAMP
bronchodilation. Precautions: Narrow
Nonselective beta agonist (stimulates
therapeutic range (10 to 20 mcg/mL);
both beta1 and beta2).
requires frequent monitoring.
adm: Inhaled or IV for severe asthma
Theophylline
attacks; seldom used due to side effects.
 Relaxes bronchial smooth
SE: Beta1 stimulation may cause muscles, improving airway
increased heart rate and tachycardia. clearance.
SE:
 GI upset
Anticholinergics  nervousness
Tiotropium (Spiriva): Dry-powder  headache
capsule inhaler; used for maintenance in  risk of seizures.
COPD AE:
SE and AE:  dysrhythmias
 dry mouth  convulsions
 constipation  cardiorespiratory collapse
 vomiting Drug Interactions: Requires monitoring
 dyspepsia to avoid toxicity; smoking may affect
 abdominal pain metabolism.
 depression
 insomnia
 headache
Leukotriene Receptor Antagonists and
 joint pain
Synthesis Inhibitors
 and peripheral edema.
 Chest pain Leukotrienes (LT): Chemical mediators
causing inflammation in the lungs.
Ipratropium Bromide: dilate the
bronchioles Aerosol  Increase eosinophil migration.
 Promote mucus production and
adm. with few systemic effects; often used
airway wall edema.
with beta agonists or glucocorticoids.
 Result in bronchoconstriction
Combination Therapy: Combivent (airway narrowing).
(ipratropium + albuterol) offers extended
LT Receptor Antagonists: Block
efficacy.
leukotriene receptors, reducing
bronchoconstriction.
LT Synthesis Inhibitors: Inhibit
Methylxanthine (Xanthine) Derivatives leukotriene formation.
 Usage: Effective for inflammatory  Improve symptoms and decrease
asthma symptoms triggered by attack frequency when used
allergens or environmental factors. regularly.
 Not for Acute Attacks: Used for 
chronic management, especially in
Oral Inhalers vs. Oral/IV
exercise-induced asthma.
Glucocorticoids
Zafirlukast (Accolate):
 Inhaled: Preferred for chronic
 First LT receptor antagonist in this asthma due to localized effect,
class. reducing systemic side effects.
 Adm: Oral; absorbed rapidly.  Systemic (Oral/IV): For acute
 Half-Life: Moderate; requires asthma exacerbations (high doses
dosing twice daily. for short periods).
 Maintenance Dosage: May
Zileuton (Zyflo CR):
require tapering to prevent adrenal
 LT synthesis inhibitor, short half-life suppression in prolonged use.
(2.5 hours).
Combination Therapy Example
Montelukast (Singulair):
Advair Diskus:
 Newer LT receptor antagonist with
 Combines-Fluticasone
a half-life of 2.7-5.5 hours.
(glucocorticoid) and Salmeterol
 Safe for ages 6 and above.
(long-acting beta-agonist).
 Dosage: Once in the morning,
once at night.
Glucocorticoids for Asthma  Reduces airway constriction and
 Part of corticosteroids, used to inflammation but does not replace
reduce inflammation. fast-acting inhalers for acute
symptoms.
Indications:
Side Effects:
 For asthma unresponsive to
bronchodilators.  Throat irritation
 Asthma attacks despite maximum  hoarseness
doses of theophylline or adrenergic  dry mouth
drugs.  cough
Methods of Glucocorticoid • Fungal Infections: • Oral and

Administration pharyngeal fungal infections (e.g. Candida
 Inhaler: e.g., Beclomethasone albicans)
(Qvar) • Preventive Measures: Use a spacer,
 Tablet: e.g., rinse mouth post-use, clean inhaler
o Dexamethasone, regularly.
o Prednisone
Side Effects of Systemic
Glucocorticoids (Oral/IV)
 Intravenous (IV): e.g.,  Short-term Use: Generally, no
Hydrocortisone for rapid relief significant side effects.
Inhaled glucocorticoids need 1-4  Long-term Effects:
weeks for full effect o Hyperglycemia
o osteoporosis
o peptic ulcers
o adrenal suppression
 Adverse Reactions:
o Depression
o fluid retention
o weight gain
o hypertension
o skin thinning
o impaired immune
response.
Cromolyn and Nedocromil Sodium
 Mast cell stabilize
• Cromolyn Sodium (Nasal Crom):

Prophylactic treatment; must be taken
daily. Inhibits histamine release,
preventing asthma reactions.
SE: Cough, bad taste.
Nedocromil Sodium:
 Similar to Cromolyn; prevents
bronchospasm, reduces histamine
release.
 More effective than Cromolyn for
inflammation suppression
Mucolytics for Thick Mucus in Asthma

and COPD
 Liquefy and loosen mucus for
easier expectoration.
Acetylcysteine (Mucomyst): Delivered

by nebulization, used as an adjunct to
bronchodilators.
Side Effects:
 Nausea
 vomiting
 runny nose
 Also serves as an antidote for
acetaminophen overdose.
Dornase Alfa (Pulmozyme): Specifically
for cystic fibrosis, reduces respiratory
infections and improves lung function.

Lower Respiratory Tract Agents

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Lower Respiratory Tract Agents

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Lower Respiratory Tract Agents Mechanism: Increase cyclic adenosine

monophosphate (cAMP), leading to

Restrictive Lung Disease

Methods of Glucocorticoid • Fungal Infections: • Oral and

• Cromolyn Sodium (Nasal Crom):

Mucolytics for Thick Mucus in Asthma

Acetylcysteine (Mucomyst): Delivered

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