1. Bronchodilators and Other Respiratory Agents
Chapter 16
Bronchodilators and Other Respiratory Agents

2. Bronchodilators Medications used to relax and open the airways
Open or maintain the bronchial airways
Treat several disease syndromes
Chronic obstructive pulmonary disease
Asthma
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3. Classes of Bronchodilators
Sympathomimetic agents
Xanthine bronchodilators
Anticholinergics
Leukotriene receptor antagonists
5-lipoxygenase inhibitors
Mast cell stabilizers
Corticosteroids
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4. Sympathomimetics Beta2-adrenergic receptors
Used during the acute phase of asthmatic attacks
Quickly reduce airway constriction and restore normal airflow
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5. Uses for Sympathomimetics
Treat acute attacks as well as prevent attacks
Quickly reduce airway constriction and restore normal airflow
Relief of bronchospasm, bronchial asthma, bronchitis, and other pulmonary diseases
Treat hypotension and shock
Produce uterine relaxation to prevent premature labor
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6. Sympathomimetic Agents
Nonselective adrenergics
Stimulate alpha1, beta1 (cardiac), and beta2 (respiratory) receptors
Example: epinephrine
(continues)
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7. Sympathomimetic Agents
(continued)
Sympathomimetic Agents
Nonselective beta-adrenergics
Stimulate both beta1 and beta2 receptors
Example: isoproterenol (Isuprel)
Selective beta2 drugs
Stimulate only beta2 receptors
Example: albuterol
(continues)
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8. Sympathomimetic Agents
(continued)
Sympathomimetic Agents
Frequent use leads to beta1 receptors being stimulated
Albuterol loses its action
General side effects
Nausea, increased anxiety, palpitations, tremors, and increased heart rate
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9. Xanthines Chemical class of agents Oldest class of bronchodilators
Contain caffeine
Oldest class of bronchodilators
Used in ancient times
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10. Xanthine Bronchodilators: Mechanism of Action
Increase levels of energy-producing cAMP
Inhibit phosphodiesterase
Enzyme that breaks down cAMP
Result
Smooth muscle relaxation
Bronchodilation
Increase airflow (oxygen/carbon dioxide) in the lungs
Cause cardiac life-threatening side effects
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11. Xanthine Derivatives: Side Effects
Nausea, vomiting, anorexia
Gastroesophageal reflux during sleep
Sinus tachycardia, extrasystole, palpitations, ventricular dysrhythmias
Transient increased urination
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12. Anticholinergics: Mechanism of Action
Acetylcholine (ACh) causes bronchial constriction.
Anticholinergics bind to the ACh receptors, preventing ACh from binding.
Result: bronchoconstriction is prevented, airways dilate
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13. Anticholinergic Bronchodilators
Ipratropium bromide (Atrovent)
Tiotropium bromide (Spiriva HandiHaler)
Actions
Local effects
Slow and prolonged action
Used to prevent bronchoconstriction
Not used for acute asthma exacerbations!
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14. Anticholinergics: Side Effects
Usually not absorbed systemically
If absorbed, have the potential to produce:
Dry mouth or dry throat
Gastrointestinal distress
Headache
Coughing
Anxiety
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15. Leukotriene Receptor Antagonists
Directly prevent bronchoconstriction
Developed to treat asthma
Popular and effective
Leukotrienes are inflammatory molecules
Released by mast cells
Cause the bronchials to contract
Development of edema in the lungs
(continues)
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16. Leukotriene Receptor Antagonists
(continued)
Leukotriene Receptor Antagonists
By blocking leukotrienes:
Prevent smooth muscle contraction of the bronchial airways
Decrease mucus secretion
Prevent vascular permeability
Decrease neutrophil and leukocyte infiltration to the lungs
(continues)
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17. Leukotriene Receptor Antagonists
(continued)
Leukotriene Receptor Antagonists
Currently available agents:
Montelukast (Singulair)
Zafirlukast (Accolate)
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18. Leukotriene Receptor Antagonists: Side Effects
Headache
Nausea
Diarrhea
Liver dysfunction
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19. Leukotriene Receptor Antagonists: Client Education
Educate the client.
Use for chronic management of asthma, not acute asthma
Improvement should be seen in about 1 week
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20. 5-Lipoxygenase Inhibitors
New class of leukotriene receptor antagonists
Action
Inhibit the formation of leukotrienes
Used to inhibit some cancer growth
Outcome
Prevent lung inflammation
Example
One agent: Zileuton
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21. Mast Cell Stabilizers Used prophylactically
No direct bronchodilator activity
Indirect-acting
Stabilize the cell membranes of the inflammatory cells–mast cells, monocytes, macrophages
Prevent release of harmful cellular contents
(continues)
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22. (continued)
Mast Cell Stabilizers
Adjuncts to the overall management of clients with lung disease
Prevent bronchospasm when exposed to:
Cold air
Exercise
Allergens
Dry air
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23. Mast Cell Stabilizers: Examples
Cromolyn (Nasalcrom, Intal)
Nedocromil (Tilade)
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24. Mast Cell Stabilizers: Side Effects
Coughing
Taste changes
Sore throat
Dizziness
Rhinitis
Headache
Bronchospasm
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25. Inhaled Corticosteroids
Anti-inflammatory
Inhaled forms
Reduce systemic effects
Used for chronic asthma
Does not relieve acute asthma
(continues)
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26. Inhaled Corticosteroids
(continued)
Inhaled Corticosteroids
Stabilize membranes of cells that release harmful bronchoconstricting substances
Also increase responsiveness of bronchial smooth muscle to beta-adrenergic stimulation
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27. Inhaled Corticosteroids: Examples
Beclomethasone dipropionate (Beclovent, Vanceril)
Triamcinolone acetonide (Azmacort)
Flunisolide (AeroBid)
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28. Inhaled Corticosteroids: Side Effects
Pharyngeal irritation
Coughing
Dry mouth
Oral fungal infections
Systemic effects are rare
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29. Respiratory Agents Combination product
Fluticasone propionate and salmeterol (Advair): a dry powder in a circular diskus
Salmeterol: long-acting bronchodilator
Corticosteroid: anti-inflammatory agent
Used daily
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30. Respiratory Agents: Client Education
Instruct clients to:
Receive flu and pneumonia vaccination
Receive prompt treatment for any illness
Check with health care provider before taking other medications
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