1. Focus on Pharmacology Essentials for Health Professionals
Jahangir Moini, MD, MPH
Chapter 25 Effects of Drugs on Respiratory Disorders

2. Asthma
Chronic disease caused by increased reactivity of the tracheobronchial tree to various stimuli
Affects about 16 million Americans
Classified according to cause: allergy, exercise-induced, or infections of respiratory tract

3. Isoproterenol
Isoproterenol (Isuprel) is often used to treat asthma in children
However, this use is not a labeled indication for the drug
Advise parents and children that saliva and sputum may appear pink after inhalation—this is normal

4. Bronchodilators
Agents that widen the diameter of bronchial tubes:

5. Corticosteroids: Uses
Mechanism of action believed to be diminished activation of inflammatory cells and increased production of anti-inflammatory mediators, which reduces production of mucus and decreases edema
Used to treat respiratory conditions such as nasal congestion and allergic conditions such as rhinitis and asthma

6. Corticosteroids: Adverse Effects
Irritation of mucous membranes
Headache
Pharyngitis
Epistaxis
Nausea and vomiting
Coughing

7. Corticosteroids: Contraindications
Contraindicated in children younger than 4 years
Cautious use in pregnancy and lactation, and in those with immune system infections, tuberculosis, herpes simplex, ulcers, and nasal surgery or trauma

8. Mast Cell Stabilizers: Uses
Inhibit release of bronchoconstrictors such as histamine from pulmonary mast cells (cells in connective tissue)
Used for prophylaxis of mild to moderate seasonal bronchial asthma and allergic rhinitis; prevention of exercise-related bronchospasm; prevention of acute bronchospasm

9. Mast Cell Stabilizers: Adverse Effects
Nausea and vomiting
Dry mouth
Throat irritation
Cough
Hoarseness
Headache
Dizziness
Rash

10. Mast Cell Stabilizers: Contraindications
Contraindicated in patients with coronary artery disease or history of arrhythmias, acute asthma, during pregnancy; or in children younger than 6 years

11. Mast Cell Stabilizers: Patient Information
Advise patients to gargle with water or to suck on lozenges after each treatment to reduce throat irritation, cough, and hoarseness.

12. Antitussives: Uses
Opioids work by causing respiratory depression; nonopioids reduce activity of peripheral cough receptors and appear to increase threshold of central cough centerl.
Opioids are used to suppress nonproductive cough; nonopioids offer temporary relief of cough spasms.

13. Antitussives: Adverse Effects
Difficulty breathing
Drowsiness
Rash
Itching
Dizziness
Nausea
Nervousness and restlessness

14. Antitussives: Contraindications
Contraindicated in asthma, emphysema, diabetes, heart disease, seizures, thyroid conditions, chronic bronchitis, and liver disease.
Cautious use in pregnancy and lactation

15. Antitussives: Patient Information
Advise patients to call physician if coughing continues longer than 1 week or mucus is yellow.

16. Natural Expectorant
Wild cherry bark acts as an expectorant and a mild sedative. It is available in syrup or tincture forms.
It should not be used during pregnancy.

17. Opioids for Cough
Opioid analgesics are among most effective drugs used as cough suppressants: 15-mg doses are often sufficient.

18. Expectorants and Mucolytics: Uses
Work by lowering viscosity and facilitating removal of mucous secretions or enhancing reflex outflow of respiratory tract fluids by irritating gastric mucosa (guaifenesin)
Used to treat bronchopulmonary disease and cystic fibrosis

19. Expectorants and Mucolytics: Adverse Effects and Contraindications
Common adverse effects: very few
Contraindicated in pregnancy and lactation.
Guaifenesin may interact with heparin.

20. Expectorants and Mucolytics: Patient Information
Instruct patients to increase fluid intake.
Tell patients to report a persistent cough beyond 1 week.

21. Decongestants: Uses
Vasoconstricting agents that shrink swollen mucous membranes of nasal airway passage
Used for relief of nasal congestion due to common cold, upper respiratory allergies, and sinusitis.

22. Decongestants: Adverse Effects
Nervousness and restlessness
Insomnia
Dizziness
Headache
Irritability

23. Decongestants: Contraindications
Diabetes
Heart disease
Uncontrolled hypertension
Hyperthyroidism

24. Decongestants: Patient Information
Instruct patients to avoid taking oral decongestants with 2 hours of bedtime because they may act as stimulants.
Advise patients to discontinue and immediately report extreme restlessness or signs of sensitivity.
Women should not breast feed.