Overview
This lecture covers key respiratory medications that cause bronchodilation, including their classes, mechanisms, uses, side effects, and important administration considerations.
Beta-2 Adrenergic Agonists
- Medications: albuterol (short-acting), salmeterol (long-acting).
- Used for asthma and COPD, alone or with glucocorticoids/anticholinergics.
- Bind to beta-2 lung receptors to cause bronchodilation.
- Side effects: nervousness, tremors, chest pain, palpitations.
- Albuterol treats acute asthma attacks; salmeterol is used for long-term prevention.
- When combined with glucocorticoid, use the bronchodilator first, wait 5 minutes, then use glucocorticoid.
Xanthines
- Key medication: theophylline (long-term control of asthma/COPD).
- Increases cAMP to cause bronchodilation.
- Side effects: GI upset, headache, nervousness, dysrhythmias, seizures.
- Requires regular blood monitoring; therapeutic level is 10–20 mcg/mL.
- Not used as often due to risk of severe side effects.
Anticholinergic Medications
- Key medication: ipratropium (inhaled or intranasal).
- Used for COPD, rhinitis (nasal congestion), sometimes off-label for asthma.
- Blocks acetylcholine receptors in airway smooth muscle to cause bronchodilation.
- Side effects: dry mouth, bitter taste, throat/nasal irritation.
- Advise patients to increase fluids and suck on candy for dry mouth.
- Combination of ipratropium and albuterol (DuoNeb) is contraindicated in patients with a peanut allergy.
Key Terms & Definitions
- Bronchodilation — Widening of the airways in the lungs.
- Beta-2 adrenergic agonists — Drugs that activate lung beta-2 receptors for airway relaxation.
- Xanthines — Drug class that increases cAMP for bronchodilation (e.g., theophylline).
- Anticholinergic (ipratropium) — Blocks acetylcholine to relax airway muscle and reduce secretions.
- COPD — Chronic obstructive pulmonary disease, a lung disease causing airflow limitation.
- Therapeutic level — Drug blood concentration range ensuring efficacy with minimal toxicity.
Action Items / Next Steps
- Review the differences between albuterol and salmeterol.
- Memorize the therapeutic range for theophylline (10–20 mcg/mL).
- Be prepared to discuss corticosteroids, leukotriene receptor antagonists, and antitussives in the next session.