Generic Name
Fast acting
bronchodilators
Brand Name
albuterol
Proventil,
Ventolin, Pro-air
(asthma COPD,
pulmonary
emphysema
Picture of drug
Category/
Classification
Dosage of MDI/DPI
when available
Onset, peak
and duration
of the drug
Indications/side
effects
MODE OF
ACTION
(how does it
work)
Fast acting front
door
bronchodilator,
Beta-2
Adrenergic
sympathomimeti
c bronchodilator
SVN: 0.5% solution,
0.5ml,
2.5MG with 3ml NS tid,
qid
MDI: 90 µg/puff, 2
puffs,
tid, qid
Onset: 15
minutes
Peak: 30 – 60
minutes
Duration: 5 – 8
hours
tremor ,nervousness, ,
dizziness,
hypokalemia,
tachycardia,
headache,
nervousness,
nosebleed, upset
stomach, vomiting,
stomach pain, muscle
cramps, cough dry
mouth (inhalation
only), throat irritation
(inhalation only)
Headache, angina,
palpitations,
tachycardia. Use
precaution with use
with antihistamines or
tricyclic
antidepressants may
cause cardiac effects.
Bronchodilation,
increases heart rate,
increases cardiac
contractile force.
Narrowing of the
airways called
paradoxical
bronchospasm in
some patients, which
may be life
threatening. Same
effects as albuterol.
Fast acting
bronchodilator.
Bronchodilation of
smooth muscle,
promotes
Bronchodilation
via the
neurotransmitter
norepinephrine,
which is similar to
epinephrine
(Adrenaline)
MDI: same frequency
with 2-4 puff w/spacer
racemic
epinephrine
Micro-Nefrin,
Asthma-Nefrin
VapoNefrin
Alpha- 1
Adrenergic
Sympathomimetic effect
Inhalation only
SVN: 2.25% solution,
0.25 – 0.5 ml, qid
Onset: 3 – 5
minutes
Peak: 5 – 20
minutes
Duration:
0.5 – 2 hours
Xopenex,
Chemical
name: Racemic
Albuterol
Fast acting front
door
bronchodilator,
Beta- 2
Adrenergic
Sympathomimeti
c Bronchodilator
0.31mg/3mL (Infants),
0.63mg/3mL (Children,
Adults) & 1.25mg/3mL
(Adults) unit dose vials
Onset: 1-5
minutes,
Peak:
30-60 minutes
Duration:
6-8 hours
(airway swelling)
levalbuterol
MDI- 45mcg/puff
Fast acting
Bronchodilator.
Mucosal
vasoconstriction
decreases subglottic
edema. Used for
stridor/upper
airway swelling.
AMP which leads to
activation of protein
kinase A, which
inhibits
phospholylation of
myosin and lowers
intracellular ionic
calcium
concentrations
resulting in
relaxation of all the
airways (trachea,
bronchi and
bronchioles)
Generic Name
Long Acting
Bronchodilators
Brand Name
(fluticasone
furoate and
vilanterol
Breo
Category/
Classification
Dosage of MDI/DPI
when available
Onset, peak
and duration
of the drug
Indications/side
effects
long-acting beta2adrenergic
agonist (LABA)
DPI- Breo Ellipta 100
mcg/25 mcg should be
administered as 1
inhalation once daily by
the orally inhaled route
only. After inhalation,
the patient should rinse
his/her mouth with
water without
swallowing to help
reduce the risk of
oropharyngeal
candidiasis.
Onset: 1Hr.
Peak:1-2 Hrs.
Duration: 24hr.
Breo Ellipta is only
approved for use in
COPD. Is not approved
for use in asthma. This
can cause serious side
effects including:
runny nose and sore
throat upper
respiratory tract
infection headache
thrush in the mouth
and/or throat. Rinse
your mouth without
swallowing after use
to help prevent
infection
Aerosol
SVN: 15
µg/2 ml unit dose,
twice daily
Onset: 15

minutes
Peak: 30 – 60
minutes
Duration: 12
hours
Side effects:
weakness; headache,
sleep problems
(insomnia); nausea,
vomiting, diarrhea; leg
cramps; fever; stuffy
nose; or. hoarseness
or deepened voice
Medicines in
Breo Ellipta have
an increased risk
of death from
asthma problems
Fluticasone–
decreases airway
inflammation
Vilanterol– relaxes
bronchial smooth
muscle
arformoterol
(has a short
acting
component)
Picture of drug
Brovana
is used to prevent
bronchoconstriction in people
with COPD,
chronic bronchitis
and emphysema.
Beta2
Agonist
MODE OF
ACTION
(how does it
work)
Breo Ellipta
inhalation powder
contains a
combination of
fluticasone and
vilanterol.
Fluticasone is a
steroid. It prevents
the release of
substances in the
body that cause
inflammation.
Vilanterol is a
bronchodilator. It
works by relaxing
muscles in the
airways to improve
breathing. Breo
Ellipta inhalation p
wder is used to
prevent airflow
obstruction or
bronchospasm in
people with COPD
(chronic obstructive
pulmonary disease).
This is a Long acting
bronchodilator. It
works by relaxing
muscles in the
airways to improve
breathing. It will not
treat an attack that
has already begun.
formoterol
Foradil
(combined with
It is also used in
pulmicort to
people with
make symbicort) chronic
Beta2
Agonist
DPI: 12 µg/inhalation,
twice daily
obstructive
pulmonary disease
(COPD) such as
emphysema and
chronic bronchitis.
salmeterol
(combined with
Flovent to make
Advair)
Serevent
Acting inhaled
Beta 2
agonists.
DPI: 1 inhalation
(50mcg) twice daily, 12
hours apart
Onset: 15

minutes
Peak: 30 – 60

minutes
Duration: 12

hours
Side effects: dizziness,
anxiety, headache;
sleep problems
(insomnia);
back pain, muscle
cramps;

sore throat, dry
mouth, cough, stuffy
nose;

skin rash, itching; or.

changes in your voice.
Onset: 10-20 
min
Peaks: 3-4 hours

Duration of
action: 12 hours

Typically
combined with
Flovent to
Make ADVAIR 
Side effect: A Spasm
of the LarynxSevere.
Abnormal Heart
RhythmSevere.
Abnormally HighPitched Breathing
SoundSevere.
Acute Infection of the
Nose, Throat or
SinusSevere.

Allergic Reaction
caused by a
DrugSevere.

BronchitisSevere.

Chest PainSevere.

Giant HivesSevere
Long-acting
bronchodilator that
relaxes muscles in
the airways to
improve breathing.
Used to prevent
bronchospasm in
people with
reversible
obstructive airways
disease, including
symptoms of nighttime asthma.
Treatment and
prevention of
bronchospasm.
Serevent is not
intended for the
treatment of acute
asthma
exacerbations or for
symptoms.
Generic Name
Anticholinergics
Brand Name
Ipratropium
bromide
Atrovent
tiotropium
bromide
Spiriva
Given with
handi haler
Picture of drug
Category/
Classification
Dosage of MDI/DPI
when available
Onset, peak
and duration
of the drug
Indications/side
effects
MODE OF
ACTION
(how does it
work)
Anticholinergic
agent
MDI: 17 µg/puff, 2
puffs 4 times daily
SVN: 0.02% solution,
0.5 mg,
3-4 times daily
Nasal Spray: 0.03%,
0.06%
solution, 2 sprays per
nostril, 2 to 4 times
daily
Unit dose is 0.5 mg or
0.02%, usually mixed
with Albuterol or
Xopenex.
Onset: 15
minutes
Peak: 1 – 2
hours
Duration: 4 – 6
hours
Fever, infection,
headache, skin rash or
hives, swelling of lips,
tongue or face,
vomiting, cough,
blurred vision, dry
mouth
It relaxes airway
muscles by
impacting
neurotransmitters
sent to the
autonomic nervous
system, a process
different than how
beta-agonist drugs
act. Sometimes
given in addition to
shorter-acting
bronchodilator
therapy, if the
shorter-acting meds
are not doing
enough. Tends to
have longer-lasting
effect than betaagonist drugs.
Anticholinergic
agent
Bronchodilator
DPI:
18 µg/inhalation, 1
inhalation daily
Onset: 30

minutes
Peak: 3 hours

Duration: 24

hours
Side effect: dry
mouth;

fast heart rate;

upset stomach;

chest pain; or.

cold symptoms such
as stuffy or runny
nose, sinus pain, sore
throat.
It’s a long-acting,
antimuscarinic
agent, which is
often referred to as
an anticholinergic. It
has similar affinity
to the subtypes of
muscarinic
receptors, M1 to
M5. In the airways,
it exhibits
pharmacological
effects through
inhibition of M3receptors at
the smooth
muscle leading to
bronchodilation.
blurred vision;
constipation, painful
or difficult urination;
aclidinium
bromide
Tudorza
Anticholinergic
Agent
Bronchodilator
(Adults) One inhalation
(400 mcg) twice daily.
Onset: 1-2Hrs.
Peak: 2-4 hrs.
Duration: 12hrs.
Side effects
CNS: headache
EENT: worsening of
narrow-angle
glaucoma
Resp: paradoxical
bronchospasm
GU: urinary retention
Misc: immediate
hypersensitivity
reactions
Aclidinium bromide
is a long-acting
antimuscarinic
agent, which is
often referred to as
an anticholinergic. It
has
similar affinity to
the subtypes of
muscarinic
receptors M1 to
M5. In the airways,
it exhibits
pharmacological
effects through
inhibition of M3
receptor at
the smooth
muscle leading to
bronchodilation.
The competitive
and reversible
nature of
antagonism was
shown with human
and animal origin
receptors and
isolated organ
preparations.
Category/
Classification
Dosage of MDI/DPI
when available
Onset, peak
and duration
of the drug
Indications/side
effects
MODE OF
ACTION
(how does it
work)
Advair Diskus
combines an
inhaled
corticosteroid and
an inhaled longacting
bronchodilator
DPI: 100 µg fluticasone
/ 50 µg salmeterol
250 µg fluticasone / 50
µg salmeterol
500 µg fluticasone / 50
µg salmeterol
Adults and children >
12 years:
100 µg fluticasone / 50
µg salmeterol, one
inhalation twice daily,
about 12 hours apart
Children > 4 years:
100 µg fluticasone / 50
µg salmeterol, one
Advair Diskus 
does not replace

fast-acting
inhalers for
sudden

symptoms.
Advair Diskus 
effectively
treats the two
main
components of
asthma at the 
same time:
constriction, the

tightening of the
BronchitisSevere.
Constriction and
inflammation cause
the airways to
narrow and reduce
airflow into the
lungs, which may
result in symptoms
such as wheezing,
coughing, chest
tightness, or
shortness of breath.
The combination of
fluticasone
(Flovent-steroid)
and salmeterol
COPD agent
Generic Name
Combination
drugs
Brand Name
fluticasone
propionate/
salmeterol
xinafoate
Advair Diskus
Advair HFA
Before inhaling
your dose of
Advair Diskus,
breathe out as
far as is
comfortable,
holding the
DISKUS level
and away from
your mouth.
Picture of drug
Acute Infection of the
Nose, Throat or
SinusLess Severe.
CoughLess Severe.
Fungal Yeast Infection
of the ThroatLess
Severe.
Head PainLess Severe.
Muscle PainLess
Severe.
Sinus Irritation and
Remember,
never breathe
out into the
DISKUS
mouthpiece.
Put the
mouthpiece to
your lips.
Breathe in
quickly and
deeply
through the
Advair Diskus,
not through
your nose.
This inhaler
delivers 20 mcg
of ipratropium
bromide
(monohydrate)
and 100 mcg
albuterol
Combivent
Respimat
Combo drug
The two
classes of
medications
(an
anticholinergic
and a beta2adrenergic
agonist) are
both
bronchodilator
s.
inhalation twice daily,
about 12 hours apart
MDI: 45 µg fluticasone
/ 21 µg salmeterol
115 µg fluticasone / 21
µg salmeterol
230 µg fluticasone / 21
µg salmeterol
Adults and children >
12 years:
2 inhalations twice
daily, about 12 hours
apart
muscles around
the airways, and
inflammation, 
the swelling and
irritation of the
airways.
CongestionLess
Severe.
The recommended
dose is one inhalation
four times a day.
Patients may take
additional inhalations
as required; however,
the total number of
inhalations should not
exceed six within 24
hours.
Onset: 15
minutes
Peak: 30 – 60
minutes
Duration: 5 – 8
hours
Serious side effects
may include
bronchospasms,
ocular changes, and
cardiac complications.
Manifestations of
overdosage with
albuterol may include
anginal
pain, hypertension, hy
pokalemia, tachycardi
a with rates up to 200
beats per minute,
metabolic acidosis,
Throat IrritationLess
Severe
(Sereventbronchodilator) is
used to prevent
wheezing, shortness
of breath, and
breathing
difficulties caused
by asthma, but also
be prescribed for
COPD.
Simultaneous
administration of
both an
anticholinergic
(ipratropium
bromide) and a
beta2sympathomimetic
(albuterol sulfate) is
designed to
produce a greater
bronchodilator
effect than when
either drug is
utilized alone at its
recommended
dosage. The efficacy
of COMBIVENT
RESPIMAT is likely
to be due to a local
effect on the
muscarinic and
beta2-adrenergic
receptors in the
lung.
mometasone
furoate/
formoterol
fumarate
dihydrate
Dulera
Combo Drug
Long-acting
beta2-adrenergic
agonists
MDI given BID, 100/5 or
200/5 mcg dose
Onset:15
minutes
Peak:30-60 min.
Duration: 12
hrs.
Patients should be
informed that
formoterol, one of the
active ingredients in
Dulera, increases the
risk of asthma-related
death
formotero/
budesonide
2 doses, combo
drug
Symbicort
Combo drug
Contains
formoterol, a
long-acting
beta2adrenergic
agonist (LABA)
and
budesonide
(steroid)
MDI given BID, two
doses 160/4.5 mcg,
80/4.5 mcg
Onset: 15 min.
Peak: 30-60
minutes
Duration: 12
hrs.
.
Side effects: nose and
throat irritation,
headache, upper
respiratory tract
infection, sore throat,
sinusitis, stomach
discomfort, flu, back
pain, nasal congestion,
vomiting, and thrust in
the mouth and throat
Dulera contains
both mometasone
furoate and
formoterol
fumarate;
therefore, the
mechanisms of
actions described
below for the
individual
components apply
to Dulera. These
drugs represent two
different classes of
medications (a
synthetic
corticosteroid and a
selective long-acting
beta2-adrenergic
receptor agonist)
that have different
effects on clinical,
physiological, and
inflammatory
indices of asthma.
This medicine helps
control asthma,
which contains 2
medicines to reduce
the inflammation in
the lungs and keep
airways open.
Generic Name
Inhaled Steroids
Brand Name
(flunisolide)
Aerospan
Picture of drug
Category/
Classification
Corticosteroid
Aerobid is
now
Aerospan
Dosage of MDI/DPI
when available
Onset, peak
and duration
of the drug
Indications/side
effects
MODE OF
ACTION
(how does it
work)
MDI
80mcg/actuation
[60, 120
actuations]
May require
hours to days to
gain full benefits
Daily
compliance is
essential to
maximizing
effects
Indications: Antiinflammatory
maintenance therapy
of persistent asthma
and COPD. Control of
seasonal allergic or
non-allergic rhinitis.
side effects
Dysphonia, Cough
Bronchoconstriction
Corticosteroid; not
established. Shown
to have a wide range
of anti-inflammatory
effects, inhibiting
both inflammatory
cells (eg, mast cells,
eosinophils,
neutrophils,
macrophages,
lymphocytes) and
release of
inflammatory
mediators (eg,
histamine,
eicosanoids,
leukotrienes,
cytokines) involved
in allergic and nonallergic-mediated
inflammation.
Corticosteroid; not
established. Shown
to have inhibitory
effects on multiple
cell types (eg, mast
cells, eosinophils,
neutrophils,
macrophages, and
lymphocytes) and
mediators (eg,
histamine,
eicosanoids,
leukotrienes, and
cytokines) involved
in inflammatory and
asthmatic response.
Headache, allergic
reactions, bacterial
infection, vomiting,
dyspepsia, pharyngitis,
rhinitis, sinusitis,
epistaxis, urinary tract
infection.
(mometasone
furoate)
Asmanex
Corticosteroid
DPI 40/80 ug dose
May require
hours to days to
gain full benefits
Daily
compliance is
essential to
maximizing
effects
Indications: Antiinflammatory
maintenance therapy
of persistent asthma
and COPD. Control of
seasonal allergic or
non-allergic
rhinitis.Side effects
Headache, allergic
rhinitis, pharyngitis,
URTI, sinusitis, oral
candidiasis,
dysmenorrhea,
musculoskeletal pain,
back pain, dyspepsia,
myalgia, abdominal
pain, nausea.
fluticasone
propionate
Flovent
Corticosteroid
MDI: 44, 110, and 220
µg/puff
Adults > 12 years:
88 µg twice daily; 88 –
220 µg twice daily; or
880 µg twice daily
Children 4 – 11 years:
88 µg twice daily
DPI: 50, 100, and 250
µg
May require
hours to days to
gain full benefits
Daily
compliance is
essential to
maximizing
effects
Indications: Antiinflammatory
maintenance therapy
of persistent asthma
and COPD. Control of
seasonal allergic or
non-allergic rhinitis.
May be administered
as orally inhaled
aerosol or intranasal
Corticosteroid;
shown to have a
wide range of
actions on multiple
cell types (eg, mast
cells, eosinophils,
neutrophils,
macrophages,
lymphocytes) and
mediators (eg,
Adults:
100 µg twice daily; 100
– 250 µg twice daily; or
1000 µg
twice daily
Children 4 – 11 years:
50 µg twice daily
aerosol, side effects
Dysphonia, Cough
Bronchoconstriction
histamine,
eicosanoids,
leukotrienes,
cytokines) involved
in inflammation.
budesonide
Pulmicort
Corticosteroid
Aerosol DPI: 200
µg/actuation
Adults:
200 – 400 µg twice
daily; 400 – 800 µg
twice daily
Children > 6 years:
200 µg twice daily
SVN: 0.25 mg/2 ml; 0.5
mg/2 ml
Children 1 – 8 years:
0.5 mg total dose once
daily or twice daily in
divided doses
1 mg given as 0.5 mg
twice daily or once daily
May require
hours to days to
gain full benefits
Daily
compliance is
essential to
maximizing
effects
Respiratory infection.
(Flexhaler)
Nasopharyngitis,
headache, fever,
sinusitis, pain, N/V,
insomnia, dry mouth,
weight gain.
(Respules) Rhinitis,
otitis media, coughing,
viral infection, ear
infection,
gastroenteritis.
Corticosteroid; not
established. Shown
to have inhibitory
activities against
multiple cell types
and mediators
involved in
inflammatory and
asthmatic response.
beclomethasone
dipropionate
Qvar
Corticosteroid
MDI: 40 and 80
µg/puff.
Adults > 12 years:
40 to 80 µg twice
daily, or 40 to 160 µg
twice daily
Children > 5 years:
40 to 80 µg twice
daily
May require
hours to days to
gain full benefits
Daily
compliance is
essential to
maximizing
effects
Headache, pharyngitis,
URTI, rhinitis,
increased asthma
symptoms, oral
symptoms (inhalation
route), sinusitis,
dysphonia,
dysmenorrhea,
coughing.
Corticosteroid; has
multiple antiinflammatory
effects, inhibiting
both inflammatory
cells (eg, mast cells,
eosinophils,
basophils,
lymphocytes,
macrophages,
neutrophils) and
release of
inflammatory
mediators (eg,
histamine,
eicosanoids,
leukotrienes,
cytokines).
Generic Name
Systemic
Steroids
Brand Name
Decadron
Picture of drug
Category/
Classification
Dosage of MDI/DPI
when available
Onset, peak
and duration
of the drug
Indications/side
effects
MODE OF
ACTION
(how does it
work)
dexamethasone
long-acting
synthetic
adrenocorticoid
Oral solution: 0.5
mg/0.5 ml, 0.5 mg/5 ml
Tablets: 0.25 mg, 0.5
mg, 0.75 mg, 1 mg, 1.5
mg, 2 mg, 4 mg, 6 mg
Onset: 1-2 hrs.
Peak: 1-2 Hrs.
Duration: 2Days
CNS: euphoria,
insomnia, psychotic
behavior,
pseudotumor cerebri,
vertigo, headache,
paresthesia, seizures.
CV: heart
failure, hypertensione
dema, arrhythmias, th
rombophlebitis, throm
boembolism.
Prednisone
Glucocorticoid
Concentrate, oral 5
mg/mL
Onset: rapid
Peak:1-2 Hr.
Duration:1.5
days
increased blood

pressure, behavior or
mood changes,
increased appetite,
weight gain.
Dexamethasone
stimulates the
synthesis of
enzymes needed to
decrease the
inflammatory
response. It causes
suppression of the
immune system by
reducing activity
and volume of the
lymphatic system,
producing
lymphocytopenia
(primarily Tlymphocytes),
decreasing passage
of immune
complexes through
basement
membranes, and
possibly by
depressing
reactivity of tissue
to antigen-antibody
interactions.
Prednisone is a
medicine used to
reduce swelling and
improve symptoms
associated with
certain allergic, skin,
stomach, intestinal,
blood, eye, kidney,
lung, or joint
disorders;
rheumatoid
arthritis; certain
cancers; and certain
infections.
solumederol
Sympathomime 50 mcg blister via bid
tic LABA
Serevent
Onset: 20 min
Peak:3-5hrs.
Duration: 12hrs
Indication: Asthma
attacks,bronchospasms. Side effects:
tachycardia, heart
arrhythmia, HTN,
tremors,
dysrhythmias, anxiety.
Generic Name
Anti-allergen
Brand Name
zafirlukast
Accolate
Indicated for
prophylactic
control of
mild to
moderate
asthma
montelukast
Singulair
Picture of drug
Salmeterol is a
bronchodilator of
the beta-2 agonist
type. Beta-2
agonists are
medications that
stimulate beta-2
receptors on the
smooth muscle cells
that line the
airways, causing
these muscle cells
to relax, thus,
opening airways.
Category/
Classification
Dosage of MDI/DPI
when available
Onset, peak
and duration
of the drug
Indications/side
effects
MODE OF
ACTION
(how does it
work)
Leukotriene
receptor
antagonist
Tablets: 10 and 20 mg
Adults and children >
12 years:
20 mg twice daily,
without food
Children 5 – 11 years:
10 mg twice daily
Onset: 30 min
Peak:3.5 hrs
Duration:12hrs
Mast cell stabilizers.
Indicated for
prophylactic control of
mild to moderate
asthma. Side effect:
Headache, myalgia,
nausea,
pharygolaryngeal pain,
sinusitis, upper
respiratory tract
infection
Leukotriene
receptor
antagonist
Tablets: 10 mg; 4 and 5
mg chewable; 4 mg
packet of granules:
Adults and children >
15 years:
one 10 mg tablet daily
Children 6 – 14 yrs
one 5 mg chewable
tablet daily
Onset: unknown
Peak:2-4 hrs.
Duration:
unknown
Indicated for
prophylactic control of
mild to moderate
asthma. Side effects:
Headache, myalgia,
nausea,
pharygolaryngeal pain,
sinusitis, upper
respiratory tract
Leukotriene
blockers act by
either reducing the
synthesis or direct
actions of proinflammatory
molecules called
leukotrienes.
Leukotriene
blockers (also
referred to as
leukotriene
modifiers) can
either directly block
the signaling effects
of leukotrienes
directly at their
sites of action
(typically LTC4,
LTD4 or LTE4
receptors).
Leukotriene
blockers act by
either reducing the
synthesis or direct
actions of proinflammatory
molecules called
leukotrienes.
Leukotriene
Children 2 – 5 years:
one 4 mg chewable
tablet daily
Children 6 – 23 months:
one 4 mg packet of
granules daily
(omalizumab)
Xolair
Reoccurring allergic
reactions in
asthmatic individuals
can lead to chronic
lung inflammation,
lung remodeling
and/or inductions or
worsening of acute
asthmatic
exacerbations. Xolair
is a synthetic
antibody that binds
(attaches) to IgE
antibodies,
effectively
preventing them
from binding to
allergens.
Indicated for
prophylactic
control of
mild to
moderate
asthma.
Monoclonal
antibody/IgEblocker
Do not administer more
than 150mg (contents
of one vial) per inj site
150mg inj involves 1 inj
(1.2mL total volume inj)
225mg inj involves 2 inj
(1.8mL total volume inj)
300mg inj involves 2 inj
(2.4mL total volume inj)
375mg inj involves 3 inj
(3.0mL total volume inj)
infection,
inflammation of the GI
tract
The inj may take
5-10 sec to
administer
Onset: unknown
Peak: 7-8 days
Duration:
Unknown
Anaphylaxis, inj-site
reactions, URTI,
sinusitis, headache,
nasopharyngitis, pain,
fatigue, arthralgia, leg
pain, dizziness.Side
effect: arthralgia, pain
(general), leg pain,
fatigue, dizziness,
fracture, arm pain,
pruritus, dermatitis,
and earache.
blockers (also
referred to as
leukotriene
modifiers) can
either directly block
the signaling effects
of leukotrienes
directly at their
sites of action
(typically LTC4,
LTD4 or LTE4
receptors).
Antibodies are the
body’s first line of
defense against
foreign invaders,
such as viruses and
bacteria. Antibodies
attach themselves
to the foreign
invading pathogens
and signal the
immune system to
destroy the
invaders. One of
these antibodies,
IgE as it is called,
also binds to
“allergens” such as
pollen, dust mites
or mold spores
causing an “allergic”
immune response,
which is somewhat
similar to
inflammatory
processes.
Asthmatic
individuals may
have higher than
normal levels of IgE
or their IgE
antibodies may be
more sensitive to
allergens.
Generic Name
Mucolytics
Brand Name
(guaifenesin)
Mucinex
Picture of drug
Category/
Classification
Expectorants
These are
defined as
medications
that improve
the ability to
expectorate
purulent
secretions.
Dosage of MDI/DPI
when available
600mg Tab,
Extended-Release
Onset, peak
and duration
of the drug
Indications/side
effects
MODE OF
ACTION
(how does it
work)
Duration: 12
Hrs.
Medications that
increase airway
water or the volume
of airway
secretions, including
secretagogues that
are meant to
increase the
hydration of luminal
secretions (eg,
hypertonic saline or
mannitol) and
abhesives that
decrease the
adhesivity of
secretions and thus
unstick them from
the airway (eg,
surfactants).
The general term
for medications
that are meant to
affect mucus
properties and
promote
secretion
clearance is
“mucoactive.”
Mucoactive
medications are
intended either to
increase the
ability to
expectorate
sputum or to
decrease mucus
hypersecretion.
Onset: 1 min.
Peak: 3-5
min.
Duration:n/a
They destroy the
elasticity of mucus while
reducing the viscosity.
Elasticity is crucial for
mucociliary transport.
Side effects
Airway obstruction
secondary to rapid
liquefaction of secretions
Disagreeable odor
(rotten eggs)
Nausea
Rhinorrhea
Bronchospasm
The general term
for medications that
are meant to affect
mucus properties
and promote
secretion clearance
is “mucoactive.”
Mucoactive
medications are
intended either to
increase the ability
to expectorate
sputum or to
decrease mucus
hypersecretion.
(ER):
1 or 2 tabs q12h
Max: 4 tabs/24 hrs
1200mg Tab, ER:
1 tab q12h
Max: 2 tabs/24 hrs
Sputum is the
expectorated
secretions that
contains mucus, as
well as
oropharyngeal and
nasopharyngeal
secretions (saliva).
acetylcysteine
Mucomyst
May be directly
instilled during
bronchoscopy to
remove mucus plug
ALWAYS GIVE
WITH A
BRONCHODILATO
R and not given
with thin
secreations
Mucus
controlling
Normal dosage via
SVN: 3 – 5 ml
Draw up with a syringe
and instill into
nebulizer. Given orally
to reduce liver injury
with acetaminophen
(Tylenol) overdose.
Mix with cola or given
by NG tube
dornase alfa
Pulmonzyme
Mucolytic
agent without
Clone of the
natural human
pancreatic
DNase enzyme
which digests
extracellular
DNA.
This treats
cystic fibrosis
(CF) to reduce
number of
infections and
improve
pulmonary
function
Breaks down
DNA material
from
neutrophils
this agent there is
an increase in
Viscosity of mucus
Less Ciliary
effectiveness
Mucus plugs
Airway Resistance
Infections
Obstructed
bronchioles leads
to atelectasis
Sodium
bicarbonate
Mucolytic
agent
Mucolysis is
needed in
diseases in
which there is
increased mucus
production:
Cystic Fibrosis,
COPD,
Bronchiectasis,
Respiratory
infections,
Asthma,
Pneumonia
Generic Name
Anti-Infectives
Brand Name
without this agent
there is an
increase in
Viscosity of mucus
Less Ciliary
effectiveness
Mucus plugs
Airway Resistance
Infections
Obstructed
bronchioles leads
to atelectasis
Picture of drug
Category/
Classification
Normal dosage via SVN:
2.5 mg/ampule, 1
ampule daily
Supplied in single dose
vials (unit
dose).Concentration is
1 mg/mL (0.1%
solution).
Each vial contains 2.5
mg /2.5 mL.
Administer one unit
dose vial (2.5 mL) daily.
Some patients may
benefit from BID
administration.
Do not mix or dilute
with other drugs.
Nebulizer specific (per
manufacturer).
Onset 3-7 days
Peak:9 days
Duration:
unknown
Indications
Reduce viscosity of
secretions during an
infection by breaking
down extracellular
DNA.Used in cystic
fibrosis, chronic
bronchitis or
bronchiectasis. Side
effects voice
Alteration
Pharyngitis/Laryngitis
Rash, Chest pain
Conjunctivitis
The general term
for medications that
are meant to affect
mucus properties
and promote
secretion clearance
is “mucoactive.”
Mucoactive
medications are
intended either to
increase the ability
to expectorate
sputum or to
decrease mucus
hypersecretion.
2-5 mL of a 2.5%
solution Q4-Q8.
Mix 5% solution with
equal volume of sterile
water.
Onset: 2-10 min
Duration: 30-60
min
An effect is that they
destroy the elasticity
of mucus while
reducing the viscosity.
Elasticity is crucial for
mucociliary transport.
The patient must be
able to cough
adequately to remove
the mucus. Side effect
mucosal irritation.
The general term
for medications that
are meant to affect
mucus properties
and promote
secretion clearance
is “mucoactive.”
Mucoactive
medications are
intended either to
increase the ability
to expectorate
sputum or to
decrease mucus
hypersecretion.
Dosage of MDI/DPI
when available
Onset, peak
and duration
of the drug
Indications/side
effects
MODE OF
ACTION
(how does it
work)
Can be irritating
(especially the 5
& 7.5%
solutions).
pentamidine
isethionate
Nebupent
Indication:
Prevention of
Pneumocystis
carinii
pneumonia
(PCP) in high
risk, HIVinfected
patients.
tobramycin
Tobi
Aerosolized
Anti-Infective
Agents
Aminoglycosid
e
Treat or
prevent
colonization
zanamivir
Relenza
The
bioavailability of
zanamivir is 2%.
After inhalation,
zanamivir is
concentrated in
the lungs and
oropharynx,
where up to
15% of the dose
is absorbed and
excreted in
urine.
Neuraminidase
inhibitor
300 mg powder in 6
ml sterile water,
once every four
weeks.
Given using a
scavenger
nebulizer/SPAG
Onset Unknown
Pneumocystis is
commonly found in the
lungs of healthy people,
but being a source of
opportunistic infection it
can cause a lung
infection in people with a
weak immune system.
Pneumocystis pneumonia
is especially seen in
people with cancer,
HIV/AIDS and the use of
medications that affect
the immune system. Side
effects include Cough,
Bronchial irritation,
ronchospasm, Shortness
of breath, Fatigue,
Pharyngitis, Chest Pain
The drug interferes
with protozoa
nuclear metabolism
inhibition of DNA,
RNA, phospholipid
and protein
synthesis. It is
known to have
activity against
pneumocystis
carinii.
One 5 mL ampule
contains 300mg of
tobramycin. Given
B.I.D. / Q12 with
recommended
nebulizer (Pari type
neb)
Onset: 10 min
Peak:unknow
Duration:8hrs
Indicated for
management of
chronic infection with
Pseudomonas
aeruginosa; typically
seen with CF and
immune suppressed
patient. Side effects
are ototoxicity and
tinnitus,
Bronchospasm,
Fetal harm (deafness)
Aminoglycoside
antibiotic disrupts
protein synthesis
eventually resulting
in cell death (gram
negative organisms)
Powder, Inhalation:
5mg/inh [4
blisters/disk]
Onset: Rapid
Peak: 1-2 Hrs
Duration 12hrs
Indicated for
treatment of
uncomplicated llness
due to influenza virus
Side effects
Diarrhea, nausea,
sinusitis,
ear/nose/throat
infections, viral
respiratory
infections, cough,
headaches, nasal
signs/symptoms,
throat/tonsil
discomfort and pain
used in the
treatment and
prophylaxis of
influenza caused by
influenza A virus
and influenza B
virus.
Neuraminidase
inhibitor; inhibits
influenza virus
neuraminidase,
affecting release
of viral particles.
Dosing is limited to the
inhaled route. This
restricts its usage, as
treating asthmatics
could induce
bronchospasms
Aminoglycoside;
acts primarily by
disrupting protein
synthesis, leading to
altered cell
membrane
permeability,
progressive
disruption of the cell
envelope, and
eventual cell death.
virazole
Ribavirin
Used on ventilated
patients
Indicated as
anti-viral agent
to treat
respiratory
syncytial virus
(RSV)
Generic Name
Surfactants
Brand Name
(poractant alfa)
Curosurf
Picture of drug
Ribavirin is a class
of antiviral
medications called
nucleoside
analogues.
Administered via small
particle aerosol
generator (SPAG)
sterilized 500mL SPAG2 reservoir and further
dilute to final volume of
300mL w/ sterile water
for inj or inh to a final
concentration of
20mg/mL
Onset unknown
Skin rash
Eyelid erythema
Occlusion of
endotracheal tube
Deterioration of
pulmonary function
It works by stopping
the virus that
causes hepatitis C
from spreading
inside the body. It is
not known if
treatment that
includes ribavirin
and another
medication cures
hepatitis C
infection, prevents
liver damage that
may be caused by
hepatitis C, or
prevents the spread
of hepatitis C to
other people.
Category/
Classification
Dosage of MDI/DPI
when available
Onset, peak
and duration
of the drug
Indications/side
effects
MODE OF
ACTION
(how does it
work)
First dose 2.5 cc/Kg,
second dose is the
same; third dose is 1.25
cc/kg.
Rapid onset
5-30 Min.
Indicated for
surfactant deficiency,
such as in infant
respiratory distress
syndrome and
following lung lavage.
Side effects
bradycardia,
hypotension,
endotracheal tube
blockage, oxygen
desaturation
This essential fluid
is produced by the
Type II alveolar
cells, and lines the
alveoli and smallest
bronchioles.
Surfactant reduces
surface tension
throughout the
lung, thereby
contributing to its
general compliance.
It is also important
because it stabilizes
the alveoli.
Pig extract
Natural
surfactant used
to treat
prematurely of
the lung as
demonstrated by
RDS.
(lucinactant)
Surfaxin
Lung
surfactant
5.8mL/kg birth weight
Up to 4 doses can be
administered in the first
48 hrs of life; give doses
no more frequently
than q6h
Rapid onset
5-30 Min.
Prevention of
respiratory distress
syndrome (RDS) in
premature infants at
high risk for RDS.
Reduces the incidence
of RDS at 24 hrs and
mortality due to RDS.
beractant
Survanta
Natural
surfactant
Four divided doses
given through ET tube,
instilled with tracheal
adapter, surfactant is
drawn up in syringe and
instilled down ETT
directly into lungs.
Doses: A dose of
5ml/kg birth weight of
reconstituted Survanta4cc/Kg given initially,
second dose 2cc/Kg.
Rapid onset
5-30 Min.
Indicated for
surfactant deficiency,
such as in infant
respiratory distress
syndrome and
following lung lavage.
Side effects: Proteins
may elicit immune
response
Refrigerated
suspension
surfactant reduces
surface tension, more
at lower volumes and
less at higher volumes,
leading to alveolar
stability and reducing
the likelihood of
alveolar collapse. It is
also important
because it stabilizes
the alveoli.
This essential fluid
is produced by the
Type II alveolar
cells, and lines the
alveoli and
smallest
bronchioles.
Surfactant reduces
surface tension
throughout the
lung, thereby
contributing to its
general
compliance.
used to treat
prematurely of
the lung as
demonstrated by
RDS.
This essential fluid
is produced by the
Type II alveolar
cells, and lines the
alveoli and smallest
bronchioles.
Surfactant reduces
surface tension
throughout the
lung, thereby
contributing to its
general compliance.
It is also important
because it stabilizes
the alveoli.
The active
component
colfosceril palmitate
(dipalmitoylphosph
atidylcholine) is the
major surface active
component of
natural lung
surfactant and acts
by forming a stable
film that stabilizes
the terminal
airways by lowering
the surface tension
of the pulmonary
fluid lining them.
The lowered surface
tension prevents
alveolar collapse at
end-inspiration; the
hysteresis effect
equalizes the
distension of
adjacent alveoli and
hence prevents
over distension
which might result
in alveolar rupture
and pulmonary air
leak.
Generic Name
Xanthines
Brand Name
(caffeine
citrate)
theophylline
ER
Picture of drug
Category/
Classification
Dosage of MDI/DPI
when available
Onset, peak
and duration
of the drug
Indications/side
effects
MODE OF
ACTION
(how does it
work)
Caffeine
Cafcit
CNS stimulant
Premature Infants 28<33 Weeks Gestational
Age:
LD: 1mL/kg (20mg/kg)
IV over 30 min
Maint: 0.25mL/kg
(5mg/kg) IV over 10
min or PO q24h
beginning 24 hrs after
LD
Onset:
Unknown
Peak : 5075min.
Duration:
Unknown
Necrotizing
enterocolit is
reported. Caution with
seizure disorders. May
increase HR, left
ventricular output,
and stroke volume;
caution with
cardiovascular disease
(CVD). Caution with
renal/hepatic
impairment; monitor
serum concentrations
and adjust dose to
avoid toxicity.
CNS stimulant; not
established.
Suspected to
stimulate
respiratory center,
increase minute
ventilation,
decrease threshold
and increase
response to
hypercapnia,
increase skeletal
muscle tone,
decrease
diaphragmatic
fatigue, increase
metabolic rate, and
increase oxygen
consumption,
mostly attributed to
antagonism of
adenosine
receptors, both
A1 and A2 subtypes.
Theophylline
Methylxanthine
Once Daily Tab,
Extended-Release
(ER): 100mg*,
200mg*, 300mg*,
400mg*, 450mg*,
600mg*
Onset: Rapid
Peak 1-2 hr.
Duration: 6
Hrs.
Treatment of the
symptoms and
reversible airflow
obstruction associated
with chronic asthma
and other chronic lung
diseases (eg,
emphysema, chronic
Acts via smooth
muscle relaxation
and suppression of
airway response to
stimuli.
Bronchodilatation
suggested to be
mediated by
inhibition of 2
isozymes of
phosphodiesterase
(PDE) while nonbronchodilator
prophylactic actions
are probably
mediated through
one or more different
molecular
mechanisms that do
not involve inhibition
of PDE III or
antagonism of
adenosine
bronchitis). Side effect
include headache,
insomnia, diarrhea,
irritability, restlessness,
fine skeletal muscle
tremors, transient
diuresis.
receptors. Also,
increases the force
of contraction of
diaphragmatic
muscles due to
enhancement of
Ca2+ uptake through
an adenosinemediated channel.
Generic Name
Pulmonary
Hypertension
Brand Name
(epoprostenol
sodium)
Flolan
(nitric oxide)
Inomax
Neonates known to
be dependent on
right-to-left shunting
of blood.
Picture of drug
Category/
Classification
Dosage of MDI/DPI
when available
Onset, peak
and duration
of the drug
Indications/side
effects
MODE OF
ACTION
(how does it
work)
Prostaglandin
analogue
Vasodilator
Initial: 2ng/kg/min IV
chronic infusion
Titrate: Increase in
increments of 2ng/kg/min
every 15 min or longer
until dose-limiting effects
are elicited or until
tolerance limit is
established. Use a lower
dose if initial infusion rate
is not tolerated
If symptoms of PAH persist
or recur, increase dose in
increments of 12ng/kg/min at intervals of
at least 15 min
Onset: Rapid
Peak: unknown
Duration:2-3
min.
Treatment of
pulmonary arterial
HTN (PAH) (WHO
Group I) to improve
exercise capacity.
Flushing, headache,
N/V, hypotension,
anxiety, nervousness,
agitation, chest pain,
abdominal pain,
dizziness, bradycardia,
anorexia, eczema,
myalgia,
musculoskeletal pain.
Prostaglandin
analogue; causes
direct vasodilation
of pulmonary and
systemic arterial
vascular beds and
inhibition of platelet
aggregation.
Usual: 20ppm
Maintain treatment for
up to 14 days or until
underlying oxygen
desaturation has
resolved and the
neonate is ready to be
weaned from therapy
Max: 20ppm
Onset of action:
2-3 minutes
Indicated for the
treatment of
pulmonary
hypertension in
neonates
Hypotension
Formation of
Methemoglobinia
Withdrawal
Causes relaxation of
vascular smooth
muscle, producing
pulmonary
vasodilation
Vasodilator
Peak effect:
Dose dependent
Duration of
effect: 15-30
minutes
Maria Castanon
Mr. Haines
RT 30