RESPIRATORY CARE PHARMACOLOGY
RT205b
Adrenergic Agents:
Adrenergic – Term applied to nerve fibers that, when stimulated, release epinephrine at
their endings. Includes nearly all sympathetic postganglionic fibers except those
innervating sweat glands.
Adrenergic neuron-blocking agents – Substances that inhibit transmission of
sympathetic nerve stimuli regardless of whether alpha- or beta-adrenergic receptors are
involved
Sympathomimetic – Are substances that mimic the effects of the hormone epinephrine
(adrenaline) and the hormone/neurotransmitter norepinephrine (noradrenaline). They all
raise blood pressure and are all weak bases.
1. Short-acting beta-2 agonist (SABA)
a. Albuterol Sulfate (s-albuterol) (Proventil, Ventolin, ProAir)
SVN: Proventil, Ventolin
1. (Unit Dose 0.083%) 2.5 mg in 3.0ml
2. Dilute 0.5 milliliter (2.5mg) of the 0.5 % solution with 2.5
ml of sterile 9% normal saline solution.
3. TID, QID, Q4WA, Q4, Q2 (crisis), Continuous (crisis)
4. Time course:
a. Onset: 5 minutes
b. Peak: 30-60 minutes
c. Duration: 4-6 hours
MDI: ProAir HFA, Proventil HFA, Ventolin HFA, Airet
5. 90 ug/puff
6. 2-3 puffs TID, QID
7. Time course
a. Onset: 5 minutes
b. Duration: 4-6 hours
b. Levalbuterol hydrochloride (r-albuterol) (Xopenex)
B2 – Bronchodilator
SVN: Xopenex
1. Unit Dose:
a. .31 mg/3 ml; 6-11 years
b. .63 mg/3 ml; 6 years - older
c. 1.25 mg/3 ml; 12 years – older
2. Q 4-8 hours
3. Time course
a. Onset: 5-10 minutes
b. Duration: 5-8 hours
MDI (Levalbuterol tartrate): Xopenex HFA
4. 90 ug/puff
5. 1-2 puffs Q 4-6 Hours
6. Time course
a. Onset: 5-10 minutes
b. Duration: 5-8 hours
c. Pirbuterol acetate (Maxair)
i. B2 – Bronchodilator
ii. MDI: Maxair
1. 0.2 mg/puff
2. 2 puffs Q 4-6 Hours
3. Time course
a. Onset: 5 minutes
b. Duration: 5-6 hours
d. Terbutaline sulfate – (Brethine, Bricanyl, Brethaire) USED TO STOP
UTERINE CONTRACTIONS TO PREVENT EARLY DELIVERY
i. B2 – Bronchodilator
ii. SVN: Bricanyl, Brethine
1. Unit dose 2.5 mg/ml
2. Q 4-6 Hours
3. Time course
a. Onset: 5 minutes
b. Duration: 4-8 hours
MDI: Terbutaline (Brethine, Bricanyl)
4. 0.2 mg/puff
5. 2 puffs Q 4 -6 Hours
6. Time course
a. Onset: 5 minutes
b. Duration: 4-8 hours
DPI: Bricanyl
7. 0.5 mg/dose
8. 1 inhalation Q 4-6 Hours
9. Time course
a. Onset: 5 minutes
b. Duration: 4-8 hours
e. Bitolterol mesylate – (Tornalate)
B2 – Bronchodilator
SVN: Image not available at this time
1. 2.5 mg
2. Q 6-8 Hours
3. Time course
a. Onset: 4 minutes
b. Duration: 6-8 hours
2. Long-acting beta-2 agonist (LABA)
a. Salmeterol xinafoate – (Serevent)
B2 – Bronchodilator
MDI: Servent
1. 25 ug/puff
2. 2 puffs BID
3. Time course
a. Onset: 10-20 minutes
b. Duration: 12 hours
DPI: (Serevent Diskus)
4. 50 ug/puff
5. 1 puff BID
6. Time course
a. Onset: 10-20 minutes
b. Duration: 12 hours
b. Formoterol fumarate - (Foradil)
B2 – Bronchodilator
SVN: Perforomist NEW FALL 2007!
1. (Unit Dose) 20 ug in 2 ml solution?
2. 1 vial Q 12 Hours
DPI: (Foradil)
3. 12 ug/inhalation
4. BID
5. Time course
a. Onset: 15 minutes
b. Duration: 12 hours
c. Arfomoterol tartrate (Brovona)
SVN Inhalation Solution (unit-dose vial for nebulization): 15 mcg/2 mL solution
Some fast acting response, but dosed BID for COPD as a LABA only
3. Ultra-short-acting beta-2 agonist (USABA)
a. Racemic epinephrine – (Vaponefrin, MicroNefrin, Asthma Nefrin)
Moderate A – Increases blood pressure
Moderate B1 – Increases heart rate
Moderate B2 – Bronchodilation
SVN: Image not available at this time.
1. Unit dose
2. (2.25% solution) 0.25 – 0.75 (5.63-11.25 mg) ml in 2.5 to 3
ml normal saline solution
3. Onset: 10 minutes
4. Duration: 1-4 hours
b. Isoetharine mesylate – (Bronkosol, Bronkometer, Arm-A-Med,
Isoetharine HCl)
Moderate B1 – increases heart rate
Strong B2 – bronchodilator
SVN: No image at this time.
1. (1% solution) 0.25-0.50 ml (2.5-5.0 mg) Q 4-6 hour
2. Time course
a. Onset: 5 minutes
b. Duration: 4 hours
c. Epinephrine – (Adrenalin Cl, Adrenalin)
Strong A – increased blood pressure
Strong B1 – increases heart rate
Strong B2 – Bronchodilation
SVN: No image available at this time.
1. (1% solution) 0.25-0.5 ml (2.5-5.0 mg)
2. Time course
a. Onset: 1-2 minutes
b. Duration: 1-3 hours
Tablets: Bronkaid
3. 1 caplet ever 4 hours
4. Not to exceed 6 caplets in 24 hours
d. Isoproterenol hydrochloride – (Isuprel, Isuprel Mistometer,
Isoprenaline)
Warning! Isoproterenol is no longer available in the United States.
Strong B1 – Increases heart rate
Strong B2 – Bronchodilation
SVN: Isuprel
1. (0.5% solution) 0.25 – 0.50 ml (1.25-2.50 mg) in 2.5 to 3
ml normal saline solution
2. Time course
a. Onset: 1-5 minutes
b. Duration: 1-2 hours
Anticholinergic Agents:
Anticholinergic – Impeding the impulses of cholinergic, esp. parasympathetic, nerve
fibers. An agent that blocks parasympathetic nerve impulses. SYN: parasympatholytic.
Parasympatholytic – Having a destructive effect on or blocking parasympathetic nerve
fibers.
1. Bronchodilators
a. Ipratropium bromide – (Atrovent)
Used as maintenance drug for COPD including chronic bronchitis
and emphysema.
Intensifies bronchodilator (acts stronger and longer)
Do not give to patients with glaucoma or peanut allergy!
SVN:
1. Unit Dose – 0.5 mg/ 2.5 ml (2% solution)
2. QID or Q 6 Hours
3. Time course
a. Onset: 20 minutes
b. Duration: 5-8 hours
MDI:
4. 2 puffs QID or Q 6 Hours
5. Time course:
a. Onset: 20 minutes
b. Duration: 5-8 hours
b. Tiotropium bromide – (Spiriva HandiHaler)
Careful handling of drug! Wash hands! Getting medication in eyes
can cause blurring of vision, pupil dilation and glaucoma.
Dry Powder Inhaler (DPI); MDI IS NEW!
Using HandiHaler Device
Capsules packaged 6 – 30 count.
MDI:
1. 9 mcg/puff
2. QD
3. Time course – unknown at this time.
DPI:
4. 18 ug per inhalation
5. Once a day (best taken in AM)
6. Time course
a. Onset: 20 minutes
b. Duration: 24 hours
c. Atropine sulfate
SVN:
1. 1mg per dose QID
2. Time course
a. Onset: 5-20 minutes
b. Duration: 1-4 hours
Combination Drugs:
1. Bronchodilators
a. DuoNeb
Warning! Do not give to patient’s who are allergic to soybean and
peanuts. (Ipratropium bromide component)
SVN
1. 3 mg Albuterol sulfate & 0.5 mg Ipratropium bromide
2. 5-15 minute treatment
3. QID
4. Time course
a. Onset: Albuterol sulfate 5 min. Ipratropium
bromide 20 min.
b. Duration: Albuterol sulfate 4 -6 hr. Ipratropium
bromide 5 -8 hr.
b. Combivent
Ipratropium bromide is an anticholinergic with bronchodilator
activity.
Albuterol sulfate is a B2 selective adrenergic bronchodilator.
Contraindications: Patients with seizures, narrow angle glaucoma,
Soya lecithin allergy (soybean or peanuts)
MDI
1. 90 mcg Albuterol sulfate & 18 mcg Ipratropium bromide
2. 2 puffs Q6 or QID
3. Max. 20 puffs daily
4. Time Course
a. Onset: Albuterol sulfate 5 min. Ipratropium
bromide 20 min.
b. Duration: Albuterol sulfate 4 -6 hr. Ipratropium
bromide 5 -8 hr.
c. Advair
Serevent and Fluticasone Dipropionate (Long-acting
bronchodilator + corticosteroid) 3 doses (500/50,
250/50, 100/50) steroid being the changing dose
1. 1 Puff BID (Must have patient rinse mouth after
administration of meds to decrease chances of “Thrush”
(oropharyngeal candidiasis or yeast infection)
d. Symbicort
Contains formoterol, a long-acting beta2-adrenergic agonist (LABA) and
budesonide (steroid); given BID, two doses 160/4.5 mcg, 80/4.5 mcg; MDI
e. Dulera (mometasone furoate/ formoterol fumarate dihydrate)
BID, 100/5 or 200/5 mcg dose MDI
Xanthine Drugs:
Xanthine – A nitrogenous extractive contained in muscle tissue liver, spleen, pancreas,
and other organs, and in the urine. It is formed during the metabolism of nucleoproteins.
The three methylated xanthines are caffeine, theophylline, and theobromine. Trimethyl
xanthine = caffine. Dimethyl xanthine = Theobromine
1. Dimethyl xanthines
a. Theophylline – Theo-Dur, Theolair, Theovent, SloBid, Aerolate,
Bronkodyl, Elixophylin, Uniphyl, Quibron-T
Belongs to a class of drugs called phosphodiesterase inhibitors.
These drugs inhibit the breakdown of cyclic 3’-5’ AMP to 5’ AMP
by the enzyme phosphodiesterase which causes
bronchoconstriction—end result is Bronchodilation
Narrow therapeutic index:
1. 10-20 mg/L needed for Bronchodilation with minimum
side effects.
2. Above 20 mg/L associated with unacceptable incidence of
adverse effects
3. Above 35 mg/L associated with seizures and cardiac
arrhythmias.
P.O. (Tablet or Liquid)
4. 13 mg/kg per dose or 900 mg divided into even doses Q 6-8
Hours.
5. Average is 400 mg per day
6. Time course
a. Onset: 15-60 minutes
b. Duration: varies
b. Aminophylline – Phyllocontin, Truphylline
Prevent and relieve symptoms of acute bronchial asthma, and
treatment of bronchospasm associated with chronic bronchitis and
emphysema.
Unlabeled uses: respiratory stimulant to cheyne-stokes respiration.
Treatment of apnea and bradycardia in premature babies. Cardiac
stimulant and diuretic treatment of CHF.
SVN: Aminodic
1. 0.25 gm/ 1.0 ml (25% solution)
Tablets: Aminophylline
2. 100 mg anyhydrous equivalent of 85 mg theophylline
3. 200 mg anyhydrous equivalent of 170 mg theophylline
4. 300 mg anyhydrous equivalent of 236 mg theophylline
5. All doses based on weight
Example: Adult dose – 200 mg tab – 1 capsule TID
6. Maintenance therapy; 13 – 24 mg/kg/day
7. Q 6-8 Hours
8. Time course
a. Onset: 30 minutes
b. Duration: varies
IV: Aminophylline
9. Must be given slowly (can cause cardiac arrest)
10. Emergency: 4.4 - 7 mg/kg followed by maintenance dose
11. Maintenance: 0.5 – 0.0 mg/kg/hr
12. Smoker: 0.75 mg/kg/hr
13. Time course
a. Onset: 5 – 15 minutes
b. Duration: varies
Corticosteroid Agents:
Corticosteroid – Any of a number of hormonal steroid substances obtained from the
cortex of the adrenal gland. They are classified according to their biological activity as
glucocorticoids, mineralocorticoids, and androgen. Adrenal corticosteroids do not initiate
cellular and enzymatic activity but permit many biochemical reactions to proceed at
optimal rates.

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Corticosteroids: used widely in the management of the inflammatory process
associated with asthma, reactive airway disease, and other pulmonary disorders.
Helps prevent mast cell degranulation that leads to the inflammatory response.
1. Anti-inflammatory Drugs
a. Beclomethasone – Beclovent Rotacaps, Beclodisk, Vanceril, QVAR HFA
MDI
a. 40-80 ug/puff
b. 2 puffs TID or QID
c. 2-4 puffs BID (max 20 puffs/day)
d. Time course:
i. Onset: Varies
ii. Duration: Varies
b. Budesonide – Pulmicort
i. SVN: Pulmicort Respule
a. Used to prevent asthma attacks—not to treat them.
b.
c.
d.
e.
Unit dose: 0.5 mg/ml
BID
1 mg is total daily dose
Time course:
i. Onset: within 24 hours
ii. Duration: varies
DPI: Pulmicort Turbuhaler
f. 200 ug/puff
g. 1 – 3 puffs BID
h. Time course:
i. Onset: within 24 hours
ii. Duration: Varies
c. Dexamethasone – Decadron, Dexasone, Diodex, Hexadrol, Maxidex,
Dexamehasone Sodium Phosphate, Dexamethason Acetete.
Dexamethasone is a synthetic glucocorticoid. Its naturally occurring
counterparts are hydrocortisone and cortisone. Although the drug is used
in a variety of ways, in general, it reduces inflammation and depresses the
immune system.
Decreases inflammation by suppression of neutrophil migration, decreased
production of inflammatory mediators, and reversal of increased capillary
permeability; suppresses normal immune response.
MDI:
1. 84 ug/puff.
2. 2-3 puffs BID or QID
3. Time course
a. Onset: 1 Hour
b. Duration: 2-3 Days
Tablets: Dexamethasone
1. Decadron 0.25 mg – orange, scored, five-sided tablet
2. Decadron 0.50 mg – yellow, scored, five-sided tablet
3. Decadron 0.75 mg – bluish-green, scored, five-sided tablet
4. Decadron 1.50 mg – pink, scored, five-sided tablet
5. Decadron 4.00 mg – white, scored, five-sided tablet
6. Decadron 6.00 mg – green, scored, five-sided tablet
Injectables: Dexafort
1. 2 mg/ml
2. 4 mg/ml
3. 8 mg/ml
4. 10 mg/ml
5. 16 mg/ml
6. 20 mg/ml
7. 24 mg/ml
Liquid preparation: Dexamethasone
1. 0.5 mg/ml
Flunisolide – Aerobid
Similar to Azmacort, but said to have a longer duration time.
MDI
a. 250 mcg/puff
b. 2 puffs BID
c. Max 8 puffs/day
d. Time course
i. Onset: Varies
ii. Duration: Varies
e. Fluticasone
MDI: Flovent HFA
a. 44, 110, 220 ug/puff
b. 2 puffs BID
c. Time course
i. Onset: 24 hours
ii. Duration 2-3 days
DPI: Flovent (Rotadisk)
a. 50, 100, 250 ug/blister
b. 100-1000 ug BID (titrated dose)
c. Time course
i. Onset: 24 hours
ii. Duration: 2-3 days
f. Triamcinolone – Azmacort
Indicated for the maintenance of asthma and as prophylactic therapy.
Azmacort may reduce or eliminate the need for systemic corticosteroids
Pulmonary function improvements seen after 1-2 weeks.
It is desirable to titrate the lowest effective dose.
MDI
a. 100 mcg/puff
b. 2-4 puffs
c. BID or QID
d. Max 16 puffs/day
g. Prednisone – Prednisone, Deltasone, Meticorten, Orasone, Sterapred
Reduces inflammation and enhances the actions of Sympathomimetic
agents.
Effective as an immunosuppressant and affects virtually all of the immune
system
Many side effects include weight gain and “moon face”.
Tablet or Liquid
a. 5-60 mg dose
b. QD
c. Time course
i. Onset: Varies
ii. Duration: Varies
h. Hydrocortisone
Is a corticosteroid similar to a natural hormone called cortisol produced by
the adrenal glands
Commonly used as a replacement therapy in adrenocortical deficiency
states.
Tablet – Cortef
i. 5 -30 mg
j. BID or QID
k. Time course
i. Onset: varies
Intravenous/Intramuscular (IV or IM) –
Solu-Cortef
l. 4 mg/kg
m. Q 4-6 Hours
n. Time course
Methylprednisolone
a. Prevents mast cell degranulation
b. PO (by mouth): Medrol
4-48 mg/daily
Time course
1. Onset: 1-3 hours
2. Duration: 1-2 days
IV (intravenously): Solu-Medrol
1-2 mg/kg
Q 4-6 Hours
Time course
3. Onset: rapid
4. Duration: 7 days
c. IM (intramuscular): Solu-Medrol
10-250 mg/kg
Q 6 Hour
Time course
1. Onset: 4-8 days
2. Duration: 1-5 weeks
Mucolytics & Wetting Agents:
Mucolytics are used to thin & liquefy thick, tenacious secretions. Mucolytics increase the
production of respiratory tract fluids & reduce viscosity of secretions. Secretions can then
be more easily expectorated or suctioned. Many Mucolytics can cause bronchospasms,
which can be minimized or avoided by giving a bronchodilator just before or with
mucolytic, depending on compatibility.
Mucolytic – Breakdown of mucus
1. Mucoactive Agents
a. Acetylcysteine - Mucomyst 10% & 20 %, Mucosil 10 & 20
i. Breaks disulfide bonds in mucus & decreases viscosity.
ii. Give with bronchodilator to prevent bronchospasm.
iii. Store in refrigerator after opening.
iv. Also used with acetaminophen overdose as an antidote.
v. Mist may set off fire alarm systems.
vi. Smells like “rotten eggs”
v. SVN
1. 1-20 mL of 10% solution
2. 1-10 mL of 20% solution
2. TID or QID PRN
b. Dornase alfa – Pulmozyme
i. Mucolytic-hydrolyzes sputum DNA, & decreases mucous viscosity &
elasticity.
ii. Used to treat CF or other infection or disease with purulent mucus,
iii. Can cause pharyngitis & cough.
iv. Do not mix with other drugs.
v. SVN (use Hudson Updraft, Pari LC plus or Marquest Acorn II)
1. 2.5 mL of 1 mg/ml solution
2. QD PRN
c. Aqueous aerosols; water, saline (0.45%, 0.9%, 3%-10%)
i. (2-5 ml) 0.45% used with ultrasonic nebulizer to humidify and thin
secretions.
1. Deposits more distally.
2. Less irritating to mucosa than 0.9% NS via ultrasonic.
ii. (2-5 ml) 0.9% used via SVN or instilled intratracheally PRN to
humidify and thin secretions.
1. Also used as a diluent for full strength bronchodilators
2. Isotonic NaCl
iii. (2-5 ml) 3%-10% used to induce sputum.
1. Irritant to lung
2. Given with Neb PRN
3. Used with caution for patients with edema or salt restrictions.
4. Hypertonic NaCl
d. Sodium bicarbonate – NaHCO3
i. 2-5 ml of 2%-7.5% solution via Neb or instilled intratracheally PRN
ii. Breaks saccharide chains in mucus, lowers surface tension and
decreases adhesiveness.
iii. Give bronchodilator to reduce bronchospasm
iv. Caution in edema, salt restrictions, or metabolic alkalosis
Aerosolized Anti-Infective Medications:
1. Anti-Infectives
a. Tobramycin – Nebcin, TOBI
i. Antibiotic used to treat CF & many bacterial pulmonary infections
ii. Give B2 bronchodilator first to prevent bronchospasms.
iii. May need to increase flow rate to 8-12 lpm depending on solution
viscosity.
iv. SVN
1. 80 mg dose
2. BID for 28 days
b. Pentamidine isethionate – NebuPent, Pentam 300, Pentacarinat
i. Effective against Pneumocystis Carinii
ii. Give bronchodilator before Pentamidine to prevent bronchospasm
iii. RCP should wear mask as protective barrier
iv. Drug delivered with Respirgard II nebulizer (See Image)
v. SVN: NebuPent
1. 300 mg dose
2. 35-40 minute treatment
3. Administered Q 4 week
c. Ribavirin – Virazole
Neuromuscular Blocking Agents:
1. Neuromuscular Blockers
a. Succinylcholine chloride – Anectine (Depolarizing)
b. Pancuronium – Pavulon (Nondepolarizing
c. Tubocurarine chloride – Tubarine (Nondepolarizing)
d. Vecuronium bromide – Norcuron (Nondepolarizing)
Leukotriene Inhibitors:
1. Leukotrienes
a. Montelukast Sodium - Singulair
b. Zafirlukast - Accolate
c. Zileuton - Zyflo
Cromolyn & Nedocromil:
Nonsteroidal anti-inflammatory drugs (NSAIDs). Inhibiting mast cell degranulations
during antigen-antibody reaction. Prevents the release of chemical mediators, including
histamine, serotonin, & slow-reacting substances of anaphylaxis (SRS-A). These
mediators cause inflammation and bronchospasm. More beneficial to children than
adults.
Cromolyn Sodium – Intal, Crolom
SVN
20 mg/ 2 mL NS
QID
Time course
Onset: 20-30 minutes
Duration: 2-6 hours
MDI
800 mcg/puff (age 4 and older)
2 puffs QID
Time course
Onset: 20-30 minutes
Duration: 2-6 hours
DPI (Spinhaler)
20 mg/capsule
QID
Time course
Onset: 20-30 minutes
Duration: 2-6 hours
Nedocromil sodium - Tilade
Surfactant Agents:
1. Surfactants
a. Beractant – Survanta
b. Colfosceril - Exosurf
c. Calfactant – Infasurf
d. Poractant alfa - Curosurf
e. Lusupultide – Venticute