1. Pharmacology
Drugs used to treat:
Asthma
Rhinitis & Cough

2. Topics
• Bronchodilators • Decongestants
• Methylxanthines • Antihistamines
• Anticholinergics • Antitussives
• Anti-inflammatory • Expectorants &
Agents mucolytics
• Leukotriene
Antagonists
• Mast cell stabilizers

3. Asthma
• Inflammatory response to allergen
• Antibody binds with & ruptures mast cells
– Releases histamine, prostaglandins,
leukotrienes
• Two primary issues
– Bronchoconstriction
– Inflammation (mucous production)

4. Approaches to Treatment
• Relax bronchial smooth muscle
– ß2 agonists
– methylxanthines
– anticholinergics
• Inhibit release of mediators
– Glucocorticoids
– Mast cell stabilizers
• Block affects of mediators
– Leukotriene antagonists

5. Bronchodilators
ß2 agonists albuterol (Proventil®),
metaproterenol (Alupent®)
terbutaline (Breathair®)
Nonselective epinephrine (Adrenalin®)
Methylxanthines theophylline (TheoDur®)
aminophyllin, (Aminophylline®)
Anticholinergics ipratropium bromide (Atrovent®)

6. Antiinflammatory Agents
Glucocorticoids
inhaled beclomethasone (Beclovent®)
flucticasone (Flovent®)
oral prednisolone (Deltasone®)
injected methylprednisolone (Solu-Medrol®)
dexamethasone (Decadron®)
Mast cell Stabilizer cromolyn (Nasalcrom®, Intal®)
Leukotriene Antagonists zafirlukast (Accolate®)
zileuton (Zyflo®)

7. Colds and Allergies
• Nasal Inflammation
– Vasodilation & engorgement
• Itching, redness, rhinorrhea
– Mast/basophil degranulation

8. Nasal Decongestants
∀ ⇓ congestion via • phenylephrine (Neo-
vasodilation Synephrine®)
• Alpha1 stimulation • pseudoephedrine
– Topical administration (Sudafed®, Actifed®)
• A moment of silence
for:
– phenylpropanolamine
(AlkaSeltzer Cold®,
Contact®, Allerest®)

9. Antihistamines
• H1 receptors • Other histamine
– Vasodilation receptors
– Increased capillary – Sedation
permeability
– Bronchoconstriction
• H2 receptors
– Increase gastric acid
secretion (Zantac®),
etc)

10. Antihistamine Agents
• First generation • Second generation
– Sedation – No sedation
• chlorpheniramine – blood-brain barrier
(Chlor-Trimeton®) • Sniff, sniff:
• diphenhydramine – terfenadine (Seldane®)
(Benadry®) • fexofenadine
• clemastine (Tavist®) (Allegra®)
• promethazine • cetirizine (Zyrtec®)
(Phergan®) • loratadine (Claritin®)

11. Cough Suppressants
• Antitussives • Expectorants
– Decrease cough reflex – guaifenesin may work
– Opioids – others are doubtful
• codeine & hydrocodone • Mucolytics
– Non-opioids – Decreases viscocity
• dextromethorphan
– acetlycysteine
• benzonatate
(Tessalon®) (Mucomyst®)
– hypertonic saline