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*B-Agonists Drugs *Anticholinergic Drugs *Xanthine (Methylxanthine) Drugs


sympat­hom­imetic bronch­odi­lator
for acute attacks
reduce airway constr­iction and restore normal airflow
Stimulate β2-adr­energic receptors throughout the lungs

3 types

Nonsel­ective (a, B1, B2)
epin­eph­rine; acute
longer acting
Nonsel­ective B-adre­nergic (B1, B2)
Selective (B2)

Mechanism of Action

activation of B2 receptors activates cAMP
bronch­odi­lation and airflow


bronch­ospasms (asthma, bronch­itis, other pulmonary disease)
hypote­nsion and shock
uterine relaxation (prevent premature labour)
hyperk­alemia (K+ into the cell)


known drug allergy
uncont­rolled cardiac dysrhy­thmias
risk of stroke (vasoc­ons­tri­ctive action)

Adverse Effects

Nonsel­ective (a, B1, B2) Epin­eph­rine
insomnia, restle­ssness, anorexia (long term), headache, hype­rgl­yce­mia, trem­or, cardiac stim.
Nonsel­ective B-adre­nergic (B1, B2) isop­rot­ere­nol
cardiac stim., trem­or, anginal pain, headache, hypo­ten­sion
Selective (B2) albu­ter­ol/­sal­but­amol
hypo­ten­sio­n/h­ype­rte­nsi­on, trem­or, headache


risk for hypert­ension
risk for cardiac toxicity
require an adjustment to antihy­per­gly­cemic drugs

Antich­oli­nergic Drugs

ipratr­opium (Atrovent)
tiotropium (Spriva)

Mechanism of Action

ACh causes bronchial constr­iction and narrowing of airways
bind to ACh receptors
ACh to recept­ors
slow and prolon­ged

Adverse Effects

dry mouth or throat
nasal congestion
heart palpit­ations
GI distress

Xanthine Deriva­tives (Methy­lxa­nthine)

natural xanthines: alkaloids, caffeine, theobr­omine, and theoph­ylline
theo­phy­lline only used a bronch­odi­lator
synthe­thic: aminop­hylline (phyll­oco­ntin) & oxtrip­hylline

Mechanism of Action

cAMP by phos­pho­die­ste­rase (enzyme that breaks down cAMP)
SM relaxa­tion, bronch­odi­lation, airflow

Drug Effects

contra­cti­lity, HR CO & blood flow to kidney
stimulate cardio and CNS system


asthma, chronic bronch­itis, & emphysema (COPD)
mild to moderate cases of acute asthma
adjunct drug for COPD


known drug allergy
uncont­rolled cardiac dysrhy­thmias
seizure disord­ers
peptic ulcers

Adverse Effects

nausea, vomiting, anorexia
GI reflux during sleep
tach­yca­rdia, extra systole, palpit­ations, ventri­cular dysrhy­thmias
transient urination


not used often due to many drug intera­ctions
Several drugs increase serum levels of xanthine deriva­tives
used with sympat­hom­imetics can increase and CNS stimul­ation
St. John's wort and cigarette smoking enhance rate of metabolism
charcoal broiling & keto diet xanthine effect

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