B-Agonistssympathomimetic bronchodilator | for acute attacks | reduce airway constriction and restore normal airflow | Stimulate β2-adrenergic receptors throughout the lungs |
3 typesNonselective (a, B1, B2) | epinephrine; acute | | | longer acting | Nonselective B-adrenergic (B1, B2) | isoproterenol | Selective (B2) | salbutamol |
Mechanism of Actionactivation of B2 receptors activates cAMP | bronchodilation and airflow |
Indicationsbronchospasms (asthma, bronchitis, other pulmonary disease) | hypotension and shock | uterine relaxation (prevent premature labour) | hyperkalemia (K+ into the cell) |
contraindicationsknown drug allergy | uncontrolled cardiac dysrhythmias | risk of stroke (vasoconstrictive action) |
Adverse EffectsNonselective (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 |
Interactions risk for hypertension | risk for cardiac toxicity | require an adjustment to antihyperglycemic drugs |
| | Anticholinergic Drugs-pium | ipratropium (Atrovent) | tiotropium (Spriva) |
Mechanism of ActionACh causes bronchial constriction and narrowing of airways | bind to ACh receptors | ACh to receptors
| slow and prolonged | bronchoconstriction
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Adverse Effectsdry mouth or throat | nasal congestion | heart palpitations | GI distress | headache | coughing | anxiety |
| | 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 |
Indicationsasthma, chronic bronchitis, & emphysema (COPD) | mild to moderate cases of acute asthma | adjunct drug for COPD |
Contraindicationsknown drug allergy | uncontrolled cardiac dysrhythmias | seizure disorders | hyperthyroidism | peptic ulcers |
Adverse Effectsnausea, vomiting, anorexia | GI reflux during sleep | tachycardia, extra systole, palpitations, ventricular dysrhythmias | transient urination |
Interactionsnot 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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