MOA: aid in the expectoration of

excessive mucus in respiratory tract, by

breaking down and thinning out
secretions

loosening and thinning of respiratory

tract secretions Therapeutic effects

Productive cough

Common colds

Bronchitis

laryngitis
Indications
Expectorants
pharyngitis

pertussis MOA: compete to block histamine to

prevent histamine which include
influenza vasodilation, ^secretions, ^ capillary
permeability and edema

measles
relax smooth muscle in bronchial tree

Known drug allergy Contraindication

reduce secretions (salivary, lacrimal,
bronchial, gastric) exerts a drying (
nausea anticholinergic) effect
Therapeutic Effects

vomiting Adverse Effects reduces dilation and permeability of

blood vessels, capillaries
gastric irritation
reduces itching, edema

MOA: Suppress cough reflex through Allergic reactions

direct action on cough center in CNS (
medulla)
Nasal allergies

Suppresses cough
Nausea and vomiting

analgesia
Therapeutic Effect Anaphylaxis
Indications
^ viscosity of secretion
Seasonal or perennial allergic rhinitis (
dry effect on mucosa of respi tract hay fever)
Decreases runny nose
Motion sickness
Known hypersensitivity or allergy to Antihistamines
codeine or morphine
Parkinson’s disease symptoms

In respiratory depression, increased

Sleep disorders
intracranial pressure, seizure disorders, Opioids
or severe respiratory disorders.
known drug allergy

Known opioid dependency, and

contraindicated with alcohol use not recommended (as only treatment)
Contraindication for acute asthma attack, open angle
glaucoma, heart disease, kidney disease,
Pts with CNS depression, hypercapnia, hypertension, bronchial asthma, chronic
impaired kidney function, liver disease, Contraindicated obstructive lung disease, peptic ulcer
BPH, Addison’s disease, COPD disease, benign prostatic hypertrophy, or
during pregnancy
Interacts with other opioids, general
anesthetics, tranquilizers, sedatives, use with caution for children, lactating
hypnotics, tricyclic antidepressants, mothers, people with kidney and liver
alcohol, and other CNS depressants disease
Antitussives
cause sedation, nausea, vomiting, light- Drowsiness - mild to deep sleep, sedation
headedness, constipation Adverse effects more pronounced with traditional
antihistamines
Non opioids usually in combination with
other products: Dextromethorphan Dysrhythmias, hypotension,
hydrobromide and diphenhydramine palpitations, syncope, muscular
weakness, paradoxical excitement,
Therapeutic effects: same as opioid restlessness, nervousness, seizures

Adverse Effects
Dextromethorphan Drug allergy, Anticholinergic effects: dry mouth, nose,
hyperthyroidism, advanced heart and throat, urinary retention, , constipation,
vessel disease, hypertension, glaucoma, vision changes
and MAOI use in last 14 days Non-Opioid
Diphenhydramine: hypersensitivity, use nausea, vomiting, hepatitis
with caution in nursing mothers,
neonates, and patients with lower
respiratory tract infections vertigo, tinnitus, headaches
Dextromethorphan - Dizziness,
drowsiness, nausea
Diphenhydramine - sedation, dry mouth,
anticholinergic effects MOA: relax bronchial smooth muscle
Contraindication and Adverse Effects that are constricted as a result of a
Respiratory disease process. (causes dilation of the
bronchi and bronchioles)

Able to shrink engorged nasal mucous

membranes and relieve nasal stuffiness.
Adrenergics constrict small arterioles
that supply the structures of the upper
respiratory tract, primarily the blood
vessels surrounding the nasal sinuses.
Also called sympathomimetics. Dry
secretions
Steroids cause inflammatory response to
be turned off or rendered unresponsive.
They target inflammatory response to
organisms and allergens.
Drugs MOA: activation of 2 receptors relaxes
smooth muscles of the airway, dilates
bronchi, reduces airway constriction
Prevention/relief of acute attacks of
bronchospasm salbutamol is ‘a reliever’
Short-acting ß-agonist (SABA) inhalers for acute asthma, pulmonary diseases
MOA
Hypotension and shock
Indications Short term treatment of hyperkalemia (
stimulates potassium to shift from blood
vessels into cells)

Both relieve excessive nasal secretions Can cause uterine relaxation

and inflamed and swollen nasal mucosa

Respiratory controllers
Nasal secretions in swollen mucous
membranes are able to drain Therapeutic Effect
prevention of bronchospasm caused by
asthma or chronic obstructive lung
reduced inflammatory symptoms and Indication disease
improved air exchange

Known allergy to -Agonist

colds, chronic rhinitis, sinusitis, and hay
fever or allergies. To reduce swelling of
nasal passages and facilitate Uncontrolled cardiac dysrhythmias
visualization of pharyngeal membranes Contraindication
before surgery or diagnostic procedures Indications
Nasal Decongestants->
Intranasal Anticholinergic, High risk of stroke due to
vasoconstrictive action
Drug allergy Intranasal Corticosteroids

mixed ⍺ and agonists- Insomnia,

Acute angle glaucoma, uncontrolled anorexia, restlessness, hyperglycemia,
cardiovascular disease, hypertension, vascular headache, tremor, cardiac
diabetes, hyperthyroidism, prostatitis, stimulation
not recommended in conditions where
Contraindiations
patients cannot close their eyes, such as Long-Acting Beta2 Adrenergic
a stroke, with a history of stroke or TIA, Nonselective -Agonists (ß1 and ß2)-
Bronchodilators LABA
cerebral arteriosclerosis, long standing anginal pain, tremor palpitations,
Bronchodilators
asthma, or diabetes. tachycardia, vascular headache

depress body’s immune response 2-Agonists (SABA, LABA) hypertension

systemic sympathomimetic drugs and
monoamine oxidase inhibitors (MAOIs)
to cause hypertension. Interact with
methyldopa, urinary acidifiers,
alkalinizers.
nervousness, insomnia, palpitations,
and tremors
hypertension and palpitations,
Adverse Effects
headache, dizziness
Adverse Effect or hypotension, vascular headaches,
tremor
If larger doses of salbutamol used too
frequently, loses its 2-specific actions,
Interactions stimulating 1 receptors causing nausea,
increased anxiety, palpitations, tremors,
and increased heart rate
Diminished bronchodilation when
nonselective ß-blockers are used with
the ß-agonist bronchodilators

Monoamine oxidase inhibitors

mucosal irritation, dryness, epistaxis

Interaction Sympathomimetics

MOA: Stabilize membranes of

leukocytes (white blood cells) that Monitor patients with diabetes; an
release harmful inflammatory increase in blood glucose levels can
bronchoconstricting substances occur.

inflammation MOA: Anticholinergics bind to the

acetylcholine (Ach) receptors,
Therapeutic effects
preventing ACh from binding to receptor
enhance activity of B-agonist sites

Indications: as primary treatment of Therapeutic effects: prevention of

bronchospastic disorders to control the bronchoconstriction Indirectly causes
inflammatory responses believed to dilation of bronchial airways, decreases
cause these disorders; DO NOT relieve Corticosteroids - secretions
symptoms of acute asthmatic attacks Glucocorticoids
Indications: prevention of
Drug allergy or hypersensitivity to bronchospasm associated with COPD,
glucocorticoids not for management of acute symptoms

Anticholinergic Bronchodilators
Patients whose sputum tests are positive
Contraindication
for Candida organisms Contraindication: Allergy (to atropine):
Caution with acute angle glaucoma or
BPH
Patients with systemic fungal infection

Dry mouth, throat, nasal congestion

Pharyngeal irritation Subtopic 2

Heart palpitations
Coughing
Adverse Effects
Gastrointestinal irritation
Dry mouth Adverse Effects

Urinary retention
Oral fungal infections

Increased intraocular pressure

More likely to occur with systemic (
versus inhaled) corticosteroids.
Headache, coughing, anxiety
May increase serum glucose levels,
possibly requiring adjustments in
dosages of antidiabetic drugs

May raise the blood levels of the

immunosuppressants cyclosporine and
Interactions
tacrolimus; itraconazole may reduce
clearance of the steroids

phenytoin, phenobarbital, and rifampin

Greater risk of hypokalemia with

concurrent diuretic use (e.g.,
furosemide, hydrochlorothiazide)