Aerosolized Agents Given by Inhalation PDF

## Chapter 1 Introduction to Respiratory Care Pharmacology ### Aerosolized Agents Given by Inhalation Drugs delivered by oral inhalation or nasal inhalation are intended to provide a local topical treatment of the respiratory tract. The following are advantages of this method and route of delivery...

## Chapter 1 Introduction to Respiratory Care Pharmacology ### Aerosolized Agents Given by Inhalation Drugs delivered by oral inhalation or nasal inhalation are intended to provide a local topical treatment of the respiratory tract. The following are advantages of this method and route of delivery: * Aerosol doses are smaller than doses used for the same purpose and given systemically * Side effects are usually fewer and less severe with aerosol delivery than with oral or parenteral delivery. The onset of action is rapid. Drug delivery is targeted to the respiratory system, with lower systemic bioavailability. The inhalation of aerosol drugs is painless, relatively safe, and may be convenient, depending on the specific delivery device used. The classes of aerosolized agents (including surfactants, which are directly instilled into the trachea), their uses, and individual agents are summarized in Table 1.4. #### Table 1.4 Common Agents Used in Respiratory Therapy | Drug Group | Therapeutic Purpose | Agents | |-----------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------| | **Adrenergic agents** | **Beta-Adrenergic:** Relaxation of bronchial smooth muscle and bronchodilation, to reduce airway resistance (Raw) and to improve ventilatory flow rates in airway obstruction resulting from chronic obstructive pulmonary disease (COPD), asthma, CF, acute bronchitis | Albuterol <br> Arformoterol <br> Formoterol <br> Indacaterol <br> Levalbuterol <br> Metaproterenol <br> Olodaterol <br> Salmeterol <br> Vilanterol <br> Racemic epinephrine | | **Reduce Airway Restriction from Smooth Muscle Constriction** | **Adrenaline Derivative (Short Term & Long Term)** <br> Beta - Adrenergic Agonist | | | **Anticholinergic agents** | **α-Adrenergic:** Topical vasoconstriction and decongestion <br> Used to treat upper airway swelling <br> *Relaxation of cholinergically induced bronchoconstriction to improve ventilatory flow rates in COPD and asthma* | Aclidinium bromide <br> Glycopyrrolate bromide <br> Ipratropium bromide <br> Tiotropium bromide <br> Umeclidinium bromide | | **Promotes Blocking of Acetylcholine** | *Derived from Atropine* *Short-Acting & Long-Acting* | | **Mucoactive agents** | Modification of properties of respiratory tract mucus; current agents reduce viscosity and promote clearance of secretions | Acetylcysteine <br> Dornase alfa - CF <br> Hyperosmolar saline - irritant; to promote cough <br> Manntiol | | **Corticosteroids** | Reduction and control of airway inflammatory response usually associated with asthma (lower respiratory tract) or with seasonal or chronic rhinitis (upper respiratory tract) | Beclomethasone dipropionate <br> Budesonide <br> Ciclesonide <br> Flunisolide <br> Fluticasone furoate <br> Fluticasone propionate <br> Mometasone furoate <br> Cromolyn sodium <br> Benralizumab <br> Mepolizumab <br> Montelukast <br> Omalizumab <br> Relizumab <br> Zafirlukast <br> Ziluton | | **Aerosolized** | ***Usually added to Adrenergic Agents To reduce inflammation from bronchospasm*** | | | **Antiasthmatic agents** | Prevention of onset and development of the asthmatic response through inhibition of chemical mediators of inflammation | | | **Controls mast cell** | **Can be given with corticosteroids and Adrenergic Agents** | | | **Antiinfective agents** | Inhibition or eradication of specific infective agents, such as *Pneumocystis jiroveci* (formerly *carinii*) (pentamidine), *respiratory syncytial virus* (RSV) (ribavirin), *Pseudomonas aeruginosa* in CF or influenza A and B *tobromycin* | Aztreonam <br> Pentamidine <br> Ribavirin <br> Tobramycin <br> Zanamivir | | **Exogenous surfactants** | Approved clinical use is by direct intratracheal instillation for the purpose of restoring more normal lung compliance in RDS of newborns | Beractant <br> Calfactant <br> Lucinactant <br> Poractant alfa | | **Need to be intubated** | ***Infuse intravenously*** | | | **Prostacyclin analogs** | Clinically indicated to treat pulmonary hypertension for the purpose of decreasing shortness of breath and increasing walking distance | Iloprost <br> Treprostinil | *CF: Cystic fibrosis; RDS: respiratory distress syndrome.* ### Ol- open the lungs ### Bronchial Alveolar Lavage This is a diagram of the respiratory system, including the following components: ### Antagonist - Adrenergic agents - Anticholinergic agents - Mucoactive agents - Corticosteroids - Antiasthmatic agents - Antiinfective agents - Exogenous surfactants - Prostacyclin analogs The diagram shows the path of air entering the lungs. The diagram does not include all aspects of the respiratory system, but it is a helpful visual aid for understanding the process of inhalation.