-agonists:
-salbutamol, pibuterol, terbutaline, albuterol. -salmeterol. -formoterol.
glucocorticoid receptors :] A1[
M receptors: :] A2[
M1-CNS, stomach.
M2- heart, CNS, airway SM.
M3- CNS, airway SM, vascular endothelial cells, salivary glands.
MOA: effects: uses: ADR: PHK:
1)stimulates: -2 receptors in bronchial SM of lung. 1)relaxation: of proximal 1)mild asthma: with occasional, 1)tachycardia 1)short acting & onset:
2)result in: activation of a"c. & distal SM airway. intermittent symptoms. 2)hyperglycemia, 15-30 m, relief for 4-6 hours.
3)a"c form: cAMP from ATP. 2)inhibition: of mast cell 2)dyspnea symptoms: for chronic hypokalemia, 2)given by: inhalation, & for
4)cAMP: activate PKA. mediator release. obstructive pulmonary disease (COPD) hypomagnesemia asthmatic by IV.
5)PKA inhibit: MLC & Ca C 3)increase: muco-cilliary 3)no effect: on chronic inflammation. 3)muscle tremor 3)salmeterol: long acting.
6)this: 1)relax: bronchial SM , & airway resistance clearance. 4)restlessness relief for 12+ hours.
2)inhibit: release of broncho-constrictors 5)hypoxemia 4)formoterol: long acting,
(like histamine) from mast cells. rapid onset. relief for12+ h.
corticosteroids:
-inhaled: budesonide, beclomethasone, triamcinolone, fluticasone. -IV: hydrocortisone, methyl-prednisone. -oral: prednisolone
MOA: effects: uses: ADR:
1)action: 1)enter: target cells. 2)bind: GR in cytoplasm. 1)reduce & prevent: 1)inhaled: for moderate to severe 1)local ADR: 1)dysphonia.
3)transport: the complex to the nucleus inflammatory component in asthma, & COPD. 2)oropharyngeal candidtis (5%). 3)caugh.
2)then: bind to glucocorticoid responsive elements in promoter chronic asthma. need regular bronchodilator (< 1 2)systemic ADR:
region of target genes. 2)no direct affect: on inhalation of 2-agonist daily). 1)suppression: adrenal & growth.
3)this results in: or gene transcription. contractile responses of 2)systemic (IV, oral): severe 2)bruising. 3)osteoporosis. 4)psychiatric.
4)if GR interact directly with protein transcription factor: result in airway SM exacerbation of asthma. 5)eyes: cataract & glaucoma.
protein synthesis, & independent interaction with nucleus DNA.
cromones: -cromolin. -nedocromil.
MOA: effects: uses: ADR:
1)"mast cell stabilizer": delay Cl channels in cell 1)block: allergen-induced & exercise-induced 1)anti-inflammatory agent: but not for acute minor=
membrane, thus inhibiting cell activation. bronchoconstriction. attack. 1)throat irritation
2)in mast cell: inhibit mediator (histamine) release 2)block: early & late asthmatic response to allergens. 2)asthma: mild to moderate. 2)nausea.
3)in eosinophils: inhibit inflammatory response to 3)action duration: short. 3)safe: for pregnant. ADR are rare. 3)headache.
inhalation of allergens. 4)not bronchodilator: has no direct effect on SM. 4)in long term use: reduce bronchial hyperactivity.
anticholinergic agents:
MOA: use: -ipratropium bromide: -tiotropium:
1)antagonist: of specific muscarinic receptor. 1)for asthma patient with: 1)non-selective antagonist: for M1, M2, M3 1)binds with equal affinity: to M1, M2, M3
2)block: ACH action by prevent M receptor bind 1)intolerance to -agonist 2)do not: distributed well across lipid membrane. 2)has a kinetic receptor subtype selectivity:
3)result: in phospholipase, IP3, DAG, & Ca. 2)with asthma + COPD. 3)action duration: 6 hour (peak=1-2h). slow onset dissociate rapid from M2, & slow from M1 & M3
4)taken by: inhalation. 3)action duration: long. allows for 1 daily using.
effect: ADR: -minimal:
1)produce: bronchodilation. dry mouth, RT discomfort
2)reduce: volume of respiratory secretion.
 methylxanthines: -theophylline. -aminophylline.
MOA: ADR: PHK:
1)competitve antagonist: for adenosine receptor A 1)GI: nausea, vomiting, gastric 1)has: drug & food interactions. 2)therapeutic window: narrow.
1+2, which cause bronchoconstriction & mediator discomfort. 3)require: blood C monitoring. 4)administration: oral (1) or IV (2).
release. 2)cardiac arrhythmias. 1) clearance: enzyme induction, smoke, high protein/low carb diet, meat,
2)also, inhibit PDE: thus prevent cAMP convers to 3)headaches, restlessness. childhoo
cGMP & 5'GMP= cAMP use: 2) clearance: enzyme inhibition, HF, liver disease, old age, viral infection, and
3) cAMP cause: 1)bronchodilation. 1)relief of airway obstruction: high carb diet.
2)CNS & heart stimulation. 3)vasodilator of BV. chronic asthma, COPD.
4) secretion of gastric acid & enzymes.

anti-leukotriene drugs: -zafirlukast, pranulkast, montelukast. -zileuton.

MOA: use: ADR:
1)block receptors(1): of cys-leukotriens , thus block their effects in LTC-4, LTD-4, & LTE-4. 1)asthma: mild to moderate. 1)increase liver enzymes.
2)cys-leukotriens: produced in asthma, & can cause bronchoconstriction & mucus secretion. 2)alternative: to inhaled glucocorticoids. 2)headache, rashes, dyspepsia.
3)this: prevent asthmatic bronchospasm, & inflammatory response. 3)good for children: available in chewable tablets. 3)edema, vascular leak, vasculitis
4)zileuton: inhibit synthesis of 5-lipoxigenase = inhibit formation of LTC-4, LTD-4, LTE-4, LTB-4. 4)rare: eosinophilia & neuropathy

anti-IgE antibody: -omalizumab.

MOA: use + PHK: ADR:
1)it is a: recombinant DNA- derived monoclonal A"B. 1)allergic: asthma & rhinitis. 1)mild urticaria .
2)selectively bind: to IgE, & his binding affinity to his receptor on mast cell & basophils. 2)attenuate: in early & late reaction phase of asthma. 2)headeahc.
3)this cause: reduce in allergic response. & mediators release (histamine, basophilic, NO) . 3)administrate: SC. 3)injection site reactions.
4)time to peak plasma C: <14 days. 5)half life: 1-4 w 4)eosinophilic vasculitis.
 drugs used to traeat allergic rhinitis:

-adergenic agonists: -oxymethazoline. -phenylephrine.

effect: PHK: ADR:
1)constrict: dilated arterioles in the nasal mucosa. 1)given: aero-nasal, or oral combined with antihistamines. 1)few: systematic effects.
2)reduce: airway resistance. 2)onset: rapid. 3)treatment: short term. 2)in long term use: increase the risk for rebound congestion.

anti-histamines:
MOA: 1)reversible competitive antagonist: of histamine at H1 receptor site.
2)this H1 blockade result in: 1)decrease: vascular permeability. 2)reduction: of pruritus. 3)relaxation: of SM in RT & GI.
first generation: 1)diphenhydramine. 2)hydroxyzine. 3)promethazine.
use: ADR: contraindication:
1)diseases: allergic & vasomotor rhinitis, 1)allergic: photosensitivity, anaphylactic shock, rash, dermatitis 1)hypersensitivity to specific/structural relate A"H
allergic conjunctivitis, urticaria. 2)cardiovascular: postural ho"p, palpitations, reflex tachycardia, venous 2)newborn, premature infant, nursing mothers
2)adjunctive anaphylactic therapy. thrombosis at injection site (IV promethazine). 3)narrow angle glaucoma.
3)motion sickness & vestibular disturbances (1,3) 3)CNS: drowsiness, sedation, dizziness, disturbed coordination, fatigue, 4)stenosing peptic ulcer.
4)anti-parkinsonism (1). confus 5)prostate hypertrophy & UB obstruction,
5)in pre-medication or after general anesthesia (2) 4)GI: epigastric distress, anorexia, bitter taste (nasal spray) 6)MAOI use.
6)pre & post-operative or obstetric sedation, or 5)genitourinary: urinary frequency, dysuria, urinary retention 7)old age.
adjunctive analgesia for postoperative pain (2,3) 6)RT: chest tightness, wheezing, dry mouth, nose & throat, thickening of 8)dilated patients (cyproheptadine).
bronchial secretion, epistaxis & nasal burning
2nd generation: -cetirizine. -loratdine. 3rd generation: -fexofenadine.
use: ADR: contraindication:
-certain allergic disorders: 1)allergic : photosensitivity, anaphylactic shock, rash, dermatitis 1)hypersensitivity to specific/structural relate
1)perennial or seasonal allergic rhinitis. 2)CNS: somnolence/ drowsiness, headache, fatigue, sedation A"H.
2)urticaria. 3)respiratory : dry mouth, nose & throat (2nd generation). 2)desloratadine: is contraindicated in those with
4)GI: nausea, vomiting, abdominal distress (2nd + 3rd generation). loratadine hypersensitivity
3)cetirizine: is contraindicated in those with
known hypersensitivity to hydroxyzine

corticosteroids:
intranasal corticosteroids: 1)beclomethasone: nasal Inhalation. 2)budesonide: nasal Inhaler. 3)flunisolide: nasal Inhalation.
4)fluticasone: nasal Inhalation. 5)mometasone: nasal spray. 6)triamcinolone: nasal Inhalation.
ADR: 1)nasal irritation. 2)nosebleed. 3)sore throat. 4)candidiasis. use: more effective than antihistamines.

drugs used for COPD:

PDE-4 inhibitor: 1)inhaled bronchodilators: like anti-colinergic, -2 antagonists. 2)highly selective. 3)100% low bioavailability. 4)low plasma variability.
5)low potential for drug interaction. 6)improved safety profile. 7)administration: tablet, orally. twice a day. 8)an improved new option for treatment of COPD.

drugs used to treate cough:

dextromethorphan: 1)opioid: derivative. 2)dextrorotatory stereoisomer: of methylated levorphanol derivate. 3)do not: exert analgesic effect & addiction. 4)use: suppression dry
coug
opiates: 1)names: codeine, levopropoxyphene, noscapine. 2)antitussive effect: is achieved at doses lower than those required for analgesia.
3)ADR: 1)sedation. 2)light-headedness. 3)dizziness. 4)nausea. 5)vomiting. 6)sweating.