By: Jesus Mario A. Lopez Jr.

, RN, RTRP

1. Right patient
11. Right Assessment
2. Right drug 12. Right Evaluation
3. Right dose 13. Right Attitude/Approach
4. Right time
5. Right route
6. Right drug preparation
7. Right documentation
8. Right of the patient to refuse
9. Right Education
10. Right of the client to know the reason for the
drug

Receptor
A structure or site on the surface of a cell that is able to bind a
chemical substance which gives rise to a change either within
the cell or the cell in turn releases a chemical substance
Differing types: bind with specific types of chemical
substances
Agonist
A chemical substance that binds to a receptor to produce or
amplify a physiological response
Antagonist
A chemical substance that binds to a receptor inhibiting
other chemical substances from binding to site, preventing or
reducing a physiological response

Adrenergic agents
- -Adrenergic: Relaxation of bronchial smooth muscle
and bronchodilation, to reduce Raw and to improve
ventilatory flow rates in airway obstruction resulting
from COPD, asthma, CF, acute bronchitis.
-Adrenergic: Topical vasoconstriction and
decongestion used to treat upper airway swelling
Anticholinergic agents
- Relaxation of cholinergically induced bronchoconstriction
to improve ventilatory flow rates in COPD and asthma
Antimuscarinic bronchodilator
- Same as anticholinergic bronchodilatoragent that
blocks the effect of acetylcholine at the cholinergic site.

Mucoactive agents
- Modification of properties of respiratory tract mucus;
current agents reduce viscosity and promote clearance
of secretions
Corticosteroids
- Reduction and control of airway inflammatory response
usually associated with asthma (lower respiratory tract)
or with seasonal or chronic rhinitis (upper respiratory
tract)
Antiinfective agents
- Inhibition or eradication of specific infective agents

I. ADRENERGIC; SYMPATHOMIMETICS (FRONT DOOR

BRONCHODILATORS) -Selective Beta2-adrenergic receptor
agonist
A. Catecholamines (e.g. epinephrine Adrenalin (IV), Primatene
Mist, Medihaler-Epi)
B. Resorcinol (e.g. metaproterenol - Alupent, Metaprel, terbutaline)
C. Saligenin (e.g.albuterol - Proventil, Ventolin)
D. Other
1. pirbuterol - Maxair Autohaler
2. levalbuterol - Xopenex
3. salmeterol Serevent
4. formoterol Foradil, Perforomist
5. aformoterol - Brovana

II. SYMPATHOMIMETIC DECONGESTANTS

A. phenylephrine -Neo-Synephrine, Coricidin (alpha adrenergic
nasal decongestant)
B. racepinephrine S2,
C. racemic epinephrine -Vaponephrine
III. PARASYMPATHOLYTICS; ANTICHOLINERGICS,
ANTIMUSCARINICS (BACK DOOR BRONCHODILATORS) These drugs act by blocking cholinergic parasympathetic
receptors, thus working against bronchonstriction
A. atropine
B. ipratropium bromide - Atrovent
C. tiotropium bromide - Spiriva

IV. XANTHINES: METHYLXANTHINES (SIDE DOOR

BRONCHODILATORS) - These drugs are phosphodiesterase
inhibitors. This inhibitor drug indirectly increases the amount of cAMP
within smooth muscle. The increased amount of cAMP then causes
bronchodilation.
A. theobromine
B. theophylline -Aminophylline, Theo-Dur
C. caffeine
V. MUCOLYTIC
A. acetylcysteine Formerly: Mucomyst or Mucosil (now generic only)
B. dornase alfa -Pulmozyme
C. sodium bicarbonate?

VI. MAST CELL STALIZERSIMEDIATOR

ANTAGONISTS
A. cromolyn sodium Generic (formerly Intal
and Aarane), Nasalcrom
VII. ANTI-LEUKOTRIENE
A. zileuton (Zyflo)
B. zafirlukast (Accolate)
C. montelukast (Singular)

Ultra-Short-Acting
2 Agonist
USABA(emergen
cy, urgency),
*Epinephrine
*&**Racemic
epinephrine

Brand Name

Time Course
(Onset, Peak,
Duration)

Adrenaline

1-3mins
5-20 mins
1-3 hrs

Preparation

Ampoule/vial
(0.25-0.5 ml +
2cc PNSS)

* only used prior to extubation.

** - IS GIVEN PRIMARILY AS A DECONGESTANT AND
NOT FOR ITS BRONCHODILATING EFFECTS

- not advisable for patients w/cardiac

problems.

Short-Acting 2
Agonist
SABA(rescue,
relievers), Front
Door

Brand
Name

Salbutamol/Albuterol

Ventolin,
Asmalin,
Aerovent

*Ipratropium Br

Atrovent

Salbutamol + *Ipratropium
Br

Combivent,
Duavent,
Combipul

Time Course
(Onset, Peak,
Duration)

Preparation

UDV, pMDI, DPI

2-5 mins
30- 60 mins
2-6 hrs

UDV, pMDI
UDV, pMDI,
pMDI,

Pibuterol
Maxair Autohaler

Ampules, UDV pMDI

**Terbutaline HCL
Bricanyl,
Brethaire
cardiac

*- compatible for
patients & patients w/ excessive
secretions; not for patients w/ glaucoma; can cause dry
mouth
** - not advisable for pregnant women at any trimester.

Short-Acting and
Long-Acting 2
Agonist
combinations
*Ipratropium Br +
Fenoterol

Brand Name

Time Course
(Onset, Peak,
Duration)

Berodual

Preparation

pMDI, UDV
2-15 mins
30- 60 mins
12-24 hrs

*- compatible for cardiac patients & patients

w/ excessive secretions; not for patients
w/ glaucoma; can cause dry mouth
- commonly used by COPD patients

Long-Acting 2
Agonist LABA
(preventers,
controllers), Back
Door
*Salmeterol

Brand
Name

Time Course
(Onset,
Duration)

Serevent

*Formoterol

Foradil

*Tiotropium Br

Spirivia

Preparation

pMDI, DPI,
45-90min
12-24hrs

pMDI
DPI

*- THESE ARE FOR MAINTENANCE ,

NOT FOR RESCUE!!!

Ultra-Long-Acting
2 Agonist ULABA
(preventers,
controllers), Back
Door
Incanderol maleate +
Glycopyrronium
bromide

Brand
Name

Ultibro

Time Course
(Onset,
Duration)

12-24hrs

Preparation

DPI

*- THESE ARE FOR MAINTENANCE ,

NOT FOR RESCUE!!!

Tachycardia (most common)

Muscle tremors (2nd most common)
Headache
Dizziness
Nausea
Hypokalemia
Loss of bronchoprotection?
Tolerance (tachyphylaxis)
Cough, dry mouth (for Anticholinergic)
Glaucoma (for Anticholinergic)
Dry mouth (for Anticholinergic)
Flu-like symptoms (for Anticholinergic)
Fluid Overload (for continuous nebulization)

Corticosteroids
(preventers,
controllers)

Brand Name

*Fluticasone
propionate

Flixotide

*Budesonide

Budecort
Asmavent

Time Course
(Onset
,Duration)

Preparation

pMDI, UDV
60 mins
12 - 24 hrs

*- THESE ARE FOR MAINTENANCE, NOT

FOR RESCUE!!!
- Rinse/gargle/ brush mouth thoroughly
after taking the dose then spit water out

SYSTEMIC
- Adrenal insufficiency
- Extrapulmonary allergy???
- Acute asthma
- HPA suppression (minimal, dosedependent)
- Growth retardation (for chronic users)
- Osteoporosis
LOCAL (TOPICAL)
- Oropharyngeal fungal infections
- Dysphonia
- Cough
- Oral thrush
- Bronchoconstriction (most common)
OTHER
- Cushingoid state (for chronic users)
- Water retention (for chronic users)
-Weight gain (for chronic users)

Combination Drugs
(Long-Acting 2 +
Corticosteroids)
Fluticasone +
Salmeterol

Brand
Name
Advair
Symbicort

Budesonide +
Formoterol

Time Course
(Peak, Onset
Duration)

Preparation

pMDI
30-60 mins
6-12 hrs
24 hrs

pMDI, DPI

- THESE ARE FOR MAINTENANCE, NOT

FOR RESCUE!!!
- Rinse/gargle/ brush mouth thoroughly
after taking the dose then spit water
out

MucoActive
Agents

Brand Name

*Ambroxol HCL

Mucosolvan

*Acetycysteine

Fluimucil

Time Course
(Peak, Onset
Duration)

2-3cc + 2cc
PNSS
Variable

* 3% NaCl (24cc)
*7% NaCl(2-4cc)
** 0.9% NSS
(PNSS)

Preparation

1amp + 2cc
PNSS
2tabs NaCl
+100cc sterile
H20;
5tabs NaCl+
100cc sterile H20

* - Never mixed with other drugs; use bronchodilators

None first
before administer these.
** - only diluting agent compatible for all aerosolize drugs.
(DONT USE WITH NSS +D5/DEXTROSE
combination!!!)

Other

Brand Name

Purpose

Preparation

Bland Aerosol
(Distilled/Sterile )

For humidification

n/a

*Morphine S04

2nd fastest route

Ampoule/vial
(0.25-0.5 ml +
2cc PNSS)

*NaHC03

Reduce the
Manufacturers
viscosity of airway specifications
secretions.
Manufacturers
Used to prevent
specifications
bronchoconstrictio
n in exercise
induce asthma
Manufacturers
For stroke
specifications
patients
Manufacturers
specifications
To lower sugar
Manufacturers
levels
specifications

?Heparin

?Alteplase
?Insulin
?Gluthathione

Leo Heparin

Other
?Cisplatin,
Doxorubicin

Brand Name

Purpose
For Chemo
therapy

Preparation
Manufacturers
specifications

* - Never mixed with other drugs; use

bronchodilators first before administer these.
? still on experimental phase further studies
needed.

Non-steroidal
anti asthma
(preventers,
controllers)

Brand Name

Theophylline
(Xanthines,)

Theochron,
Elixophyllin,
Theodur

Aminophylline
(Xanthines, )

Aminophyllin
e

Time Course
(Onset,
Duration)

Preparation

Tablet, syrup,
elixir

Varialble up to
24hrs

Tablet,
injectables,
suppositories

*Montelukast (ANTILEUKOTRIENE)
Singulair
*Cromolyn sodium
(MAST CELL STALIZERS
IMEDIATOR
ANTAGONISTS)

Tablet
Intal
pMDI, UDV,
ampule

*- THESE ARE FOR MAINTENANCE ,

NOT FOR RESCUE!!!

Central Nervous System Hematemesis

Headache Gastroesophageal reflux
Anxiety
Respiratory System
Restlessness
Tachypnea
Insomnia Cardiovascular System
Tremor
Palpitations
Convulsions
Supraventricular tachycardia
Gastrointestinal System
Ventricular arrhythmias
Nausea
Hypotension
Vomiting Renal System
Anorexia Diuresis
Abdominal pain
Diarrhea

Aerosolized
antiinfectives

Brand Name

Time Course
(Onset,
Duration)

Preparation

Ribavirin (anti viral)

Virazole

SPAG (vial)

Tobramycin

TOBI

Vial

Cayston

Vial

Colomycin,
Coly-mycin,
Colistin

Ampule

(antibacterial)

Aztreonam
(antibacterial)

Colistimethate
(antibacterial)

* See
manufacturers
specifications

- check for hypersensitivity to these

drugs

- Deterioration of
pulmonary function
- Dyspnea
- Chest soreness
- Bacterial
pneumonia
- Apnea
- Cardiac arrest
- Hypertension
- Pneumothorax
- Digitalis toxicity
- Rash
- Conjunctivitis
- Reticulocytosis
**Check hospital
policy before
administering
Ribavirin during
mechanical
ventilation

- Hearing
impairment
- Hepatotoxicity
- Acoustic nerve
damage
- Nephrotoxicity
- Resistance to
Pseudomonas
infections

- Neurotoxicity
- Nephrotoxicity
- Bronchospasm

If medications where not given, document

medicines were not given and its reason in
full detail
Indicate STAT medicines given, its indication,
time , evaluate its effectiveness
Write the whole drug name instead of dittos
and short cut abbreviations
ALL MEDICATION ORDERS MUST BE IN
WRITTEN REFERRALS VERBAL ORDERS IS A
NO-NO !!!!

1. Actual dosages in each clinic may vary. Consult

the Department Policy and Procedure Manual
2. Not all adverse reactions are listed. Consult
product information.
3. DO NOT USE medication if solution is pinkish to
brown in color, cloudy or contains a precipitate.
4. MIXING BRONCHODILATORS
a. Bronchodilators of the same type
(sympathomimetics or front-door) should not
be mixed together (e.g. metaproterenol,
terbutaline, albuterol). The exception is a shortacting agent being used with a long-acting agent.

b. Bronchodilators that work by a different mechanism may

be given together such as giving a sympathomimetic
(front-door) with an anticholinergic (back-door) or an
anticholinergic with a (side-door).
5. DRUG REACTIONS
a. If you suspect a drug reaction, REMEMBER:
-Stop the treatment
-Monitor vital signs
-Stay with the patient until vital signs are stable
- Assure patient safety
-Call the nurse, your supervisor and the physician
- Document thoroughly Include adverse reactions and actions taken

- Egans Fundamentals of Respiratory Care by

Kacmarek, Wilkins, Stoller, 10th edition
- Essentials in Respiratory Care by Kacmarek, 3rd
edition
- Raus Respiratory Care Pharmacology by Gardenhire,
8th edition
-