Medication Name

Category of Drug

Mechanism

Side effects/Drug
Interactions

Administration and
Max Effect/ Half-life

Dosing

Special Notes

Albuterol

Short Acting -2
Adrenergic Agonist

Stimulate adenylyl
cyclase and
increase cAMP
bronchodilation

Minimal since inhaled

Inhaler
Max Effect: 30 mins
Lasts Several Hours

PRN

Used exclusively as a Rescue

Inhaler)

Salmeterol

Long Acting -2
Adrenergics

Stimulate adenylyl
cyclase and
increase cAMP
bronchodilation

Minimal due to low

systemic absorption

Inhaler:
Takes 2 weeks for
max effectiveness
Long Duration: 12+
hours

2 puffs
daily

MUST GIVE WITH INHALED

CORTICOSTEROIDS; Not for
acute attacks

Tachycardia, muscle
tremors

Epinephrine

Nonselective Beta
Adrenergic

Stimulate adenylyl
cyclase and
increase cAMP
bronchodilation

Severe Cardiovascular
Side Effects

IV or IM; rapid action

Drug of choice for anaphylaxis

Isoproterenol

Nonselective Beta
Adrenergic

Stimulate adenylyl
cyclase and
increase cAMP
bronchodilation

Cardiac Arrhythmias

Inhaled; very potent

and fast acting

Used for severe

bronchoconstrictive episodes

Ipratropium Bromide

Anti-Muscarinings

Blocks Muscarinic
Bronchospasms

Minimal Side effects

Drying of mouth and
upper airways
Alleviated with spacer

Inhaled
Max effect: 1-2 hours

Not used for acute

Side Effects (at

therapeutic doses)

Hea
dache

Nerv
ousness

Inso
mnia

N/V

Epig
astric Pain
Side effects >30ug/mL
Hypokalemia; Cardiac
Dysfunction
>40 ug/mL
Seizures

Oral tablet

Theophylline

Phosphodiesterase
Inhibitors

Decreased
breakdown of cAMP
and favors
bronchodilation;
Antagonist to
adenosine receptors
also
Both favor
bronchodilation

Also to reduce corticosteroid dose

Found in tea; Narrow Therapeutic
Range (5-15 ug/ml)
Not for acute bronchospasm
METABOLISM: Liver CytochromeP450
(Must check serum levels of new
drug that does not have
theophylline info)
Liver disease
Febrile illness (pneumonia,
influenza) lead to increased serum
levels
Reduce dose by 50% in febrile
children

Flunisolide
Fluticasone

Corticosteroid

Prednisone

Controls Eosinophils
Reduces Mucosal
Edema
Potentiates Beta
Adrenergics
Inhibits transcription
of inflammatory
agents

Drugs that increase

serum theophylline
levels: Erythromycin, oral
contraceptives, Zileuton

Cystic Fibrosis - leads to reduced

serum concentrations of
theophylline

Drugs that decrease

serum theophylline Barbiturates
Carbamazepine
Also cigarette smoking

Also to reduce corticosteroid dose

Minimal if inhaled;
Flunisolide - metabolites
inactive

Flunisolide and
Fluticasone inhaled

They work on everyone. Given

with all LABAs

Prednisone (oral)

Combined Treatment of
Fluticasone and Salmeterol
One puff BID
Low doses less side effects
Higher doses - systemic side
effects

Effective orally

Main Purpose to lower

Corticosteroid Dose
Metabolism: Liver-Cytochrome
P450
Monitor liver enzymes for patients
taking anti-LTs

Oropharyngeal
Candidiasis (Gargle/Spit
or Spacer to avoid)
HTN, Diabetes,
Iatrogenic Cushings
(Visceral adiposity)
Adrenal Suppression
(feedback)
Peptic ulcers

Zileutin

Zafirlukast

Anti-Leukotrienes:

Zileutin
Inhibits Lipoxygenase
Zafirlukast
LT receptor
antagonist

Interactions: Increase
Theophylline levels
Decrease Warfarin
Clearance (increase PT
time)

LTB4 attracts
neutrophils

Increase Carbamazepine
effect

LTC4/D4
Bronchoconstriction
Hyperreactivity
Mucosal Edema
Mucus Secretion

Erythromycin dec.
Zafirlukast
Side Effects: abnormal
Liver function tests,
tachycardia, alopecia,
rash, fibromyalgia-like sx
Churg-Strauss
Syndrome (Eosinophilic)

Doesnt work for everyone; Used to

decrease dose of inhaled Corts

As a bronchilator: half as potent as

-adrenergics, less potent than
theophylline
Anti-inflammatory: less potent than
glucocorticoids

GOOD FOR EXERCISE and

ASPIRIN-INDUCED ASTHMA
Cromolyn/Nedrocomil

Inhibit Mediators

Inhibit Mediator
release from Mast
Cells, Neutrophils,
Eosinophils
Causes an interaction
between secretory
vesicles and
cytoskeleton
(increase moesin-like
mast cell protein)

Minimal Side effects

(poor absorption)

Inhaler (Poor GI
absorption)

High Safety Factor

Early and Late anti-inflammatory
response < steroids

Localized to Site

Thro
at irritation

Cou
gh

Mou
th dryness

Used for: Exercise, irritant, and

antigen
Not for acute
Prophylactic Use
Do not work on all Mast Cells
Both work in Human Lung

May suppres Calcium

and Chloride Channel
activity

Nedrocromil - Conjunctiveal
No effect on skin mast cells
Doesnt work on everyone
Also to reduce corticosteroid dose
Omalizumab

Anti-IgE

Binds IgE and forms

inert complexes (no
complement
activation)

No serious effects

Subcutaneous
injection
Max conc: 10 days
Half life: 3 weeks

Based on
body
weight

Goal to decrease IgE levels to <10

IU/mL
Downregulate IgE-R w/in 90 days

Shots
once or
twice per
month

Have epi-pen on standby for

anaphylactic possibility
Also to reduce corticosteroid dose

Decreased exacerbations
Decreased steroid/rescue meds
Increased FEV-1
$$$$