LLACAR, Ma. Kaile Shyla F.
BSN-
2A
Pharmacology (C-NCM106)
DRUG STUDY
DRUG NAME CLASSIFICATION MECHANISM OF ACTION
a.) Salbutamol / Albuterol Andrenergic Bronchodilators MOA: In vitro studies and in vivo
Generic Name: Salbutamol pharmacologic studies have shown
Brand Name: Airomir, that salbutamol has a preferential
Combivent, Proair, effect on beta2-adrenergic
Ventolin, Xopenex receptors compared with
Appearance: isoproterenol. Although beta2
 Aerosol Powder adrenoceptors are the predominant
adrenergic receptors in bronchial
smooth muscle and beta1
adrenoceptors are the predominant
receptors in the heart, there are
also beta2-adrenoceptors in the
human heart comprising 10% to
50% of the total beta-
adrenoceptors. The precise function Contraindications:
of these receptors has not been
established, but their presence
raises the possibility that even
selective beta2-agonists may have
cardiac effects.
Activation of beta2-adrenergic
receptors on airway smooth muscle
leads to the activation of adenyl
cyclase and to an increase in the
intracellular concentration of
cyclic-3′,5′-adenosine
monophosphate (cyclic AMP). This
increase of cyclic AMP leads to the
activation of protein kinase A,
which inhibits the phosphorylation
of myosin and lowers intracellular
ionic calcium concentrations,
resulting in relaxation. Salbutamol
 Solution
relaxes the smooth muscles of all
 Suspension:
airways, from the trachea to the
terminal bronchioles. Salbutamol
acts as a functional antagonist to
relax the airway irrespective of the
THERAPEUTICS
Indications:
 Treatment of bronchospasm
in bronchial asthma, and
other conditions with
associated reversible
airways obstruction.
Appropriate anti-
inflammatory therapy
should be considered in line
with current practice.
 To relieve attacks of acute
dyspnea.
 To prevent exercise-induced
bronchospasm.
 Patients with
hypersensitivity to any of
the active substances or the
excipients.
 Patients with high blood
pressure during pregnancy,
uterine infection,
miscarriage, and heart
disease.
EFFECTS
Side Effects: body pain, congestion, Assessment & Drug Effects:
voice changes, painful urination,
earache, headache (severe or
throbbing), muscle or bone pain,
pain, redness or swelling in the ear,
(redness, swelling) of the tongue,
sneezing, stuffy nose, swelling,
tenderness, trouble in holding or
releasing urine, trouble sleeping,
unusual drowsiness, (bad, unusual,
unpleasant) after taste, change in
taste, feeling of constant
movement of self or surroundings, Patient & Family Education
gagging, rough or scratchy sound
of voice, sensation of spinning,
tightness of throat.
Adverse Effects: irregular
heartbeat or pulse, shaking or
trembling (legs, arms, hands, feet),
bladder pain, bloody or cloudy
urine, chest discomfort or pain,
chills, cough, diarrhea, labored
breathing, difficulty with
swallowing, dizziness, feeling of
warmth, fever, frequent urge to
urinate, hives, itching, skin rash,
hoarseness, loss of appetite, lower
back or side pain, nausea, puffiness
or swelling (eyelids, eyes, face, lips,
tongue), runny nose, sore throat,
stomach pain, swollen or painful
(lymph glands in the neck, armpit,
groin), tightness in the chest,
unusual tiredness or weakness,
hives (face, eyelids, lips, tongue,
hands, legs, feet, genitals), noisy
breathing, swelling of the mouth or
NURSING CONSIDERATIONS
 Monitor for therapeutic
effectiveness: Indicated by
negative stool samples.
 Monitor for cardiovascular
effects such as orthostatic
hypotension and
tachycardia.
 Monitor for and report
inflammatory conditions of
the eyes.
 Patients should remain
compliant with the
medication dosing regimen.
 Individuals should contact
their healthcare provider if
they experience ongoing
shortness of breath
unrelieved with medication
therapy.
 If using an inhaler, the
patient should be sure to
prime the inhaler prior to
administering the dose of
medication.
 The medication can cause an
unusual taste in the mouth,
so patient should rinse their
mouth with water after each
use.
 spasmogen involved, thus
protecting against all
bronchoconstrictor
challenges. Increased cyclic AMP
concentrations are also associated
with the inhibition of release of
mediators from mast cells in the
airway.
DRUG NAME CLASSIFFICATION MECHANISM OF ACTION
b.) Montelukast Antiasthmatics MOA: Cysteinyl leukotrienes
Generic Name: (CysLT) like LTC4, LTD4, and LTE4,
Montelukast Sodium among others, are eicosanoids
Brand Name: Singulair, released by a variety of cells like
Appearance: mast cells and eosinophils. When
 Oral Granules: 4mg such CysLT bind to corresponding
packet CysLT receptors like CysLT type-1
receptors located on respiratory
airway smooth muscle cells, airway
macrophages, and on various pro-
inflammatory cells like eosinophils
and some specific myeloid stem
cells activities that facilitate the
pathophysiology of asthma and
allergic rhinitis are stimulated.
In particular, CysLT-mediated
airway bronchoconstriction,
occluding mucous secretion,
vascular permeability, and
eosinophil recruitment are all types
of effects that facilitate asthma.
 Alternatively, in allergic rhinitis,
CysLTs are released by the nasal
mucosa when exposed to allergens
during both early and late phase
reactions and participate in eliciting
symptoms of allergic rhinitis like a
congested nose and airway.
Subsequently, montelukast is a
leukotriene receptor antagonist
THERAPEUTICS
Indications:
 Prophylaxis and chronic
treatment of asthma,
seasonal allergic rhinitis,
perennial allergic rhinitis.
 Prevention of exercise-
induced
bronchoconstriction
Contraindications:
 Patients with severe
hypersensitivity to the drug
or its ingredients.
 Patients with
phemylketonuria.
 Patients with increased
eosinophils in the blood.
 Patients with suicidal
thoughts.
 Patients with depression
 Patients with inflammation of
blood vessels in the skin.
 Patients with anxiety
disorders.
 Patients who are pregnant or
lactating.
throat, agitation, pain (arm, back,
jaw), confusion, decreased urine,
faintness, drowsiness, dry mouth,
flushed or dry skin, irritability,
light headedness, muscle pain or
cramps, nightmares, numbness or
tingling (hands, feet, lips), seizures,
sweating, vomiting.
EFFECTS
Side Effects: stomach pain,
diarrhea, fever, fly symptoms, ear
pain, trouble hearing, headache,
chills, stuffy nose, sinus pain,
cough, sore throat.
Adverse Effects: CNS: headache,
asthenia, dizziness, fatigue, fever,
somnolence, weakness. EENT:
conjunctivitis, otitis media, nasal
congestion, nosebleed, laryngitis,
sinusitis, pharyngitis, rhinitis,
tonsillitis, dental pain. GI:
abdominal pain, dyspepsia,
gastroenteritis, nausea, diarrhea.
GU: pyuria. HEMATOLOGIC:
systemic eosinophilia.
RESPIRATORY: URI, cough,
wheezing, pneumonia, bronchitis.
SKIN: rash, dermatitis, urticarial,
eczema. OTHER: flu-like
symptoms, trauma, varicella, viral
infection, agitation, aggression,
restless, irritable, anxiety,
depression, confusion, problems
with memory or attention,
stuttering, tremors, uncontrolled
muscle movements, suicidal
thoughts or actions, hallucinations,
sleep problems, vivid dreams,
NURSING CONSIDERATION
Assessment and Drug Effects:
 Assess patient’s underlying
condition; monitor patient
for effectiveness.
 Drug may cause behavior
and mood changes. Monitor
patient and consider
discontinuing drug if
neuropsychiatric symptoms
develop.
Patient & Family Education
 Inform caregiver that the
oral granules may be given
directly into the child’s
mouth, dissolved in 1
teaspoon of cold or room-
temperature baby formula
or human milk, or mixed in a
spoonful of applesauce,
carrots, rice, or ice cream.
 Tell caregiver not to open
pocket until ready to use,
and after opening, to give
the full dose within 15
minutes. If drug is mixed
with food, tell caregiver not
to store excess for future use
 Tablets (chewable): that binds with high affinity and sleep walking, compulsive or and to discard the unused
4mg, 5mg selectivity to the CysLT type 1 repetitive behaviors. portion.
receptor, which consequently  Advise patient to take drug
assists in inhibiting any daily, even if asymptomatic,
physiological actions of CysLTs like and to contact prescriber if
LTC4, LTD4, and LTE4 at the asthma isn’t well controlled.
receptor that may facilitate asthma  Warn patient not to reduce
or allergic rhinitis. or stop taking other
prescribed antiasthmatics
without prescriber’s
approval.
 Advise patient to seek
medical attention if short-
acting inhaled
bronchodilators are needed
more often than usual
during drug therapy.
 Warn patient that drug isn’t
beneficial in acute asthma
 Tablets (film- attacks or in acute exercise-
coated): 10mg induced bronchospasm.
Advise patient to keep
appropriate rescue drugs
available.
 Warn patient that drug may
cause behavior and mood
changes, and to report
development of these
symptoms to prescriber.
 Advise patient with known
aspirin sensitivity to
continue to avoid using
aspirin and NSAIDs during
drug therapy.
 Advise patient with
phenylketonuria that
chewable tablet contains
phenylalanine.

References:
https://go.drugbank.com/drugs/DB00471
https://www.webmd.com/drugs/2/drug-6478-6277/montelukast-oral/montelukast-granules-oral/details/list-contraindications
https://www.drugs.com/mtm/montelukast.html#warnings
https://www.drugs.com/cons/salbutamol.htmlhttps://www.lagaay.com/Catalogus/Product%20information/049820/Salbutamol%20Inhaler%20Leaflet.pdf
https://www.medindia.net/doctors/drug_information/salbutamol.htm
https://wtcs.pressbooks.pub/pharmacology/chapter/4-13-beta-2-agonist/#:~:text=Indications%3A%20Albuterol%20is%20commonly%20used,least%202%20minutes
%20between%20inhalations.

Case #1
Jennie has been treated for adult-onset asthma for 3 years. She has been doing fairly well with her inhalers, but today she receives a prescription for montelukast, one 10-mg tablet daily.
1. How does this medication differ from the corticosteroids that are used to reduce inflammation?
Leukotrienes are inflammatory chemicals that causes tightening of airway muscle and the production of excess mucus and fluids, while corticosteroids suppress the multiple
inflammatory genes that are activated in asthmatic airways.
2. Jennie says, “I hope this medicine works better than the other one I took when I had an asthma attack.” How will you reply?
If you follow the Doctor’s order completely, it will give you best results, because taking montelukast equally effective as inhaled corticosteroid.
3. Jennie takes ibuprofen on occasion for arthritic pain. How do you advise Jennie regarding taking over- the-counter drugs with montelukast?
It is usually safe to take painkillers with montelukast. However, do not take non-steroidal anti-inflammatory if they have ever made your asthma symptoms worse.
4. After 3 months, Jennie stops taking the montelukast. She says, “My symptoms are better, and I don’t want to take medicine unless I need it.” Is this appropriate?
Do not stop taking montelukast even if your asthma seems better, because it controls the symptoms of asthma, unless your doctor told you to do so.