Pharmacy Practice Experience 

Part one

Drugs used for respiratory tract diseases 

Lecturer: Suzan B. wahhab 

Clinical Pharmacist 
MSc, Hawler Medical
University 
 Contents 
• Bronchodilators  • Corticosteroids
- Anticholinergics  - Glucocorticoids   
- Beta-2 agonists 
- Xanthine derivative 
Bronchodilators 
• Anticholinergics agents are among the oldest of all respiratory drugs,
they are available as inhalers, nebulizers and nasal preparations.
- Ipratropium
- Tiotrpium
• Beta-2 agonists are a class of drugs that act on the β2 adrenergic
receptor. they cause smooth muscle relaxation. cause dilation
of bronchial passages,. They are primarily used to treat asthma and
other pulmonary disorders, such as COPD.
• Xanthine derivatives as thephylline act as bronchodilators

• Corticosteroids inhaled glucocorticoids are the drugs of first choise in

patients with moderate to severe asthma.
• Ipratropium
• Brand name : atrovent Generic name : ipratropium
• Primary indication : maintenance treatment of bronchospasm
associated with COPD, adjunct in ashthma exacerbations, allergic and
non allergic rhinitis, common cold.
• Drug class : anticholinergics
• Dosage form : aerosol for oral inlation, solution for nebulizer, nasal
spray.
• Patient counseling information :
• Patient counseling information :
• use proper administration technique.
• Atrovent inhaler does not have to be shaken before use.
• Avoid spraying into eyes.
• Important side effects : dry mouth, chest pain, palpitaion, epistaxis
( nasal spray).
• Contraindications : hypersensitivity to ipratropium, used with caution
I patients with glaucoma or urinary retention.
• salbutamol ( albuterol) :
• Brand name : ventolin Generic name : Albuterol
• Primary indication : treatment of bronchospasm in asthma and COPD,
exercise induced bronchospasm, treatment of hyperkalemia.
• Drug class: short acting BETA-2- AGONISTS
• Dosage forms : tablet, syrup, inhaler, nebulizer, solution, extended
release tablets, solution.
• Patient counseling information for ventolin inhaler:
• 1. shake well before use
• 2. remove the cap from the mouthpiece
• 3. prime the inhaler before using it for the first time, prime by
releasing 4 sprayes into the air.
• 4. breath out fully from your mouth, expelling as much air from your
lungs as possible. Place the mouthpiece fully into the mouth, holding
the inhaler in its upright position and closing the lips around it.
• 5. while breathing deeply and slowly press the top of the metal
canister with your index finger.
6. Hold your breath as long as possible, up to 10 seconds. Before
breathing out.
7. If you need another puffs, waits for 1 minute.
Important side effects : tremor(20%), nervousness in children aged 2-6
yrs., insomnia in children aged 6-12 yrs.
• Formoterol :
• Brand name: foradil Generic name: formoterol
• primarary indication: chronic maintenace of asthma, prevention of
exercise induced bronchospasm, long term maintenance treatment of
bronchoconstriction in patients with COPD.
• Drug class : long acting BETA-2- AGONISTS
• Dosage forms: powder for oral inhalation, solution for nebulization.
• Patient counceling information:
• 1. capsules should not be inhaled, not swallowed.
• 2. not used for acute attacks.
• 3.do not use more frequently than the recommended dose.
• Important side effects: viral infections more than 10%, bronchitis,
chest infection, tremor.
• Contraindications: hypersensitivity to formoterol, tachycardia
secondary to heart condition.
• Theophylline :
• Brand name : Elixophyllin Generic name: Theophylline
• Primary indication : treatment or prevention of bronchial asthma,
COPD, apnea in infants.
• Drug class: xanthine derivative
• Dosage forms: extended release tablets and capsules, oral solution,
injection.
• Patient counseling information:
• Patient counseling information:
• Do not break, chew, crush extended release formulations.
• Avoid smoking. Smoking can change the metabolism of theophylline.
• Avoid ( tea, coffee, chocolate ) that may increase adverse effects.
• Side effects: CNS excitment, headache, seizure, tachycardia, tremors.
• Contraindications: hypersensitivity
• Corticosteroids : also known as steroids, has anti-inflammatory and
anti allergic effects. Prescribed for a wide range of conditions.
• Are available in different forms :
• Tablets, injections, inhalers, nasal sprays, nebulizers.
• prednisolone:
• Brand name: prelone Generic name: prednisolone
• Primary indication: used in acute asthma exacerbations to reduce the
bodys inflammatory response after the asthma attack.
• Drug class : corticosteroids
• Dosage forms: tablet, syrup
• Patient counseling: discuss specific use of drug and side effects with
patient as it relates to treatment.
• Patient may experience nausea, hunger, weight gain, insomnia.
• Side effects: adrenal suppression, GI perforation, glucose intolerance,
menstrual irregularity, osteoporosis, pituitary adrenal axis
suppression.
• Contraindications: documented hypersensitivity
• Inhaled corticosteroids: are used for the chronic treatment of
asthma, their mechanism of action is unknown, but they are thought
to decrease inflammatory cells and cause smooth muscle relaxation.
the most common adverse effects include hoarseness, dry mouth,
oral candidiasis.
• Beclomethasone:
• Brand name: QVAR 40 Generic name: Beclomethasone
• Primary indication: chronic treatment of asthma, COPD.
• Drug class: Inhaled corticosteroids
• Dosage forms: metered- dose inhaler (MDI)
• Patient counseling information:
• Do not use it for acute attacks.
• Rinse mouth after each use to prevent oral thrush.
• It may take 1-4 weeks to see maximal benefit.
• Side effects: dry mouth, pharyngitis, hoarseness, coughing, oral
candidiasis.
• Contraindications: hypersensitivity
• Intranasal corticosteroids: are primarily used for rhinitis and
occassionally for prevention of nasal polyps.
• Busesonide: brand name : Rhinocort Aqua Generic name :
Budesonide
• Primary indication: relief of symptoms of seasonal and perennial
allergic rhinitis. Non allergic rhinitis, prevention of nasal polyps,
adjunct to antibiotics in the treatment of sinusitis.
• Drug class: corticosteroids
• Dosage forms: nasal inhalation or nasal sprays
• Patient counseling information:
• Blow your nose before each use
• Avoid blowing your nose for 10-15 minutes.
• Shake well prior to each use.
• Side effects:
• Headache, epistaxis, throat discomfort, nasal irritation.
• BETA-2 AGONIST AND CORTICOSTERIOD COMBINATION INHALER:
• Used for chronic treatment of asthma, severe or very severe COPD.
• Fluticasone and salmeterol: brand name: advair
• Generic name: Fluticasone and salmeterol
• Primary indication: chronic treatment of asthma, COPD.
• Dosage form: powder for inhalation via Discus inhaler, inhalation aerosol.
• Patient counseling information:
• The dose indicator tells you how many doses are left
• Use proper administration technique:
• For the diskus:
• 1. Activate the dry powder inhaler by sliding the activator. Every time
the lever is pushed back, a dose is ready to be inhaled. Do not close or
tilt the diskus after the lever is pushed back.
• 2. Breath out deeply
• 3. Inhale the powder contents completely.
• 4. hold you breath fot 10 seconds.
• 5. breath out slowly.
• References:
• www.medscape.com
• Mancano MA, Gallagher JC. Frequently Prescribed Medications; Drugs
You Need to Know. 2012. Jones & Bartlett Learning (ISBN: 978-0-7637-
8177-0)
Thank you