defined as more than 2 days per week with but not daily symptoms and more than 2 nights per month with awakenings and FEV1 of 80% or greater.

This drug is indicated for the maintenance of bronchospasm in COPD, including chronic bronchitis and emphysema

genetically engineered clone of the natural human pancreatic DNase enzyme, which can digest extracellular DNA material. It is a peptide mucolytic and can reduce extracellular DNA and F-actin polymers. ■ is indicated in the management of CF to reduce the frequency of respiratory infections requiring parenteral antibiotics and to improve pulmonary function of these patients.

causes increased heart rate and myocardial contractility

Of all the medications and substances used to stimulate respiration over the last 200 years, (1-Ethyl-4- (2- morpholin-4-ylethyl)- 3,3-diphenyl-pyrrolidin-2-one; Dopram) remained into the 21st century.

It occurs when aerosol particles settle out of suspension and are deposited owing to gravity. The greater the mass of the particle, the faster it settles. During normal breathing, sedimentation is the primary mechanism for deposition of particles 1 to 5 μm.

depends on the substance for nebulization, the method used to generate the aerosol, and the environmental conditions surrounding the particle. The unaided human eye cannot see particles less than 50 to 100 μm in diameter (equivalent to a small grain of sand). The only reliable way to determine the characteristics of an aerosol suspension is laboratory measurement.

It was found to have very little effect in overcoming respiratory depression. However, it is still in use today in neonatology practice. a methylxanthine, although a weak bronchodilator, is used in three clinical settings: asthma (rarely), apnea of prematurity, and newborn bronchopulmonary dysplasia.

It is an antagonist of acetylcholine receptors. It was discovered in 1818 and used medicinally as one of the first analeptics for the purpose of stimulating respiration.

(6-[4-[Bis(4-fluorophenyl)methyl]piperazin-1-yl]-N,N'-diprop-2-enyl￾1,3,5-triazine-2,4-diamine) increases tidal volume and respiratory rate. It is considered unsuitable for clinical practice because of a significant incidence of peripheral neuropathy caused by its metabolites.

An ultra-long-acting beta agonist that is available in fixed combinations with fluticasone and umeclidinium. • It is not available as monotherapy, but has been studied with effective results in COPD.

It is the primary mechanism for deposition of small particles (<3 μm), mainly in the respiratory region where bulk gas flow ceases and most aerosol particles reach the alveoli by diffusion.

It was being used as a respiratory stimulant in the early 1900s and is still used today in the setting of organophosphate poisoning and to control secretions during surgery

relaxes bronchial smooth muscle, stimulates mucocillary activity and some inhibitory action on inflammatory mediator release bronchodilation

For children older than 12 years and adults, _________ is available for use in asthma above Step 4

drug that stimulates acetylcholine receptors specifically at parasympathetic nerve ending

is the mass of fluid or drug produced by an aerosol generator. Output is described as the mass of drug or liquid emitted (leaving) from the aerosol generator.

drug action describes the time, course, and disposition of a drug in the body based on absorption, distribution, metabolism and elimination

often used in infants and young children as alternatives to inhaled corticosteroids in Step 2 asthma because of their safety profiles

It occurs when suspended particles in motion collide with and are deposited on a surface; this is the primary deposition mechanism for particles larger than 5 μm.

short-acting adrenergic bronchodilator I. Metaproteranol II. Formoterol III. Levalbuterol IV. Albuterol

A monoclonal antibody, available for consideration in the appropriate population.

causes vasocnstriction and vasopressor effect + elevated blood pressure

The proportion of the drug mass in particles that are small enough to reach the lower respiratory tract is the ________. Not all aerosol particles delivered to the lung are retained, or deposited. A small percentage (1% to 5%) of inhaled drug may be exhaled

It acts by inhibiting the degranulation of mast cells in response to allergic and nonallergic stimuli. This inhibition prevents release of histamine and other mediators of inflammation. ■ These mediators cause bronchospasm and trigger an increasing cascade of further mediator release and inflammatory cell activity in the airway

derivatives (synthetic organic heterocyclic compounds consisting of a five-member ring of four nitrogen atoms and one carbon atom) act on the CNS. The most prominent, Leptazol (pentamethylenetetrazole), was originally synthesized in 1924.

Found in the Chinese herb Ma Huang, which has been used for over 5000 years.

drug that stimulates a receptor responding to norepinephrine or epinephrine

Derived from the Fishberry shrub, has been used for centuries to stun fish. It is a noncompetitive antagonist at the γ-aminobutyric-A (GABA-A) receptor complex, and has been used as a neuro-stimulant and pro-convulsant.

is the amount of drug inhaled.

Tyvaso is indicated for the treatment of pulmonary arterial hypertension to increase walking distance in patients with New York Heart Association class III symptoms. ■ Adverse effects: bronchospasm

drug that blocks a receptor for acetylcholine

is an antiprotozoal agent that has been used in the treatment of opportunistic pneumonia caused by Pneumocystis jiroveci, which is the causative agent of Pneumocystis pneumonia (PCP). PCP is seen in immunocompromised patients, especially patients with AIDS.

mechanism of drug action by which a drug molecule causes it's effect in the body. drug effects are caused by the combination of a drug with a matching receptors

molecules which bind the drug chemically and this complex exerts a pharmacological action

The two agents approved in the United States for oral inhalation with an effect on mucus are

extracted as a paste from the leaves of a plant from the Erythroxylumcoca species such as found in the Andean and Amazon areas of South America. During the 19th and early 20th centuries _____ was used for a variety of respiratory disorders. It was used as a respiratory stimulant, but problems of substance use disorder became a serious public health problem, and use post-surgically was found to be ineffective

an inhaled powder aerosol (DPI). Despite the availability of the oral antiinfluenza agent oseltamivir (Tamiflu), prophylactic vaccination against influenza is still recommended, especially in high-risk individuals with cardiovascular or pulmonary disease. Indicated for the treatment of uncomplicated acute illness caused by influenza virus in adults and children 5 years or older who have been symptomatic for no longer than 2 days.

not indicated for patients younger than 7 years old or patients with Burkholderia cepacia infection. This agent has been studied only in patients with FEV1 greater than 25% or less than 75% of predicted. The agent is delivered by itself using the Altera Nebulizer System.

Introduced into the United States in the 1930s as respiratory stimulants for asthma and nasal congestion

ultra-short-acting adrenergic bronchodilator

An ultra-long-acting beta agonist for once-daily treatment of COPD. • Quick onset similar to that of formoterol and indacaterol. • Currently, not approved for asthma; however, it has been shown to be effective as monotherapy and in combination with tiotropium.

defined as symptoms throughout the day and night awakenings more than once per week and FEV1 less than 60%

It is used for is for antiinflammatory maintenance therapy of persistent asthma and severe COPD

It was used as a respiratory stimulant in the 1930s, along with other agents. It was described as the “outstanding member of this group” of respiratory stimulants, of those tested. the first use of _______ was for controlling respirations during anesthesia.

In 1774, it was recommended that introducing tobacco smoke into a patient’s lungs would resuscitate a patient who had drowned.

Patients with CF have chronic respiratory infection with Pseudomonas aeruginosa and other microorganisms. Such chronic infection causes recurrent acute respiratory infections and deterioration of lung function.

drug that stimulayes a receptor for acetylcholine

if the drug has affinity but without biologic activity

Duration of effect is approx. 12 hours = maintenance therapy (esp. for nocturnal asthma) • Onset of action and peak effect are rapid than salmeterol

are lipid-soluble drugs that act on intracellular receptors.

first LABA in the US

The drug is irritating to the airway and can produce bronchospasm, especially in subjects with asthma and hyperreactive airways = less use in patients with hypersecretory states. ■ To reduce the occurrence of bronchospasm, ■ Pretreatment with an adrenergic bronchodilator, allowing adequate time for production of a bronchodilatory effect, can prevent or reduce airway resistance

typically recommended as alternatives to introducing inhaled corticosteroids in Step 2 and Step 3 asthma.

(Ventavis) inhalation is indicated for the treatment of pulmonary hypertension. ■ Adverse effects: syncope and pulmonary edema

They act as leukotriene receptor antagonists and are selective competitive antagonists of leukotriene receptors LTD4 and LTE4. Leukotrienes such as LTC4, LTD4, and LTE4 stimulate leukotriene receptors termed CysLT1 to cause bronchoconstriction, mucus secretion, vascular permeability, and plasma exudation into the airway. ■ The drug inhibits asthma reactions induced by exercise, cold air, allergens, and aspirin.

It is used for control of seasonal allergic or nonallergic rhinitis

It is indicated in the treatment of neonates (>34 weeks of gestational age) with hypoxic respiratory failure. The patient should have evidence of pulmonary hypertension in which NO would improve oxygenation and decrease the need for extracorporeal membrane oxygenation. Off-label uses include reducing pulmonary artery pressure in the neonate, pediatric patient, and adult. frequently used in cardiac surgical patients who present with perioperative pulmonary hypertension although this indication is considered off label.

long-acting adrenergic bronchodilator

defined as daily symptoms and 3 to 4 nights per month with awakening and FEV1 greater than 60% but less than 80%.

can be useful in combination with inhaled steroids to reduce the dose of the steroid and are listed as alternatives in Step 2 through Step 4 asthma.

It inhibits the 5-lipoxygenase enzyme that catalyzes the formation of leukotrienes from arachidonic acid. Omalizumab is a recombinant DNA–derived humanized antibody that binds to IgE. ■ The agent inhibits the attachment of IgE to mast cells and basophils, reducing the release of chemical mediators of the allergic response

drug that blocks receptor for norepinephrine or epinephrine

is an antiviral agent used in the treatment of severe lower respiratory tract infections caused by respiratory syncytial virus (RSV). RSV is a common seasonal respiratory infection in infants and young children that is usually self-limiting.

is a proteolytic enzyme that can break down the DNA material from neutrophils found in purulent secretions. ■ This agent is more effective than acetylcysteine in reducing the viscosity of infected sputum in CF.

An antibiotic used to treat sensitive strains of gram-negative bacilli, particularly P. aeruginosa. Available as an inhaled formulation in Europe as Promixin; this agent is not approved by the FDA for inhalation. However, nebulization of the parenteral formulation is commonly used in patients with CF.

When aerosol particles leave suspension in gas, they deposit on (attach to) a surface. Only a portion of the aerosol generated and emitted from a nebulizer (emitted dose) may be inhaled (inhaled dose). A fraction of the inhaled dose is deposited in the lungs (respirable dose)

ANy drug which has affinity and biologic activity

represent the largest group of drugs among the aerosolized agents