Airway pharmacology refers to the deliverance of aerosol medications to the respiratory tract of the lungs. As a Respiratory Therapist, this is important for the treatment and diagnosis of certain pulmonary diseases.
We created this study guide to help you develop a better understanding of the types of drugs that are commonly administered in the field of respiratory care. We included practice questions for your benefit as well. So, if you’re ready, let’s get into it.
Types of Orally Inhaled Aerosol Drug Classes:
Here is a list of the most common types of aerosolized drugs that are administered in respiratory care:
- β-agonist bronchodilators
- Anticholinergic (anti-muscarinic) bronchodilators
- Mucolytic agents
- Nonsteroidal anti-asthma drugs
- Anti-infective agents
- Inhaled pulmonary vasodilators
We have covered each drug class individually in more detail in separate study guides. You can click the links above to learn more about each individual class of medication.
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Airway Pharmacology Practice Questions:
1. What are the adverse effects of Inhaled Corticosteroids?
The Systemic adverse effects are: Adrenal Insufficiency, Extrapulmonary Allergy, Acute Asthma, HPA Suppression, Growth Retardation, and Osteoporosis. The Local adverse effects are: Oropharyngeal Fungal Infections, Dysphonia, Cough, and Bronchoconstriction.
2. What are common Inhaled Corticosteroids brand names?
Azmacort, Flovent, Pulmicort, Advair (Flovent and Serevent), and Symbicort.
3. What are side effects of the types of Non-Steroidal Antiasthma drugs?
Cromolyn-like: None. Antileukotrienes: Headache, Dyspepsia, Liver Enzyme elevation. Monoclonal Antibodies: Injection site reaction, Viral infections.
4. What are some adverse effects of using adrenergic bronchodilators?
CFC induced bronchospasm, Dizziness, Hypokalemia (Hypopotassemia), Loss of bronchoprotection, Nausea, Tolerance (Tachyphylaxis), Worsening ventilation/perfusion ratio (decrease in PaO2), Inhalation gives fewer and less sever effects than oral administration.
5. What are some common side effects of using adrenergic bronchodilators?
Tremor, Headache, Insomnia, and Nervousness.
6. What are the adverse effects of Spiriva and Atrovent?
Almost none as they are fully ionized.
7. What are the currently available Inhaled Anti-infective agents?
Pentamidine Isethionate (Nebupent), Ribavirin (Virazole), Tobramycin (TOBI), and Zanamivir (Relenza).
8. What are the four advantages of using inhaled aerosols?
(1) Aerosol doses are smaller than systemic doses. (2) Onset of drug action is rapid. (3) Delivery is targeted to the organ requiring treatment. (4) Systemic effects are often fewer and less severe.
9. What are the indications for Dornase Alfa?
It is used in cases of Cystic Fibrosis to reduce the frequency of infections and to improve the pulmonary function of these patients.
10. What are the indications for Inhaled Corticosteroids?
They are used for the anti-inflammatory maintenance of asthma and severe COPD. Intranasal use is for control of seasonal rhinitis. Patients need to be informed that the drugs will not provide immediate relief and could take days for full effect.
11. What are the indications for Long-Acting (maintenance) agents?
They are used for the maintenance of bronchodilation, control of bronchospasm, and nocturnal symptoms in asthma or other obstructive diseases, such as COPD.
12. What are the indications for Non-Steroidal Anti-asthma drugs?
They are used to manage mild to severe persistent asthma and as an alternative to steroidal treatments. No benefit for acute airway obstruction with asthma.
13. What are the indications for Racemic Epinephrine?
It is recommended for strong α-adrenergic vasoconstriction effects and is used after extubation, during epiglottitis, croup, or bronchiolitis; or to control airway bleeding during endoscopy.
14. What are the indications for Short-Acting (rescue) agents?
They are used for immediate relief of acute reversible airflow obstruction caused by asthma or other obstructive airway diseases.
15. What are the indications for using anticholinergic drugs?
They are used for effective maintenance of COPD but less in asthma.
16. What are the indications for using combined anticholinergic and β-agonist bronchodilator drugs?
They are used for COPD patients that require more bronchodilation for relief of airflow obstruction. Also in severe asthma that does not respond well to β-agonist therapy.
17. What are the most common devices used to administer respiratory drugs?
MDI (Metered Dose Inhaler), SVN (Small Volume Nebulizer), and DPI (Dry Powder Inhaler).
18. What are the three phases of drug action?
Drug Administration, Pharmacokinetic, and Pharmacodynamic.
19. What are the three types of Non-Steroidal Antiasthma drugs?
Cromolyn-like agents (Cromolyn Sodium, Nedocromil Sodium), AntiLeukotrienes (Zarfirlukast, Zileuton), Monoclonal Antibodies or Anti-IgE agents (Omalizumab).
20. What are the two inhaled vasodilators?
(1) Nitric Oxide (INOmax): Used in treatment of neonates with hypoxic respiratory failure can cause hypotension, and (2) Iloprost (Ventavis): Used in the treatment of pulmonary hypertension by dilating the pulmonary vasculature.
This book (in paperback format) has sample TMC Practice Questions on the topic of Pharmacology.
21. What does an α-receptor stimulate?
It causes vasoconstriction and a vasopressor effect (increased blood pressure).
22. What does a β1-receptor stimulate?
Increased heart rate and myocardial contractility.
23. What does a β2-receptor stimulate?
Relaxes bronchial smooth muscle, stimulates mucociliary activity, and has some inhibitory action on inflammatory mediator release.
24. What is a fully ionized drug and an example of one in the respiratory setting?
A fully ionized drug is not absorbed across a lipid membrane (not fat-soluble). Ipratropium (Atrovent) is a fully ionized drug.
25. What is a Muscarinic drug?
A drug that stimulates that ACh receptors specifically at the parasympathetic nerve-ending sites.
26. What is the difference between an Agonist and Antagonist?
Agonists are the stimulating agents. Antagonists are the blocking agents.
27.What is an isomer?
Isomers are compounds with the same molecular formula but different structural formulas compare the structures of albuterol and levalbuterol.
28. What is another term for the sympathetic receptors and parasympathetic receptors and why are they named so?
Sympathetic = Adrenergic (Adrenalin), Parasympathetic = Cholinergic (Acetylcholine).
29. What is a prodrug?
It is a drug that is not active until it is metabolized.
30. What is Combivent?
Ipratropium Bromide and Albuterol.
31. What is DuoNeb and its proper dose?
Ipratropium Bromide 0.5 mg and Albuterol 2.5 mg administered with an SVN.
32. What is Exubera?
The only inhaled human insulin currently available. Patients should not use if they are smokers or stopped smoking within the past 6 months and if they have uncontrolled lung problems. If the disease is controlled they should take all other inhaled medications before using the inhaled insulin.
33. What is the brand name for Acetylcysteine (NAC)?
34. What is the brand name for Dornase Alfa?
35. What is the brand name for Ipratropium Bromide?
36. What is the brand name for Tiotropium Bromide?
37. What is the drug administration phase?
Describes the method by which a drug dose is made available to the body.
38. What is the mode of action for Cromolyn Sodium?
Inhibits degranulation of mast cells which prevents the release of histamine and other mediators of inflammation.
39. What is the Mode of Action for Inhaled Corticosteroids?
Lipid soluble drugs that act on intracellular receptors, full effect requires hours to days, will not provide instant relief.
40. What is the pharmacodynamic phase?
Describes the mechanism by which a drug molecule causes its effects.
41. What is the pharmacokinetic phase?
Describes the Time, Course, and Disposition of a drug in the body. Based on ADME (Absorption, Distribution, Metabolism, and Elimination).
42. What should the patient know about Inhaled Corticosteroids?
They are not for use as a rescue drug.
43. Why do you always need to add Albuterol to Mucomyst?
Mucomyst can cause bronchospasm, so a bronchodilator is needed.
44. What is the most common route of drug administration to a pulmonary patient?
45. What are the three most common devices used to administer inhaled aerosols?
MDI (metered-dose inhaler), SVN (small volume nebulizer), DPI (dry-powder inhaler).
46. What are the ADVANTAGES of inhaled aerosols?
You can use smaller doses (as compared to the systemic route), onset of drug is rapid, delivery is targeted to specific organ needing treatment, less systemic side effects.
47. What are the DISADVANTAGES of inhaled aerosols?
The number of variables affecting the delivered dose AND lack of knowledge of device performance by patients and caregivers.
48. Inhaled bronchoactive aerosols are intended for local effects in the airway; undesired systemic effects result from what?
Absorption and distribution throughout the body.
49. What is the difference between a fully ionized aerosol drug and a non-ionized aerosol drug?
A fully ionized drug has little or NO systemic side effects (it is not absorbed across lipid membranes) whereas a non-ionized drug produces systemic side effects (it is lipid soluble and diffuses across cell membranes and into bloodstream).
50. What is an example of a fully ionized aerosol drug?
51. What is an example a non-ionized aerosol drug?
52. What is the L/T ratio?
Lung availability/total systemic availability; quantifies efficiency of aerosol drug to lung; L/T ratio=Lung availability/(Lung + GI Availability).
53. Using the L/T ratio, which aerosol delivery method is more efficient?
MDI (46%) works a little better than DPI (23%).
54. What is the pharmacodynamic phase?
Describes the mechanism of action by which a drug molecule causes its effects in the body.
55. What are drug effects caused by?
The combination of a drug with a matching receptor.
56. What is the usual neurotransmitter in the parasympathetic system?
57. Adrenergic directly dilates what?
The bronchial tree; anti-adrenergic blocks receptors for epinephrine.
58. Cholinergic causes what?
Bronchoconstriction; Don’t want that, so you need and anti-cholinergic drug that BLOCKS the constriction.
59. What are the indications for Adrenergic short-acting agents?
They are rescue drugs that are good for about 4 hours; they are used for the relief of acute obstructive airflow obstruction and some examples include albuterol and levalbuterol.
60. What are the indications for Adrenergic long-acting agents?
They are drugs that will last 12 hours (bid), in MDIs and DPI; some examples include salmeterol, formoterol, and arformoterol. They are used for maintenance of bronchodilation with obstructive lung disease.
61. What is the most common use of adrenergic bronchodilators?
To improve the flow rates in asthma and exercise induced asthma, acute and chronic bronchitis, emphysema, bronchiectasis, cystic fibrosis and other obstructive airway states.
62. What is alpa-receptor stimulation?
It causes vasoconstriction and a vasopressor effect (increased blood pressure).
63. What is beta-1-receptor stimulation?
It causes increased heart rate and myocardial contractility.
64. What is beta-2-receptor stimulation?
It relaxes bronchial smooth muscle, stimulates mucociliary activity, and has some inhibitory action on inflammatory mediator release.
65. Why would you choose Xopenex over Albuterol?
When patient comes in with a high heart rate.
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66. What is the main side effect of beta-2 selective agents?
67. What are the potential adverse effects with use of adrenergic bronchodilators?
Dizziness, hypokalemia, worsening ventilation/perfusion ratio (decrease in PaO2/SpO2).
68. What are the specific actions suggested to evaluate patient response to bronchodilator therapy?
Pre and post bronchodilator studies, ABG or pulse oximetry, blood glucose and potassium (if available), and blood pressure.
69. What are the two inhaled anticholinergic bronchodilators?
Ipratropium and tiotropium (both used for COPD).
70. What is combined anticholinergic and beta-agonist indicated for?
Ipratropium bromide and albuterol (DuoNeb) is indicated for patients with COPD or asthma.
71. What is the mode of action of anticholinergic bronchodilators?
Act as competitive antagonists for acetylcholine on airway smooth muscle.
72. What are the adverse effects of anticholinergic bronchodilators?
Atrovent produces side effects and eyes can accidentally be sprayed by MDI or nebulizer mask.
73. What are the side effects seen with anticholinergic aerosol agents?
Cough and dry mouth.
74. What are the two mucus-controlling agents?
N-acetylcysteine (MucoMyst) and Dornase alfa.
75. How is N-acetylcysteine given to the patient?
Either by nebulization or by direct tracheal installation.
76. How does N-acetylcysteine work?
It breaks down disulfide bonds of the mucus, thinning it, so patient can cough it out themselves.
77. What can N-acetylcysteine cause?
It can cause bronchospasm due to irritating side effects. This is the reason why you never give it without a bronchodilator like Albuterol.
78. What patients get treated with Dornase alfa?
Patients with Cystic Fibrosis.
79. What is the mode of action of Dornase alfa?
It breaks down protein bonds (DNA) and thins it.
80. What is the other name for Dornase alfa?
81. Inhaled corticosteroids will help reduce swelling if it is inflammatory, but it won’t help if it’s what?
82. What is the mode of action of inhaled corticosteroids?
They act on intracellular receptors.
83. What are the three types of drugs that prevent asthma from happening?
(1) Cromolyn sodium, (2) Antileukotrienes, and (3) Monoclonal antibodies or anti-IgE agents.
84. What are the indications for use of nonsteroidal antiasthma drugs?
Prophylactic management of asthma; they offer no benefit for acute airway obstruction in asthma.
85. What is Pentamindine isethionate?
It treats pneumonia caused by pneumocystis jiroveci which is seen in patients with AIDS.
86. What is Ribavirin?
It treats respiratory syncytial virus using a SPAG generator.
87. What is inhaled tobramycin?
It is used to fight pseudomonas aeruginosa in patients with cystic fibrosis.
88. What is inhaled zanamivir ?
It treats influenza A (Tamiflu).
89. What is nitric oxide used for?
It is used for the treatment of pulmonary hypertension.
90. The acting length on bronchodilators refers to what?
How long the drug lasts. For example, bronchodilators typically start working instantaneously.
91. How is Mucomyst administered?
It is given by aerosol or direct tracheal instillation to reduce accumulation of airway mucus via breaking the disulfide bonds of mucus DNA.
92. If you are going to administer a bronchodilator, what would you do?
Test the patient with a peak flow meter before and after administration of breathing treatments to ensure/document that the treatment was effective.
93. In general what are common side effects to Adrenergic Bronchodilators?
Dizziness, hypokalemia, nausea and tolerance to the drug.
94. In regards to aerosol inhalers, what is a solution to the problem propellant dangers?
95. What are 3 subgroups of Adrenergic Bronchodilators?
(1) Ultra-short catecholamine agents, (2) Short-acting non-catecholamine agents, and (3) Long-acting adrenergic bronchodilators.
96. What is the risk of administering a bronchodilator?
Increased heart rate. If it increased more than 20 bpm, stop the treatment and notify the physician.
97. What is the speed of onset for inhaled aerosols?
It is rapid. Peak onset is about 15 minutes.
98. What side effects do fully ionized aerosol drugs have?
Little or no systemic side effects.
99. Why would you use a long acting Adrenergic Bronchodilator?
For maintenance bronchodilation in patients with obstructive lung diseases.
100. Why would you use a short acting (rescue) Adrenergic Bronchodilators?
For the relief of acute reversible airway obstruction.
It goes without saying every Respiratory Therapist and student must learn and understand the different classes of inhaled aerosol medications. Otherwise, how would it be possible to treat and provide care for patients with a pulmonary condition?
This is why the topic of airway pharmacology is so important. Hopefully, the information in this study guide can make the learning process easier for you.
We have a similar guide on Aerosol Drug Therapy as well that I think you will enjoy. Thanks again for reading and, as always, breathe easy my friend.
- Faarc, Kacmarek Robert PhD Rrt, et al. Egan’s Fundamentals of Respiratory Care. 12th ed., Mosby, 2020. [Link]
- Faarc, Gardenhire Douglas EdD Rrt-Nps. Rau’s Respiratory Care Pharmacology. 10th ed., Mosby, 2019. [Link]
- “Airway Pharmacology: Treatment Options and Algorithms to Treat Patients with Chronic Obstructive Pulmonary Disease.” National Center for Biotechnology Information, U.S. National Library of Medicine, 11 Oct. 2019, www.ncbi.nlm.nih.gov/pmc/articles/PMC6831916.
- Caramori, Gaetano. “Pharmacology of Airway Inflammation in Asthma and COPD.” PubMed, 2003, pubmed.ncbi.nlm.nih.gov/12877818.
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