| Name | Class | Indications | Forms Available | Onset/Duration | Typical Dose | Actions | Side effects/Toxicity |
| Albuterol(Proventil, Ventolin, Volmax) | Selective β2-agonist | Asthma/Bronchospasm, COPD | MDI (90
µg/actuation) DPI (200 µg/actuation) Nebulized (0.083%, 0.5%) PO (2-,4-,8-mg tablets, 2-mg/5mL syrup) |
5 minutes (inhaled), 30 minutes (oral)/4 to 6 hours | Outpatient MDI use: 2 puffs q4h prn Outpatient nebulizer use: 2.5 mg in 2 mL saline q4h prn Intubated patients: 4 to 8 puffs q1-4 h Emergency Treatment: 2 to 4 puffs q15 min, or continuous nebulized Oral maintenance: 4 mg PO tid |
Tachycardia, palpitations, hypokalemia, lactic acidosis | |
| Aminophylline(Phyllocontin, Truphylline) | Methylxanthine | Asthma or other obstructive lung disease exacerbation, respiratory muscle weakness | PO (100-, 200-mg tablets; 225-mg sustained release,
105 mg/5mL elixir) Rectal (250,500 mg; 300-mg/5mL liquid) IV |
Minutes (IV)/approx.6 hours | Emergency treatment: Load 6 mg/kg, then 0.5 -1.2
mg/kg/h infusion IV Maintenance adult: 400 mg PO daily, divided tid-qid Maintenance child: 16 mg/kg daily, divided tid-qid |
Tachycardia and palpitations, nausea, agitation and seizures | |
| Amphotericin B (Liposomal preparations Amphotec and AmBisome) | Antifungal antibiotic | Prevention and treatment of invasive pulmonary aspergillosis in immunocompromised patients | Nebulized IV |
N/A | 0.1 mg/kg/d, or 3 mL of 10-mg/mL solution or 10 mg by nebulizer bid | Bronchospasm; potential for nephrotoxicity and ototoxicity | |
| Aspirin | Nonsteroidal antiinflammatory drug (NSAID) | Diverse inflammatory processes, pain, fever, thrombotic syndromes | Oral (81-,325-,500-,650-,975-mg tablet) Rectal (120-,200-,300-,600--mg suppository) |
Duration:6 hours | MI and stroke prevention: 81 to 325 mg PO qd Antiinflammatory/analgesic: 650 PO q6h |
Peptic ulcer disease, increased bleeding, bronchospasm, nephropathy, tinnitus, nausea | |
| Atropine | Anticholinergic | Reduction of excessive secretions, especially before procedures such as bronchoscopy and intubation | Oral (0.4, 0.6 mg) IV, IM |
5 minutes/1 to 2 hours | 0.4 to 0.6 mg PO/IV/IM q2h prn | Dry mouth, blurred vision, mydriasis, urinary retention, confusion | |
| Beclomethasone Diproprionate )Beclovent, Vanceril, Beconase, Vancenase) | Inhaled corticosteroid | Asthma and COPD maintenance therapy, rhinitis, sinusitis | MDI (42
µg/ actuation) Nasal (42 µg/actuation) |
Duration: ~8 hours | 2 to 3 puffs tid-qid (age > 12) 1 to 2 puffs tid-qid (children ages 6 to 12 |
Hoarseness, thrush, sore throat, possible growth retardation | |
| Beractant (Survanta) | Surfactant replacement | Treatment of neonatal respiratory distress syndrome (RDS), prophylaxis of RDS in neonates weighing less than 1250 g | Intratracheal liquid instillation (25 mg phospholipid/mL) | Minutes/12 hours | 4 mL/kg; repeat doses q6h prn | Reduces surface tension | Mucous plugging, transient decrease in PaO2 and hemodynamic instability |
| Budesonide (Pulmicort, Rhinocort) | Inhaled corticosteroid | Asthma and COPD maintenance
therapy, rhinitis, sinusitis
|
DPI (200
µg/actuation) Nasal (32 µg/actuation) |
Duration:~12 hours | 1 to 4 puffs bid | Hoarseness, thrush, sore throat, possible growth retardation | |
| Budesonide/Formoterol (Symbicort) | Long acting
selective β2-agonist
with inhaled corticosteroid
|
Asthma, COPD | Budesonide 80
µg
and formoterol 4.5
µg/actuation Budesonide 160 µg and formoterol 4.5 µg/actuation
|
15 minutes/~12 hours | 2 puffs bid | ||
| Colfosceril Palmitate, Cetyl Alcohol, Tyloxapol (Exosurf) | Surfactant replacement
|
Treatment of neonatal
respiratory distress syndrome (RDS), prophylaxis of RDS
in neonates weighing less than 1350 g
|
Intratracheal liquid
instillation (13.5 mg/mL when reconstituted)
|
Minutes/12 hours
|
5 mL/kg q12h, three doses | Reduces surface tension
|
Pulmonary hemorrhage, mucous plugging, transient decrease in PaO2 |
| Colistimethate (Colistin, Coly-Mycin) | Polypeptide antibiotic | Gram-negative pneumonia, especially Pseudomonas species | Nebulized (75 mg/mL) IV |
N/A | 150 mg by nebulizer bid | Binds phospholipids, dirupting bacterial cell membranes | Nephrotoxicity, neurotoxicity including neuromuscular blockade |
| Cromolyn Sodium (Intal, Nasalcrom) | Cromone | Asthma, allergic rhinitis,
conjunctivitis, mastocytosis
|
MDI (800
µg/actuation) DPI (20 mg/actuation) Nebulized (20 mg/2 mL) Nasal (5.2 mg/actuation) Oral (100 mg) Ophthalmic
|
10 minutes/2 to 6 hours | MDI: 2 puffs qid DPI: 20 mg qid Nebulized: 20 mg qid |
Mast cell stabilization | Bronchospasm, arthralgia, angioedema, eosinophilic pneumonia, pulmonary infiltrates, mucosal irritation |
| Dexamethasone (Decadron, Dexacort) | Systemic (or inhaled) corticosteroid | Multiple | MDI (dexamethasone sodium phosphate, 100
µg/actuation) Nasal (dexamethasone sodium phosphate, 100 µg/actuation) PO (0.25-,0.5-,0.75-,1-,1.5-,2-,4-,6-mg tablets; 0.5 mg/mL elixir and solution; 0.5-mg/0.5-mL solution) IV, Topical, ophthalmic |
Duration: more than 48 hours | Systemic: varies Inhaled maintenance therapy: 3 puffs tid-qid |
Multiple | |
| Dornase Alfa (DNAase, Pulmozyme) | Enzyme/secretion thinner | CF and other conditions with thick purulent secretions | Nebulized (1 mg/mL) | 15 minutes/2 hours | 2.5 mg qd-bid | Digests DNA in purulent secretions | Tachycardia and palpitations, nausea, agitation, and seizures |
| Ephedrine | Nonselective adrenergic agonist | Asthma/bronchospasm | Nasal (0.25% spray, 0.5% drops, 1% jelly) PO (25, 50 mg) SC/IM/IV (25, 50 mg/mL) |
15 minutes/4 hours | Maintenance bronchodilator: 25 to 50 mg PO q4h prn Severe bronchospasm: 12.5 to 25 mg SC, IM, or IV |
Tachycardia, palpitations, cardiac ischemia, hypertension, tremor | |
| Flunisolide (AeroBid, Nasalide) | Low-potency inhaled corticosteroid | Asthma and COPD maintenance therapy, rhinitis, sinusitis | MDI (250
µg/actuation) Nasal (25 µg/actuation) |
Duration:~12 hours | 2 to 4 puffs bid | Hoarseness, thrush, sore throat, possible growth retardation | |
| Fluticasone (Flovent, Flonase) | High-potency inhaled corticosteroid | Asthma and COPD maintenance
therapy, rhinitis, sinusitis
|
MDI (44, 110,220
µg/actuation) DPI (50, 110, 250 µg/actuation) Nasal (50 µg/actuation) Topical
|
Duration: ~12 hours | MDI: 220-880 ug (1 to 4 puffs) bid DPI: 100-500 ug (1 to 2 doses) bid Nasal: 1 spray per nostril bid |
Hoarseness, thrush, sore
throat, possible growth retardation
|
|
| Fluticasone/Salmeterol (Advair) | Long acting
selective β2-agonist
with inhaled corticosteroid
|
Asthma, COPD | Advair Diskus 100/50, Advair Diskus 250/50, and Advair Diskus 500/50 | Duration: ~12 hours | 1 puff bid | ||
| Formoterol (Foradil) | Long acting
selective β2-agonist
|
Asthma, COPD | Aerolizer (12µg capsule) | ~12 hours | Aerolizer: 1 capsule bid | Tachycardia,
palpitations (less than short-acting agents), paradoxic
bronchospasm
|
|
| Glycopyrrolate (Robinul) | Anticholinergic | Reduction of excessive
secretions, especially before procedures such as
bronchoscopy and intubation
|
Oral (1, 2 mg) IV, IM |
5 minutes/1 to 2 hours | Oral: 1 to 2 mg q4-6h IV/IM: 0.1 to 0.2 mg prn |
Reduces secretion of the liquid component of mucous | Dry mouth, blurred vision, urinary retention, confusion |
| Heparin | Anticoagulant | Prophylaxis and treatment of deep venous thrombosis and pulmonary embolism | IV, SC | Minutes/~2 hours | DVT prophylaxis: 5000 units SC q12h | Activates antithrombin III | Excessive bleeding and bruising, contraindicated in active hemorrhage, recent intracranial hemorrhage, active pericarditis |
| Hydrocortisone (A-HydroCort, Cortef, Hydrocortone, Solu-Cortef, Cortisol) | Systemic corticosteroid | Multiple | PO (5, 10, 20 mg; 10-mg/5-mL suspension) Rectal (10% foam = 90 mg/application; 100 mg/60mL) IV |
Duration:~8 hours | Adrenal insufficiency: 100 mg IV q6h Asthma/COPD exacerbation: 100 to 200 mg PO/IV q6h Pediatric: 1 mg/kg PO bid |
Multiple | |
| Ibuprofen (Advil, Motrin, Nuprin, Rufen) | Nonsteroidal antiinflammatory drug (NSAID) | Diverse inflammatory processes; pain; fever | Oral (200-,800-mg tablet) Rectal (120-,200-,300-,600-mg suppository) |
Duration:~6 hours | Antiinflammatory/analgesic: 600 PO q4-6h | Peptic ulcer, increased bleeding, bronchospasm, nephropathy, nausea | |
| Indomethacin (Indameth, Indocin) | Nonsteroidal antiinflammatory drug (NSAID)
|
Diverse inflammatory processes; pain; fever
|
Oral (25-, 50-mg tablet, 25 mg/5 mL
suspension) Rectal (50 mg suppository) IV |
Duration:~6 hours | Antiinflammatory/analgesic:
50 PO q6h
|
Peptic ulcer, increased bleeding, bronchospasm,
nephropathy, nausea
|
|
| Infrasurf | Surfactant replacement | Treatment of neonatal
respiratory distress syndrome (RDS), prophylaxis of RDS
in neonates weighing less than 1250 g
|
Intratracheal liquid installation | Minutes/12 hours | 3 mL/kg q12h | Reduces surface tension | Mucous plugging, transient decrease in PaO2 and
hemodynamic instability
|
| Ipratropium (Atrovent) | Anticholinergic bronchodilator | COPD, asthma, and other obstructive lung diseases; rhinorrhea | MDI (18
µg/actuation) Nebulized (0.02%) Nasal Spray (0.03%, 0.06%) |
1 minute/6 hours | MDI: 2 puffs q6h prn Nebulized: 2.5 mL (0.5 mg) q6h prn Nasal: 2 sprays per nostril q6h prn |
Palpitations, dry mouth, blurred vision, acute exacerbation of narrow-angle glaucoma, urinary retention | |
| Isoproterenol (Isuprel) | β-Adrenergic agonist | Asthma/bronchospasm | MDI (80, 120, 131
µg/actuation) Nebulized (0.25%, 0.5%, 1%) Sublingual (10, 15 mg) IV (200 µg/mL) |
2 minutes/2 hours | MDI: 1 to 2 puffs q4h prn Nebulized: 2 mL of 0.25% solution in 2-mL saline q4h prn Sublingual: 10 to 20 mg PO qd IV: 0.01 to 0.02 mg IV q2h prn |
Tachycardia, palpitations, tremor, hypo- or hypertension, flushing | |
| Ketorolac (Toradol) | Nonsteroidal antiinflammatory drug (NSAID)
|
Diverse inflammatory processes; pain; fever
|
Oral (10-mg tablet) IV, IM |
30 minutes/6 hours | Antiinflammatory/analgesic:
60 mg IM May repeat q6h x 1
|
Peptic ulcer, increased bleeding, bronchospasm,
nephropathy, nausea
|
|
| Levalbuterol (Xopenex) | Selective β2-agonist | Asthma/bronchospasm, COPD, especially in patients bothered by side effects of racemic albuterol | Nebulized (0.625- and 1.25-mg unit doses) | 5 minutes/6 hours | 0.625 to 1.25 mg q4h prn | Tachycardia, palpitations, tremor | |
| Lidocaine | Topical anesthetic | Cough, before bronchoscopy | Nebulized Intratracheal instillation |
10 seconds/30 minutes | Nebulized: 2 mL of 4% solution Intratracheal instillation: 2 mL of 1% solution |
Local anesthesia | Cardiac arrhythmia, decreased level of consciousness, increased risk of aspiration |
| Metaproterenol (Alupent, Metaprel) | β-adrenergic agonist (some β2-selectivity | Asthma/bronchospasm, COPD | MDI (650
µg/actuation) Nebulized (0.4%, 0.6%, 5%) PO (10-, 20-mg tablets, 10-mg/5mL syrup) |
5 to 30 minutes/4 hours | MDI: 2 to 3 puffs q3-4 h prn Nebulized: 2.5 mL of 0.6% solution q6h prn Oral, adult: 20 mg q6h prn Oral, children >27 kg: 10 mL q6h prn Oral, children <27 kg: 5 mL q6h prn |
Tachycardia, palpitations, cardiac ischemia, tremor | |
| Methylprednisolone (Medrol, Solu-Medrol) | Systemic corticosteroid | Multiple | PO (2-, 4-,8-,16-,24-,32-mg) IV (injection and slowly absorbed suspension) |
Duration: 12 to 24 hours | Asthma or COPD exacerbation: 125 mg
IV, then 60 mg q6h Pediatric: 1 to 2 mg/kg/day IV q6h Systemic: varies |
Multiple | |
| Montelukast (Singulair) | Leukotriene synthesis inhibitor | Asthma, allergic rhinitis | PO (5-mg chewable, 10-mg tablet) | 3 hours/24 hours | 10 mg qd (adults) 5 mg qd (children) |
Churg-Strauss syndrome? | |
| N-acetylcysteine (Mucomyst, Mucosil, NAC) | Secretion thinner | Cystic fibrosis and other conditions with thick secretions, acetaminophen overdose | Nebulized or oral solution (10%, 20%) | 5 minutes/1 to 2 hours | 3 to 10 mL of 20 % solution tid-qid | Cleaves disulfide bonds in mucous | Bronchospasm (usually administered with a bronchodilator), rhinitis, nausea, mild elevation in liver enzymes with oral administration |
| Nedocromil (Tilade) | Cromone | Asthma, allergic rhinitis | MDI (1.75 mg/actuation) | 30 minutes/6 to 12 hours | 2 puffs qid, then reduce to bid as tolerated | Mast cell stabilization | Bronchospasm, eosinophilic pneumonia |
| Pentamidine (NebuPent) | Antibiotic | Prophylaxis against (nebulized) or treatment of (IV) PCP in sulfa-allergic patients | Nebulized IV |
N/A | PCP prophylaxis: 300 mg in 5 mL
saline, nebulized monthly PCP treatment: 4 mg/kg IV qd |
Unknown | Cough, bronchospasm |
| Pirbuterol (Maxair) | Selective β2-agonist | Bronchospasm/asthma, COPD | MDI (200 µg/actuation) | 5 minutes/5 hours | 1 to 2 puffs q4h prn | Tachycardia, palpitations, tremor | |
| Prednisolone (Delta-Cortef, Hydeltrasol, Prelone, Pedipred, Predicort) | Systemic corticosteroid | Multiple | PO (5-mg tablet; 15-mg/5mL, 5-mg/5-mL
liquid) Ophthalmic |
12 to 24 hours | Varies | Multiple | |
| Prednisone (Deltasone, Meticorten, Orasone, Sterapred) | Systemic corticosteroid | Multiple | PO (1, 2.5, 5, 10, 20, 25, 50 mg;
5-mg/1mL solution) IV |
12 to 24 hours | Varies | Multiple | |
| Racemic Epinephrine (Adrenalin, AsthmaHaler, AsthmaNefrin, Bronkaid, Epinal, Primatene Mist, Vaponephrine) | Nonselective adrenergic agonist | Anaphylaxis; asthma/bronchospasm; upper airway edema and laryngospasm | MDI (160, 200, 250
µg/actuation) Nebulized (1%, 1.25%, 2.25% solution) SC (1:1000) IV (1:10,000 and 1:100,000) |
1 minute/1 hour | MDI: 1 puff q4h prn Nebulized: 0.5 mL of 2.25% solution in 2 mL saline, q6h prn Anaphylaxis: 0.4 mg SC |
Bronchodilation; blocks histamine release by mast cells; vasoconstriction | Tachycardia, palpitations, cardiac ischemia, hypertension, tremor |
| Ribavirin (Virazole) | Antiviral | RSV and severe influenza infection | Nebulized | 60 minutes/7 hours (children) to 24 hours (adults) | 6 g in 300 mL saline, continuous nebulization 18/24 hr for 3 to 7 days | Unknown | Bronchospasm, pulmonary edema, hypoxia, hypotension, cardiac arrhythmia (drug contraindicated in pregnancy; should be used with extreme caution with mechanical ventilators. |
| Salmeterol (Serevent) | Long acting selective β2-agonist | Maintenance therapy of asthma, COPD and other obstructive diseases; especially useful in preventing overnight exacerbation | MDI (25
µg/actuation) DPI (50 µg/actuation) |
10 minutes/12 hours | MDI: 2 to 4 puffs bid DPI: 1 inhalation bid |
Tachycardia, palpitations (less than short-acting agents), paradoxic bronchospasm | |
| Terbutaline (Brethine, Bricanyl, Brethaire) | Selective β2-agonist | Asthma/bronchospasm | MDI (200
µg/actuation) PO (2.5, 5 mg) IV (1 mg/mL) |
5 to 30 minutes/4 hours | Emergency nebulized treatment: 1 mg
in 2 mL saline q4h prn Emergency parenteral treatment: 0.25 to 0.5 mg SC or IV q4h prn Inhaled maintenance therapy: 2 puffs q4-6h prn Oral maintenance therapy: 5 to 15 mg PO tid |
Tachycardia, palpitations, tremor, paradoxic bronchospasm | |
| Tiotropium Bromide (Spiriva) | Long-acting anticholinergic | Maintenance treatment of bronchospasm associated with chronic obstructive pulmonary disease (COPD), including chronic bronchitis, emphysema, or both | Handihaler (18µg capsules) | 24 hours | Once daily | Dry mouth, constipation, increased
heart rate, blurred vision, glaucoma, urinary
difficulty, and urinary retention.
Contraindicated in patients with a history of hypersensitivity to atropine or its derivatives, including ipratropium, or to any component of this product.
|
|
| Theophylline | Methylxanthine | Asthma, especially for nocturnal symptoms and in children; COPD and respiratory muscle weakness | PO (100-,200-mg capsules; 100-, 125-,
200-, 250-, 300-mg tablet; 50-, 60-, 65-, 75-, 100-,
125-, 130-, 200-, 250-, 260-, 300-, 400-, 450-, 500-,mg
extended release; 50-mg/5-mL, 80-mg/15-mL elixir;
50-mg/5mL, 80-, 150-mg/15 mL syrup) IV |
30 minutes/ varies widely | Maintenance therapy: 13 to 24
mg/kg/day, divided q6-8h Emergency treatment: Load 4.7 mg/kg, then 0.24 to 0.55 mg/kg/h infusion IV |
Tachycardia and palpitations, nausea, agitation and seizures | |
| Thrombin | Coagulant | Hemorrhage | Topical | seconds/hours | 1 mL reconstituted | Converts fibrinogen to fibrin clot | Large clot formation may cause airway obstruction |
| Tobramycin (TOBI) | Aminoglycoside antibiotic | Patients with cystic fibrosis, and possibly other forms of bronchiectasis, colonized with Pseudomonas species | Nebulized (300 mg/5 mL unit dose) IV Ophthalmic |
Hours/Weeks | 300 mg bid x 28 days, then off x 28 days | Interferes with bacterial protein translation; reduces pulmonary levels of Pseudomonas species and other gram-negative bacteria | Ototoxicity, nephrotoxicity |
| Triamcinolone Acetonide (Azmacort) | Inhaled corticosteroid | Asthma and COPD maintenance (and rarely, exacerbation) therapy; rhinitis, sinusitis | MDI (100
µg/actuation) Nasal (55 µg/actuation) Oral (1-, 2-, 4-, 8-mg tablets; 2-mg/mL, 4-mg/mL suspension) IV |
~8 hours | MDI: 2 to 4 puffs tid-qid, tapered to
bid as tolerated Pediatric MDI: 1 to 2 puffs tid-qid, tapered to bid as tolerated Systemic: varies |
Hoarseness, thrush, sore
throat, possible growth retardation
|
|
| Warfarin (Coumadin) | Anticoagulant | Prophylaxis and treatment of deep venous thrombosis and pulmonary embolism | PO | 2 to 3 days/approx. 1 week | 2 to 8 mg PO qd | Inhibits production of vitamin K-dependent factors V, VII, IX, X | Excessive bleeding and bruising; contraindicated in active hemorrhage, recent intracranial hemorrhage, active pericarditis |
| Zafirlukast (Accolate) | Leukotriene receptor antagonist | Asthma, allergic rhinitis | PO (20-mg tablet) | 3 hours/12 hours | 20 mg PO bid | Churg-Strauss syndrome? | |
| Zileuton (Zyflo) | 5-Lipoxygenase inhibitor | Asthma, allergic rhinitis | PO (600 mg) | 1.5 hours/6 hours | 600 mg PO qid | Hepatotoxicity |