Main Categories of Respiratory Pharmacology – Part 2

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Here at SimpleNursing.com, we will be going over the respiratory drugs and the two main categories that you need to remember.

We have categorized these respiratory medications to make it easier for you to recall and identify which drugs have to be used for a particular respiratory condition, namely:

  • Bronchodilator Team
  • Anti-inflammatory Team

How do these categories act and alleviate respiratory ailments? What are the goals of your respiratory drugs? One main condition that can happen to a person’s respiratory system is increased constriction which causes inadequate oxygen exchange within the distal portions of the lung alveoli.

But before thoroughly discussing the drug categories, let’s do a bit of anatomy and physiology of the lungs.

Quick Anatomy and Physiology

Think of your lungs as an inverted tree with a stump and some branches. At the end of those branches are even smaller branches that bear apples. To apply this thought, the lungs, as your tree, have a tree stump and that stump is broken off into two bronchioles. At the distal portions of the lungs, are the alveoli (apples) – this is the area where oxygen and carbon dioxide exchange occurs.

What Can Go Wrong

What are the things that can go wrong with your lungs?

  1. Bronchiole constriction – the airways are being obstructed from allergens to different types of triggers like smoking. Without sufficient oxygen going into the distal portions of the lungs, the body won’t be getting any oxygen either.
  2. Cholinergic effects – increased mucus secretions. If there’s increased and thick mucus secretions along the branches of your lungs, there won’t be enough oxygen exchange. The client will be sluggish and will be coughing and hacking a lot of mucus which leads to infection. The lungs will drown in all the mucus and oxygen exchange will be impaired, which, technically, what happens in pneumonia.
  3. Emphysema – causes alveoli expansion and hardening it. This causes the inability of oxygen exchange and carbon dioxide build-up inside the lungs, causing increased pressure.
  4. Bronchitis – persistent infection caused by increased mucus production, leading to inadequate oxygen exchange. The lungs are unable to expectorate or cough up all the secretion from the lungs.
  5. Asthma – bronchiole constriction.

Respiratory Drug Categories

After knowing the different types of common lung problems, we’ll go into the primary drugs that help in relieving mucus production and constriction. As previously mentioned, two categories or teams work together in making the client’s lungs function properly. What are these teams?

  1. Bronchodilator Team
  2. Anti-Inflammatory Team

Bronchodilator Team

With your broncho team, three main drug types fall under this category, and they have the acronym BAM. BAM stands for:

  • Beta-2 agonists – relaxes smooth muscles
  • Anticholinergic – dilate the bronchiole tubes
  • Methylxanthines – acts as a sympathomimetic by increasing circulation inside the lungs to expand the airways, much like the effects of caffeine

In the majority of nursing exams, you’ll encounter a question that goes: What is albuterol – anti-inflammatory or bronchodilator? The answer is beta-2 agonist which is a bronchodilator.

So, what are the drugs under BAM?

  • B – Albuterol, Solu-Medrol (long-term beta-2 agonist), Pirbuterol (Maxair – fast-acting)
  • A – Ipratropium (Atrovent); or anything that ends in “-pium”
  • M – Theophylline (Theo Dur)

Anti-Inflammatory Team

With your anti-inflammatory team, three main drug types fall under this category, and they have the acronym MAL. MAL stands for:

  • Mast cell stabilizers – control or prevent specific allergic disorders
  • Anti-inflammatory steroids – decrease swelling by decreasing prostaglandins
  • Leukotrienes – bronchoconstriction

Again, in a nursing test, you’ll encounter a question that goes: What is Singulair? The answer is leukotriene which is an anti-inflammatory. A quick way to remember this is to remember that, “Luke likes to sing,” which translates to leukotriene is Singulair.

So, what are the drugs under MAL?

  • M – Cromolyn
  • A – Prednisone, beclomethasone
  • L – Singulair

Tip: You can remember cromolyn as a mast cell stabilizer by thinking about a car which has a “mass of chrome.”

Take Away

As a summary, the acronym for the bronchodilator category is BAM; while the acronym for the anti-inflammatory category is MAL.

Hopefully, this helped you differentiate bronchodilators from anti-inflammatory agents. For a more comprehensive summary, don’t forget to download the notecard on this subject at SimpleNursing.com. This notecard separates the drugs and helps you better understand every indication and how they can relieve the constriction and inflammation at the major highways of the respiratory tract.

Furthermore, if you want all the concept maps that you’ll ever need for nursing regarding respiratory lectures, drop by SimpleNursing.com to get a copy of our Pathophysiology Bible which maps out 70 different diagnoses and concept maps – from bronchitis to restrictive airway disease to asthma, COPD, and even emphysema. All of this, plus a more concise breakdown of intensive, useful lectures of over 135 pages.

See you there!

Foolproof Techniques to Easily Memorize Respiratory Drugs

Imagine having your very own technique for memorizing all the respiratory drugs. At SimpleNursing.com, we’ve put out our drug cards and made easier for you to remember one of the most complicated sets of medications in your nursing career.

Mike has stated that you just have to remember two categories when dealing with respiratory drugs – your BAM category and your SLM (pronounced as “slam”) category.

Easy, right?

Once you’ve memorized these acronyms by heart, you’ll never go wrong with the identification and administration of respiratory drugs.

Let’s get into it.

BAM: The Bronchodilator Team

Some of the most popular bronchodilators are albuterol, methylxanthines, and anticholinergic agents.

  • B stands for beta2-agonist. These are medications ending in “-terol.” One good example is albuterol (Solu-Medrol).
  • represents the anticholinergic agents that end in “-pium.” These drugs decrease mucus production in the bronchioles. An effective way to remember this kind of drug is the thought that, if you can’t pee with them, it’s anticholinergic.
  • is for methylxanthines which are drugs ending in “-phylline.” These drugs cause a sympathomimetic response that essentially increases heart rate and expands the lungs, making you breathe better. Caffeine has a similar effect. Theophylline is a typical example.

SLM: The Anti-Inflammatory Team

Anti-inflammatory drugs cause the smooth muscles and the major pathways (bronchi and bronchioles) of the lungs to relax.

  • S stands for steroids; corticosteroids ending in “-sone.” Prednisone falls under this group.

Word of caution: do not discontinue this drug abruptly. Naturally, the human body produces steroids. Consumption of corticosteroids for a period of time will make the body think that it no longer needs to secrete steroids. So the adrenal glands will eventually shut down its normal production of corticosteroids. Sudden cessation of intake will result in withdrawal symptoms, which is why it is advisable to taper off corticosteroids to allow the adrenal gland to gradually regenerate and resume regular steroid production that the body needs.

  • L is for “-leukast.” Leukotrienes, the blood cells that cause prostaglandin production leading to inflammation, are stabilized by this drug. Once leukotrienes are controlled, the bronchi and the bronchioles will start to relax. Singulair (montelukast sodium) is a leukotriene receptor antagonist.

Tip: Remember leukotrienes in singulair by memorizing, “Luke likes to sing.”

  • M stands for mast cells stabilizers, much like Cromolyn. As the name implies, this type of drug stabilizes mast cells. What is the main function of mast cells? They dilate the blood vessels which causes blood to rush into the smooth muscle.

What would happen if there is a mass of blood within the lining of the smooth muscles of the bronchi and bronchioles? There will be the presence of puffiness and inflammation. Cromolyn acts on reducing the swelling through stabilization of the mast cells.

Tip: To help you remember this, just think about “mast of crom” which is basically people who drive with massive chrome rims. I hope you get the point.

So don’t forget, for your respiratory drugs, all you need to keep in mind are: BAM and SLM.