Respiratory Pharm: Beta2-Agonist Bronchodilators?

In this lecture, we will quickly break down the different types of respiratory drugs and how they are somehow connected with anaphylactic medications, which are both necessary to increase oxygenation inside the body, specifically, the lungs.

BAM and SLM

If there’s the presence of lung inflammation, there are a couple of ways to decrease the condition – BAM and SLM.

BAM stands for:

  • Beta2-agonist
  • Anticholinergic
  • Methylxanthines

These are categorized as bronchodilators.

On the other hand, SLM stands for:

  • Steroids
  • Leukotrienes
  • Mast cells stabilizers

These are categorized as anti-inflammatory medications.

Increasing Oxygen

In order to increase oxygen supply, bronchodilators are administered to enlarge the big branch or big stump inside the lungs that lead to the bronchioles, similar to vasodilation. Once the “highways” are dilated, the amount of oxygen that is going down the lungs also increases.

Bronchodilator: Beta2-Agonists

One of the drug types under the bronchodilator team is the beta2-agonists. Beta2-agonists usually end in “-terol” like Albuterol. But what exactly are beta2-agonists and how do they differ from other bronchodilators?

What you have to remember is that inside the body, there are response systems known as beta receptors. Beta receptors are also known as sympathomimetic receptors that activate the fight and flight response. Which is why, if a person is experiencing a stressful situation, like being chased by a bear, what your body will do is to react by activating the fight and flight response. During the fight and flight response, the lungs will breath faster and better, and the heart will pump harder.

To easily identify beta receptors between the heart and lungs, remind yourself this:

Beta receptors inside the heart are called beta-1. A person has one heart; hence, beta-1. On the other hand, a person has two lungs which is why the beta receptors inside the lungs are known as beta-2.

Agonizing the Receptors

Beta2-agonists tend to “agonize” the receptors in a way that it’s like instigating a fight for the receptors at the bronchial site to react and expand. Somehow, beta2-agonists stimulate the cells responsible for the sympathomimetic response to dilate and allow more oxygen to flow inside.

Beta Blockers

Beta-1 blockers or what is commonly known as beta-blockers are medications that decrease the heart rate. Beta-blockers usually end in “-olol” like metoprolol or atenolol. These drugs are non-specific which means that it aside from blocking beta-1 receptors of the heart, they would also affect the beta-2 receptors of the lungs. Therefore, it is important to watch out for the client’s decreased breathing.

The Fast-Acting Beta2-Agonist

Albuterol is the only rapid-acting respiratory medication. Albuterol is the type of medication that can help a client during crisis or rescue situation, much like fast-acting insulins.

Anticholinergic

After beta2-agonists, the next medication from the BAM category is anticholinergic. Anticholinergics are medications that have a “drying” effect on the client due to the deactivation of the parasympathetic response and the activation of the sympathomimetic response.

This will be further discussed in the following lecture, as well as looking further into methylxanthines. For other nursing topics, visit us at SimpleNursing.com.

See you in our next article!

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!

Cholinergic and Anticholinergic Pharmacology Made Easy

Today, we’ll be focusing our attention on anticholinergic bronchodilators.

In the simplest sense, you anticholinergic bronchodilators are your drugs that have the capacity to turn off the system in your body that causes the fight and flight reaction.

To explain further…

Sympathetic versus Parasympathetic

So, there are two systems involved – the sympathetic nervous system and the parasympathetic nervous system. How do you distinguish one from the other?

  • Sympathetic nervous system (SNS) – fight and flight
  • Parasympathetic nervous system (PNS) – rest and digest

When trying to differentiate one from the other, there are a couple of questions that you need to ask:

  1. Where is the blood going?
  2. Is it headed towards your fight and flight organs or towards your digest and rest organs?
  3. What are your fight and flight organs?
  4. What are your digest and rest organs?

Your fight and flight organs are:

  1. Heart
  2. Lungs
  3. Brain

Your digest and rest organs are:

  1. Gastrointestinal (GI) Tract
  2. Kidneys
  3. Muscles
  4. Other organs

The teeter-totter figure

To make your memorization easier, imagine a teeter-totter.

On the left side, is your sympathetic nervous system (SNS), and on the right side is your parasympathetic nervous system (PNS) or the parasympathomimetics nervous system. Below your SNS, write down the organs responsible for the fight and flight reaction which is your heart, lungs, and brain. Then below the PNS, write down the organs responsible for the digest and rest reaction.

Anticholinergic versus Cholinergic

After identifying what your SNS and PNS are, we now have to relate them to your cholinergic and anticholinergic drugs.

How does one distinguish anticholinergic from cholinergic drugs?

Sympathomimetic reactions (fight and flight) – Anticholinergic drugs

The mechanism of anticholinergic drugs is to direct blood to your heart, lungs, and brain by inhibiting the parasympathetic nervous system. When the signal going to the PNS is blocked or disrupted, the involuntary functions like mucus secretion, salivation, urination, and digestion is decreased significantly.

Examples: Atropine, Epinephrine

Parasympathetic nervous system (rest and digest) – Cholinergic drugs

On the other hand, cholinergic drugs are basically the opposite of the SNS. Because with cholinergic drugs, there is an increase in involuntary functions which basically means that there is saliva production, urination, and mucus secretion.

An instructor of Mike’s once shared a very useful tip when remembering cholinergic and anticholinergic drugs. Just remember the 3 S’s:

  • See
  • Spit
  • Shit (excrete)

Simply put it this way:

Anticholinergics – can’t see, can’t spit, can’t shit

Cholinergics – can see, can spit, can shit

Easy enough?

Cholinergic agents allow you to see due to the production of fluid that moisturizes the eyes and you can salivate because of the production of mucus. You can also urinate and defecate.

Anticholinergic agents decrease all the activities mentioned above. Instead, you will increase the client’s heart rate and perfusion to the lungs and brain.

So just remember…

Administering drugs with SNS and PNS effects will directly influence where the blood will be heavily distributed for the sake of treating a number of conditions. If you turn one off, the other is turned on. Don’t forget the teeter-totter figure. 

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.