which stimulate the central nervous system (CNS) to increase respirations, dilate
coronary and pulmonary vessels, and increase urination (diuresis).
Leukotriene ModifiersBronchoconstrictors cause the contraction of smooth muscle around the bronchi
restricting airflow to the lungs. Leukotriene (LK) is the primary bronchocon-
strictor that increases migration of eosinophils, increases mucous production,
and increases edema in the bronchi resulting in bronchoconstriction.
There are two types of Leukotriene (LK) modifers: LT receptor antagonists
and LT synthesis inhibitors. These are effective in reducing the inflammatory
symptoms of asthma triggered by allergic and environmental stimuli.
Leukotriene (LK) modifiers include Zafirlukast (Accolate), zileuton (Zyflo)
and nontelukast sodium (Singulair).
Anti-inflammatoryChronic obstructive pulmonary disease causes inflammation in the respiratory
tract that results in respiratory distress for the patient. Glucocorticoids (steroids)
are the primary medication given to reduce the inflammation. You’ll learn more
about glucocorticoids (steroids) in Chapter 12.
Glucocorticoids (steroids) can be administered orally, via aerosol inhalation,
intramuscularly, and intravenously. Glucocorticoids used for aerosol inhalation
use beclomethasone (Beconase, Vanceril), dexamethasone (decadron), flunisolide
(Aerobid, Nasalid), or triamcinolone (Azmacort, Kenalog, Nasacort).
Glucocorticoids used for other routes include betamethasones (Celestone),
cortisone acetate (Cortone acetate, Cortistan), dexamethasone (Decadron),
hydrocortisone (Cortef, Hydrocortone), methylprednisolone (Medrol, Solu-
Medtol, Depo-Medrol); and prednisolone, prednisone, and triamcinolone
(Aristocort, Kenacort, Azmacort).
ExpectorantAs you learned previously in this chapter, an expectorant—referred to as
mucolytics—liquefies and loosens thick mucous secretions so they can be
removed through coughing. A commonly prescribed expectorant for chronic
obstructive pulmonary disease is acetylcysteine (Mucomyst), which is adminis-
tered by nebulizor five minutes after the patient receives a bronchodilator.
Acetylcysteine should not be mixed with other medications and can cause
nausea, vomiting, oral ulcers (stomatitis), and a runny nose. Acetylcysteine is
also an antidote for acetaminophen overdose if given within 12 to 24 hours after
the overdose.
CHAPTER 14 Respiratory Diseases^265