Brand name: Atrovent Generic name: Ipratropium Bromide Category: bronchodilator Action: anticholinergic (parasympatholytic); reverses bronchospasm (blocks cGMP) Onset of action: 15 minutes Peak effect: 1-2 hours Duration of action: 5-8 hours Contraindications: sensitivity to anticholinergic drugs; sensitivity to soybeans / peanuts. Side effects: mouth dryness Drug strength: Solution (unit dose) 2.5 ml containing 0.2% drug (500 mcg) Dosage adult: MDI: (adults and children over 12) 1 2 puffs four times a day. Solution: (adults and children over 12) 1 unit dose every 4 6 hours Dosage pediatric: Solution (age 5 12) adult dose every 4 6 hours Additional information: Often used in conjunction with albuterol for optimal bronchodilation effect.

Brand name: Spiriva Generic name: tiotropium bromide Category: bronchodilator (long acting) Action: anticholinergic (parasympatholytic); muscarinic receptor antagonist inhibits M3 receptors on smooth muscles leading to bronchodilation Onset of action: 20 minutes Peak effect: 1 - 3 hours Duration of action: 24 hours Contraindications: hypersensitivity to ipratroprium or tiotroprium or its derivatives Side effects: dry mouth, sinusitis, constipation, abdominal pain, urinary tract infection, upper respiratory tract infection, chest pain, edema, vomiting, myalgia, moniliasis, rash, dyspepsia, pharyngitis, rhinitis Drug strength: 18 mcg Dosage adult: DPI: (18 ug/inhalation) 1 inhalation daily (one capsule) Solution: Dosage pediatric: 12 years old 88 ug BID, 88 220 BID, 880 ug BID Solution: Dosage pediatric: MDI Children 4 11 years old 88 ug BID Additional information: rinse mouth after to avoid thrush

Brand name: Advair Diskus Generic name: fluticasone propionate/salmeterol Category: inhaled corticosteroid Action: corticosteroid (glucocorticoid) which reduces inflammation by stabilizing leukocyte lysosomal membranes and may enhance the effectiveness of B2 bronchodilators Onset of action: Serevent, 10-20 minutes and Flovent, varies Peak effect: 1 2 weeks Duration of action: Serevent 12 hours and Flovent varies Contraindications: Not for acute episode of bronchospasms (give fast actingacting bronchodilator first) Not for those with systemic fungal infections. Side effects: headache, cushingoid state, dizziness, muscle wasting, seizures, arrhythmias, insomnia, bronchospasm, nausea, cough/ hoarseness, weight gain, sore mouth, water retention, Candidiasis/thrush Drug strength: DPI 100 ug fluticasone/50 ug salmeterol, 250 ug fluticasone/50 ug salmeterol, or 500 ug fluticasone/50 ug salmeterol Dosage adult: DPI 100 ug fluticasone/50 ug salmeterol 1 inhalation twice daily about 12 hours apart (starting dose if not currently taking inhaled corticosteroids) Solution:

Dosage pediatric: children >4 year old DPI 100 ug fluticasone/50 ug salmeterol, 1 inhalation twice daily, about 12 hours apart (for patients who are symptomatic while taking inhaled corticosteroid) Additional information: rinse mouth after to avoid thrush

Brand name: Tilade Generic name: nedocromil sodium Category: non-steroidal anti-asthma Action: non-steroidal anti-inflammatory drugs (NSAIDs) , inhibit mast cell degranulation during antigen antibody reaction which prevents the release of chemical mediators (histamine, serotonin, and slow reacting substance of anaphylaxis SRS-A) Onset of action: 20-30 minutes Peak effect: 30 minutes Duration of action: 3.5 hours Contraindications: not for acute bronchospasms or acute asthmatic episodes Side effects: headache, dizziness, nausea, rash, pharyngitis, cough, bronchospasm, dyspnea Drug strength: 1.75 mg/spray Dosage adult: 2 puffs QID (age 12 and older) Solution: Dosage pediatric: > 6 years old same as adult Additional information: more beneficial in children with asthma than in adults

Brand name: TOBI, nebcin Generic name: tobramycin Category: inhaled anti-bacterial that is actively transported across the bacterial cell membrane, tobramycin binds to a specific receptor protein on the 30 S subunit of bacterial ribosomes and interferes with an initiation complex between messenger RNA (mRNA) and the 30 S subunit, thus inhibiting protein synthesis. The mRNA base sequence may be misread, thus producing nonfunctional proteins Action: anti-infective Onset of action: 10 minutes Peak effect: Duration of action: varies, 4 6 hours Contraindications: Previous reactions to aminoglycosides Side effects: headache, fever, confusion, nausea, vomiting, diarrhea, rashes, itching, pain at injection site, ringing or roaring in ears, dizziness, or hearing loss Drug strength: 300 mg/5 mL ampoule Dosage adult: 1 single-use ampule 300 mg bid 28 days on/ 28 off drug Solution:

Dosage pediatric: 1 single-use ampule (300 mg) administered BID for 28 days/ 28 days off Additional information: Give B2 bronchodilator first to prevent bronchospasms, may need to increase flow rate to 8-12 L/m, depending on solution viscosity. The doses should be taken as close to 12 hours apart as possible; they should not be taken less than 6 hours apart. If patient is on multiple therapies, other therapies should be taken first followed by tobramycin. Instruct patient to take as close to 12h apart as possible. Do not take less than 6h apart

Brand name: Nebupent, Pentam 300 Generic name: pentamidine isethionate Category: inhaled anti-bacterial Action: Anti-protozoal agent that effects DNA, RNA, phospholipid, and protein synthesis Onset of action: unknown Peak effect: 0.5 hour Duration of action: variable, 4 6 hours Contraindications: Known hypersensitivity to pentamidine or any ingredient in the formulation Side effects: cough, bronchospasm, wheezing, shortness of breath, diarrhea, nausea, decreased appetite Drug strength: 300 mg of powder Dosage adult: SVN 300 mg in 6 mL sterile water every 4 weeks Solution: 300 mg of powder in 6 mL of sterile water

Dosage pediatric: Children 5 years of age: 300 mg every 4 weeks (once monthly) Additional information: Give B2 bronchodilator first to prevent bronchospasms, clinician should use protective barrier mask ; patient should use Respiragard II nebulizer. Not absorbed orally. prescribed in the treatment and prevention of pneumonia caused by Pneumocystis jiroveci, particularly in patients who have human immunodeficiency syndrome. It can also be used to treat trypanosomiasis and visceral leishmaniasis.

Brand name: Xopenex Generic name: levalbuterol Category: bronchodilator Action: beta agonist (sympathomimetic) short acting inhaled selectively stimulates beta-2 adrenergic receptors, relaxing airway smooth muscle Onset of action: 5 10 minutes Peak effect: 30 60 minutes Duration of action: 4 - 8 hour Contraindications: hypersensitivity to drug/class/component, MAO inhibitor use w/in 14 days, caution if arrhythmias, caution if CAD, caution if HTN, caution if hypokalemia, caution if diabetes mellitus, caution if seizure disorder, caution if hyperthyroidism caution if pheochromocytoma, Side effects: Serious Reactions = bronchospasm paradoxical, anaphylaxis, angioedema

MI, cardiac arrest, arrhythmias, hypokalemia, Common Reactions = palpitations, dizziness, nervousness, tremor, tachycardia, headache, chest pain, dry mouth, asthenia Rhinitis, Drug strength: MDI 45 mcg/puff , SVN 0.63-1.25 mg/NS Dosage adult: MDI 1-2 puffs every 4 6 hours, SVN 0.63-1.25 mg/NS every 48 hours Solution: Dosage pediatric: Info: 0.31 mg/3 mL = 0.01%; 0.63 mg/3 mL = 0.021%; 1.25 mg/3 mL = 0.042% Bronchospasm [6-11 yo]: 0.31 mg NEB tid prn; Max: 0.63 mg NEB tid [>11 yo] 0.63 mg NEB tid prn; Max: 1.25 mg NEB tid Additional information:

Brand name: Ventolin, Proventil, Aerolin, Respolin, Salbutamol, Volmax, AccuNeb (pediatric) Generic name: albuterol Category: bronchodilator Action: beta agonist (sympathomimetic) short acting inhaled selectively stimulates beta-2 adrenergic receptors, relaxing airway smooth muscle Onset of action: 5 minutes Peak effect: 30 60 minutes Duration of action: 5 8 hours Contraindications: hypersensitivity to drug/class/component, caution if ischemic heart disease, caution if HTN, caution if arrhythmias, caution if hypokalemia, caution if diabetes mellitus, caution if seizure disorder, caution

if hyperthyroidism, caution if pheochromocytoma, caution if pregnancy, caution in elderly pts Side effects: Serious Reactions = hypersensitivity rxns, bronchospasm paradoxical, HTN, angina, MI, hypokalemia, arrhythmias, metabolic acidosis (nebulized use), Common Reactions = throat irritation, URI sx, cough, bad taste, tremor, dizziness, Nervousness, nausea, headache, palpitations, tachycardia Drug strength: MDI 90 mcg/puff, DPI 200 mcg/cap, SVN 2.5-5 mg/NS Dosage adult: MDI 1-3 puffs every 4-6 hours, DPI 200 mcg every 4-6 hours, SVN 2.5-5 mg/NS every 4-6 hours Solution: Dosage pediatric: Info: 1 spray = 103 mcg albuterol sulfate equivalent to 90 mcg albuterol base Bronchospasm [>4 yo] 2 puffs inhaled q4-6h prn; Max: 12 puffs/day; Alt: 1 puff inhaled q4h prn Additional information:

Brand name: Serevent Generic name: salmeterol Category: bronchodilator Action: beta agonist (sympathomimetic) long acting inhaled selectively stimulates beta-2 adrenergic receptors, relaxing airway smooth muscle Onset of action: 10 20 minutes Peak effect: Duration of action: 12 hours

Contraindications: hypersensitivity to drug/class/component, asthma monotherapy, acute asthma, caution if HTN, caution if cardiovascular disease, caution if arrhythmias caution if hypokalemia, caution if hyperthyroidism, caution if diabetes mellitus, caution if seizure disorder, caution if pheochromocytoma Side effects: Serious Reactions = bronchospasm paradoxical, asthma exacerbation, death asthma-related, anaphylaxis, angioedema, laryngospasm, arrhythmias, HTN Common Reactions = headache, throat irritation, nasal congestion, rhinitis, tracheitis/bronchitis, pharyngitis, urticaria, rash, palpitations, tachycardia, tremor, Nervousness Drug strength: MDI 25 mcg/puff, DPI 50 mcg/puff Dosage adult: MDI 2 puffs BID, DPI 1 puff BID Solution: Dosage pediatric: Dosage forms: 50 mcg/blister DPI asthma, maintenance tx [>4 yo] 50 mcg inhaled q12h; Info: for use only in combo w/ asthma controller medication; fixed-dose combination product preferred to incr. compliance; use shortest effective tx duration Additional information:

Brand name: Brethine, Brethaire Generic name: terbutaline Category: bronchodilator Action: beta agonist (sympathomimetic) selectively stimulates beta-2 adrenergic receptors, relaxing airway smooth muscle

Onset of action: 5 minutes Peak effect: Duration of action: 4 8 hours Contraindications: hypersensitivity to drug/class/component, prolonged tocolysis >48-72h (SC/IV use), caution if arrhythmias, caution if cardiovascular disease, caution if HTN, caution if hyperthyroidism, caution if diabetes mellitus, caution if seizure disorder Side effects: Serious Reactions = hypersensitivity rxn, bronchospasm paradoxical, HTN QT prolongation, arrhythmias, myocardial ischemia, pulmonary edema, hypokalemia, hyperglycemia, seizures, neonatal hypoglycemia reactive, fetal tachycardia, Common Reactions = nervousness, tremor, headache, tachycardia, palpitations, drowsiness, nausea, vomiting, sweating, muscle cramps, hypokalemia, hyperglycemia Drug strength: MDI 0.2 mg/puff Dosage adult: MDI 2 puffs every 4 6 hours Solution: Dosage pediatric: Dosage forms: 2.5,5; SC Bronchospasm [6-12 yo] 0.05 mg/kg PO tid, give q6h while awake; Max: 0.15 mg/kg/dose or 5 mg/day PO; 0.4 mg/dose SC; Alt: 0.005-0.01 mg/kg SC q15-30min x2 [12-15 yo] 2.5 mg PO tid, admin. q6h while awake; Max: 7.5 mg/day PO; 0.5 mg/4h SC; Alt: 0.25 mg SC q15-30min x2 [>15 yo] 2.5-5 mg PO tid, admin. q6h while awake; Max: 15 mg/day PO; 0.5 mg/4h SC; Alt: 0.25 mg SC q15-30min x2 Additional information:

Brand name: Alupent Generic name: metaproterenol Category: bronchodilator

Action: beta agonist (sympathomimetic) short acting inhaled selectively stimulates beta-2 adrenergic receptors, relaxing airway smooth muscle Onset of action: 5 minutes Peak effect: 60 minutes Duration of action: 3 4 hours Contraindications: hypersens. to drug/class/component, tachycardia or arrhythmias, caution if HTN, caution if heart disease, caution if diabetes mellitus, caution if cirrhosis, caution if w/ cardiac glycosides, caution if hypokalemia Side effects: Serious Reactions = cardiac arrest, Common Reactions = nervousness Tachycardia, tremor, headache, palpitations, nausea, dizziness, asthma exacerbation, Insomnia, diarrhea Drug strength: MDI 0.65 mg/puff, SVN 15 mg Dosage adult: MDI 2 3 puffs every 4 hours, SVN 15 mg every 4 hours Solution: Dosage pediatric: Dosage forms: 10,15/2.5 mL neb Bronchospasm [>12 yo] 10-15 mg NEB tid-qid prn Additional information:

Brand name: Vaponephrine, MicoNephrin

Generic name: racemic epinephrine Category: bronchodilator Action: beta agonist (sympathomimetic) stimulates alpha and beta adrenergic receptors, reducing mucosal secretions and relaxing bronchial smooth muscles Onset of action: 10 minutes Peak effect: 5 20 minutes Duration of action: 1 4 hours Contraindications: hypersens. to drug/class/component, hypersensitivity to sulfites (mutidose vial form), caution if cardiac disease, caution if HTN, caution if hyperthyroidism, caution if diabetes mellitus, caution if glaucoma, angle-closure caution if BPH Side effects: Serious Reactions = arrhythmias, bronchospasm paradoxical, Common Reactions = nervousness, tremor, insomnia, nausea, tachycardia, dizziness, headache, loss of appetite Drug strength: SVN 2.25% Dosage adult: SVN 0.25 to 0.5 mL + NS PRN Solution: Dosage pediatric: croup [4 yo] 0.5 mL NEB q3-4h; Info: onset 1-5min, duration 1-3h Additional information: primarily for the alpha effects of reducing edema in the upper airway, reducing stridor, and treating croup

Brand name: Foradil Generic name: formoterol Category: bronchodilator Action: beta agonist (sympathomimetic) long acting inhaled selectively stimulates beta-2 adrenergic receptors, relaxing airway smooth muscle Onset of action: 5 15 minutes Peak effect: 30 60 hours Duration of action: 12 hours Contraindications: not for acute bronchospasms, hypersensitivity to drug/class/component, asthma monotherapy, acute asthma, caution if hypersensitivity to milk protein, caution if cardiovascular disease, caution if HTN, caution if arrhythmias, caution if hypokalemia, caution if diabetes mellitus, caution if hyperthyroidism, caution if seizure disorder Side effects: Serious Reactions = bronchospasm paradoxical, asthma exacerbation, death, asthma-related, anaphylaxis, angioedema, hypokalemia, arrhythmias, Common Reactions = URI, dyspepsia, chest pain, back pain, fever, diarrhea, nausea/vomiting, dry mouth, dizziness, insomnia, nervousness, tremor, palpitations, tachycardia, hyperglycemia, transient Drug strength: DPI 12 mcg/puff Dosage adult: DPI 1 puff BID Solution: Dosage pediatric: [>5 yo] 1 cap inhaled q12h; Max: 2 caps/day; Info: for use only in combo w/ asthma controller medication; fixed-dose combination product preferred to incr. compliance; use shortest effective tx duration; caps for use w/ Aerolizer inhaler only Additional information:

Brand name: Brovana Generic name: arformaterol Category: bronchodilator Action: beta agonist (sympathomimetic) Long-acting Inhaled selectively stimulates beta-2 adrenergic receptors, relaxing airway smooth muscle Onset of action: 7 12 minutes Peak effect: 30 60 minutes Duration of action: 12 hours Contraindications: not for acute bronchospasms, hypersenstivity to drug/class/component, pediatric pts, bronchospasm acute, COPD acute deteriorating, caution if cardiovascular disease, caution if CAD, caution if HTN, caution if arrhythmias, caution if seizure disorder, caution if thyrotoxicosis, caution if diabetes mellitus, caution if hypokalemia, caution if hepatic impairment Side effects: bronchospasm paradoxical, anaphylaxis, angioedema, hypokalemia, QT prolongation, arrhythmias, heart block, Common Reactions: pain, chest pain, back pain Diarrhea, sinusitis, leg cramps, dyspnea, rash, flu syndrome, peripheral edema, pulmonary/chest congestion Drug strength: 15 ug/2mL unit dose max 30 mcg/ day Dosage adult: 15 ug/2mL unit dose, BID Solution: Dosage pediatric: not available Additional information:

Brand name: Generic name: Category: Action: Onset of action: Peak effect: Duration of action: Contraindications: Side effects: Drug strength: Dosage adult: Solution: Dosage pediatric: Additional information:

Brand name: Generic name: Category: Action: Onset of action: Peak effect: Duration of action: Contraindications: Side effects: Drug strength: Dosage adult: Solution: Dosage pediatric: Additional information: