1. Beta Agonist
1.1. Catacholamine based
1.1.1. Epinephrine
1.1.2. Isoproterenol
1.2. Non-catacholamine based
1.2.1. Non-selective
1.2.1.1. Metproteronal
1.2.2. Selective (based on Beta)
1.2.2.1. SABA
1.2.2.1.1. Albuterol
1.2.2.1.2. Terbutaline
1.2.2.2. LABA
1.2.2.2.1. Formoterol
1.2.2.2.2. Salmoterol
1.2.2.3. Very Long Acting
1.2.2.3.1. Vilanterol (Breo [combined Vilanterol and ICS]
1.2.2.4. MOA and PK
1.2.2.4.1. Structure
1.2.2.4.2. Exosite Hypothesis
1.2.2.5. Dosing
1.2.2.5.1. - Formoterol (6-12 mcg)> Salmeterol (25-50 mcg)> Albuterol (100mcg)
1.2.2.6. Onset of Action
1.2.2.6.1. Based on hydrophilic vs. hydrophobic
1.2.2.7. Non-bronchodilator effect
1.2.2.8. Adverse Effect
1.2.2.8.1. 1
1.2.2.8.2. 2
1.2.2.8.3. Beta 2 polymorpshim
2. Anti-cholnergic
2.1. MOA
2.1.1. Paraympethatic
2.1.1.1. Bronchoconstriction
2.1.1.2. Mucus secretion
2.1.1.3. Vasodilation
2.1.2. Inhibiting Acetylcholine
2.2. Muscrinic Receptor
2.2.1. M3
2.2.1.1. Bronchoconstriction
2.2.2. M2
2.2.2.1. It is the majority of airway receptor
2.2.2.2. Excitatory type located in smooth muscule
2.2.2.2.1. Bronchoconstriction
2.2.2.3. Inhbitory type
2.2.2.3.1. Prevent further release of ACH in the nerve junction.
2.3. Medications
2.3.1. Atropin
2.3.1.1. We don't use due to side effect and crossing blood brain barrier
2.3.2. Atropin-dervitiave
2.3.2.1. Ipratropium Bromide
2.3.2.2. Tiotropium
2.3.2.3. These are quaternary Atropin derivative that has poor systemic absorption from resp and GI---> decrease side effec