RT-10 · Initiation & Modification

Pharmacology: Bronchodilators, Steroids & Adjunct Agents

Drug classes by mechanism, dosing, side effects, and the exam's favorite question: which agent for this patient, right now.

~22 min read3 concept sections·4 questions with rationale

What you'll be able to do

  • Match drug class to mechanism and onset
  • Separate rescue from maintenance therapy
  • Recognize adverse effects that change therapy
  • Select the correct agent for an acute clinical scenario
Concept breakdown
01

Bronchodilators

Two mechanisms: stimulate beta-2 to relax smooth muscle, or block muscarinic receptors to prevent constriction.

  • Short-acting beta agonists (albuterol, levalbuterol): onset 5–15 minutes, duration 4–6 hours. Rescue therapy. Side effects: tachycardia, tremor, hypokalemia, hyperglycemia.
  • Long-acting beta agonists (salmeterol, formoterol): maintenance only, never rescue, and never as monotherapy in asthma.
  • Short-acting anticholinergic (ipratropium): onset 15 minutes, duration 6–8 hours; strongest role in COPD and combined with albuterol in severe asthma.
  • Long-acting anticholinergic (tiotropium): once daily maintenance in COPD; side effects are dry mouth and urinary retention.
  • Racemic epinephrine: upper airway edema and croup — mucosal vasoconstriction, not bronchodilation. Watch for rebound.
At the bedside

Tremor and a heart rate of 130 after continuous albuterol is expected pharmacology, not an allergy — reassess, don't necessarily stop.

Practice quiz

Check yourself before you read the rationale.

Question 1 of 1

A patient in status asthmaticus has already received continuous albuterol, ipratropium, and IV steroids without improvement. The next agent most likely indicated is:

Practice questions

Answer first, then read why the distractors fail.

Question 1

A patient in status asthmaticus has already received continuous albuterol, ipratropium, and IV steroids without improvement. The next agent most likely indicated is:

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2 more concept sections, 3 more questions, and the exam-day playbook for this module.

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