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newSchoolWorks.com › VoTechWorks › Health & Personal Services › Pharmacy Technician › Pharmacology and the Top 200 Drugs › Lesson 9
HLT-PHAR41-02 · Lesson 9 · 15 clock hours · theory

Respiratory, gastrointestinal and allergy drugs

Objective. Tell rescue inhalers from controller inhalers, and identify proton-pump inhibitors, H2 blockers, antihistamines and common OTC products.

⚠ Pending professional review

This lesson, its worked examples and its practice questions has not yet been verified by a licensed pharmacist or by a certification or approval body. It is a study draft and may contain errors. Do not use it to make decisions about any patient or medication. Always follow your instructor, your supervising professional, and current official references and regulations.

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Respiratory Drugs: Rescue vs. Controller Inhalers

One of the most important distinctions a pharmacy technician must learn is the difference between rescue inhalers and controller inhalers. Confusing these two categories can have serious consequences for patients with asthma or chronic obstructive pulmonary disease (COPD).

Rescue Inhalers (Short-Acting Bronchodilators)

Rescue inhalers provide rapid relief of acute bronchospasm. They work within minutes by relaxing the muscles around the airways. The most common class is the short-acting beta-2 agonists (SABAs). Albuterol (brand names ProAir HFA, Ventolin HFA, Proventil HFA) is the prototype SABA and the most widely dispensed rescue inhaler in the United States. Levalbuterol (Xopenex) is another SABA used when patients experience excessive side effects from albuterol.

Rescue inhalers are used as needed for sudden symptoms such as wheezing, chest tightness, or shortness of breath. They are not meant for daily scheduled use. When a patient is using a rescue inhaler more than twice a week, it is a clinical signal that their asthma is not well controlled and that a prescriber should be notified.

Controller Inhalers (Long-Term Maintenance Agents)

Controller inhalers are taken on a scheduled, daily basis to prevent symptoms. They do not provide immediate relief and must never be used for acute attacks. The main classes include:

A helpful rule of thumb: if the inhaler is a steroid or a long-acting agent, it is a controller; if it is a short-acting beta agonist, it is a rescue inhaler.

Gastrointestinal Drugs

Gastrointestinal (GI) complaints such as heartburn, acid reflux, and peptic ulcer disease are among the most common reasons patients seek both prescription and over-the-counter medications.

Proton-Pump Inhibitors (PPIs)

PPIs are the most potent acid-suppressing medications available. They work by irreversibly blocking the hydrogen-potassium ATPase enzyme (the "proton pump") in the stomach lining. PPIs are used for gastroesophageal reflux disease (GERD), peptic ulcer disease, and Helicobacter pylori eradication regimens.

Common PPIs include omeprazole (Prilosec, available OTC), pantoprazole (Protonix), esomeprazole (Nexium, available OTC), lansoprazole (Prevacid, available OTC), and rabeprazole (Aciphex). PPIs are typically taken 30–60 minutes before a meal for best effect. Long-term PPI use may be associated with reduced magnesium absorption and increased risk of C. difficile infection.

H2 Blockers (Histamine-2 Receptor Antagonists)

H2 blockers reduce acid production by blocking histamine receptors in the stomach. They are less potent than PPIs but have a faster onset for on-demand heartburn relief. Common agents include famotidine (Pepcid, available OTC) and cimetidine. Ranitidine was withdrawn from the US market by the FDA in 2020 due to concerns about NDMA contamination. H2 blockers are used for mild-to-moderate GERD, heartburn, and ulcer prevention.

Allergy Drugs: Antihistamines

Antihistamines block H1 histamine receptors and are divided into two generations based on their sedating properties.

First-Generation Antihistamines

First-generation antihistamines cross the blood-brain barrier and commonly cause sedation. Diphenhydramine (Benadryl) is the prototype. It is also found in many OTC sleep aids and combination cold products. Chlorpheniramine is another first-generation antihistamine found in many multi-ingredient cold preparations.

Second-Generation Antihistamines

Second-generation antihistamines are preferred for daytime allergy management because they cause little to no sedation. Common examples include loratadine (Claritin, OTC), cetirizine (Zyrtec, OTC), and fexofenadine (Allegra, OTC). These agents are taken once daily for seasonal or perennial allergic rhinitis.

Common OTC Products Technicians Should Recognize

During an OTC aisle audit, technicians should be able to identify these product categories:

When assisting patients in the OTC aisle, technicians should recognize the limits of their scope and refer clinical questions to the pharmacist.

Key terms10

Rescue inhalerA short-acting bronchodilator (typically a SABA such as albuterol) used for immediate relief of acute bronchospasm; used as needed, not on a scheduled basis.
Controller inhalerA maintenance inhaler (such as an inhaled corticosteroid or LABA) taken daily on a schedule to prevent asthma or COPD symptoms; not for acute relief.
Short-acting beta-2 agonist (SABA)A class of bronchodilators that rapidly relax airway smooth muscle; albuterol is the most common example and is the standard rescue inhaler.
Inhaled corticosteroid (ICS)Anti-inflammatory controller agents delivered by inhaler (e.g., fluticasone, budesonide) that reduce airway inflammation; patients must rinse mouth after use to prevent oral thrush.
Proton-pump inhibitor (PPI)A class of drugs that suppress gastric acid by irreversibly inhibiting the hydrogen-potassium ATPase proton pump; examples include omeprazole and pantoprazole.
H2 blockerA drug that reduces stomach acid production by blocking histamine-2 receptors in the gastric lining; famotidine is a common example available OTC.
First-generation antihistamineAn H1-blocking allergy drug that crosses the blood-brain barrier and causes sedation; diphenhydramine (Benadryl) is the prototype.
Second-generation antihistamineA non-sedating or minimally sedating H1-blocking allergy drug preferred for daytime use; examples include loratadine, cetirizine, and fexofenadine.
CMEA (Combat Methamphetamine Epidemic Act)Federal law requiring that pseudoephedrine-containing products be kept behind the pharmacy counter and that purchasers show ID and sign a logbook.
GuaifenesinAn OTC expectorant (Mucinex) that thins and loosens mucus in the airways to make coughs more productive.
In class: Inhaler device demos · OTC aisle audit · Case: asthma action plan
Materials: Placebo inhalers, spacers, OTC products
Check: Quiz ≥ 80%

Practice check8

Answer each question, then check it. Nothing is recorded; this is your own practice.

Medications
1. A patient with asthma calls the pharmacy saying she is having difficulty breathing right now and needs to know which inhaler to use immediately. Which of the following is the appropriate rescue inhaler?
Medications
2. Which of the following inhaled medications is classified as a controller agent and should be taken on a daily scheduled basis to prevent asthma symptoms?
Patient Safety and Quality Assurance
3. A patient picking up a prescription for fluticasone/salmeterol (Advair Diskus) asks why the pharmacist told her to rinse her mouth after each use. What is the primary reason for this counseling point?
Medications
4. A pharmacist asks you to retrieve a proton-pump inhibitor for a patient with GERD. Which of the following medications belongs to the PPI class?
Federal Requirements
5. Which of the following H2 blocker products was withdrawn from the US market by the FDA in 2020 due to NDMA contamination concerns?
Medications
6. A customer asks for something non-drowsy for her seasonal allergies. Which of the following OTC antihistamines is classified as second-generation and least likely to cause sedation?
Federal Requirements
7. Under the Combat Methamphetamine Epidemic Act (CMEA), which of the following products must be kept behind the pharmacy counter and require purchaser identification and a sales logbook?
Order Entry and Processing
8. A technician is verifying an order for pantoprazole (Protonix). For maximum effectiveness in treating GERD, when should the patient take this medication?
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