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Generic Name Trade Name Classification albuterol Proventil bronchodilators Peak Onset Duration 60-90 min 5-15 min 3-6 hr Why is your patient getting this medication Used as a bronchodilator to control and prevent reversible airway obstruction caused by asthma or COPD. Used as a quick-relief agent for acute bronchospasm and for prevention of exercise-induced bronchospasm Mechanism of action and indications (Why med ordered) Binds to beta2-adrenergic receptors in airway smooth muscle, leading to activation of adenyl cyclase and increased levels of cyclic-3', 5'-adenosine monophosphate (cAMP). Increases in cAMP activate kinases, which inhibit the phosphorylation of myosin and decrease intracellular calcium. Decreased intracellular calcium relaxes smooth muscle airways. Relaxation of airway smooth muscle with subsequent bronchodilation. Relatively selective for beta2 (pulmonary) receptors. Dose Route Time/frequency 2.5mg/0.5mL NIH Q 6 hrs per RT Normal dosage range 2.5-5 mg q 20 min for 3 doses then 2.5-10 mg q 1-4 hr prn For IV meds, compatibility with IV drips and/or solutions N/A
Nursing Implications (what to focus on) Contraindications/warnings/interactions Hypersensitivity. Cardiac disease, HTN, hyperthyroidism, diabetes, glaucoma, seizure disorder, geriatric patients (increased risk of adverse reactions; may require dosage reduction) Common side effects Nervousness, restlessness, tremor, chest pain, palpitations
Interactions with other patient drugs, OTC or herbal medicines (ask patient specifically) Coreg: Beta blockers may antagonize the effects of bronchodilator betaadrenergic agonists, which may result in life-threatening bronchospasm. The mechanism is increased airway resistance and inhibition of betaagonist-induced bronchodilation due to beta-2-adrenergic blockade. Ophthalmically applied beta blockers undergo some systemic absorption and may also interact. Propranolol has been used in the treatment of albuterol overdose. Demadex: Beta-2 adrenergic agonist bronchodilators may cause hypokalemia and/or prolongation of the QT interval. The coadministration of potassium-wasting diuretics may exacerbate hypokalemia, potentially increasing the risk of ventricular arrhythmias including ventricular tachycardia and torsade de pointes. Patients who are taking systemic or nebulized beta agonists, high doses of beta agonists, or concomitant theophylline or corticosteroids may be at a greater risk of developing hypokalemia. Levaquin: Beta-2 adrenergic agonists can cause dose-related prolongation of the QT interval and potassium loss. Theoretically, coadministration with other agents that can prolong the QT interval may result in elevated risk of ventricular arrhythmias, including ventricular tachycardia and torsade de pointes, because of additive arrhythmogenic potential related to their effects on cardiac conduction. In general, the risk of an individual agent or a combination of agents causing ventricular arrhythmia in association with QT prolongation is largely unpredictable but may be increased by certain underlying risk factors such as congenital long QT syndrome, cardiac disease, and electrolyte disturbances (e.g., hypokalemia, hypomagnesemia). In addition, the extent of drug-induced QT prolongation is dependent on the particular drug(s) involved and dosage(s) of the drug(s). Clinically significant prolongation of QT interval and hypokalemia occur infrequently when beta-2 adrenergic agonists are inhaled at normally recommended dosages. However, these effects may be more common when the drugs are administered systemically or when recommended dosages are exceeded. Seroquel: There is some concern that quetiapine may have additive adverse cardiovascular effects in combination with other drugs that are known to prolong the QT interval of the electrocardiogram. Data are conflicting. In clinical trials, there was no statistically significant difference between quetiapine and placebo in the proportions of patients experiencing potentially important changes in ECG parameters including QT, QTc, and PR intervals. However, QT prolongation has been reported in quetiapine overdose and with therapeutic use of other atypical antipsychotic agents such as sertindole, ziprasidone, and risperidone. In one case report, torsade de pointes arrhythmia developed in a patient treated with low-dose quetiapine. However, the relationship to quetiapine is uncertain, as there were multiple confounding risk factors such as hypomagnesemia, a history of QT prolongation (possibly prior to initiation of quetiapine), a history of substance abuse, and uncertain medication compliance. In general, the risk of an individual agent or a combination of agents causing ventricular arrhythmia in association with QT prolongation is largely unpredictable but may be increased by certain underlying risk factors such as congenital long QT syndrome, cardiac disease, and electrolyte disturbances (e.g., hypokalemia, hypomagnesemia). In addition, the extent of drug-induced QT prolongation is dependent on the particular drug(s) involved and dosage(s) of the drug(s).
Lab value alterations caused by medicine May cause transient ↓ in serum potassium concentrations with nebulization or higher-than-recommended doses. Be sure to teach the patient the following about this medication Instruct patient to take albuterol exactly as directed. If on a scheduled dosing regimen, take missed dose as soon as remembered, spacing remaining doses at regular intervals. Do not double doses or increase the dose or frequency of doses. Caution patient not to exceed recommended dose; may cause adverse effects, paradoxical bronchospasm (more likely with first dose from new cannister), or loss of effectiveness of medication. Instruct patient to contact health care professional immediately if shortness of breath is not relieved by medication or is accompanied by diaphoresis, dizziness, palpitations, or chest pain. Advise patient to consult health care professional before taking any OTC medications , natural/herbal products, or alcohol concurrently with this therapy. Caution patient also to avoid smoking and other respiratory irritants. Inform patient that albuterol may cause an unusual or bad taste. Advise patients to use albuterol first if using other inhalation medications and allow 5 min to elapse before administering other inhalant medications unless otherwise directed. Advise patient to rinse mouth with water after each inhalation dose to minimize dry mouth.
Nursing Process- Assessment (Pre-administration assessment) Assess lung sounds, pulse, and blood pressure before administration and during peak of medication. Note amount, color, and character of sputum produced. Monitor pulmonary function tests before initiating therapy and periodically during therapy to determine effectiveness of medication. Observe for paradoxical bronchospasm (wheezing). If condition occurs, withhold medication and notify physician or other health care professional immediately.
Assessment Why would you hold or not give this med? Undesirable side effects
Evaluation Check after giving Prevention or relief of bronchospasm.