ALBUTEROL SULFATE
GENERIC NAME: albuterol sulfate
BRAND NAME: AccuNeb, Novo-Salmol, Proventil, Proventil HFA, Salbutamol, Ventodisk, Ventolin HFA
DRUG CLASSES: Beta2-selective adrenergic agonist, Bronchodilator, Antasthmatic
Pregnancy Category C
THERAPEUTIC ACTIONS
In low doses, acts relatively selectively at beta2-adrenergic receptors to cause bronchodilation and vasodilation; at higher doses, beta2 selectivity is lost, and the drug acts at beta2 receptors to cause typical sympathomimetic cardiac effects.
INDICATIONS
1. Relief and prevention of bronchospasm in patients with reversible obstructive airway disease;
2. Inhalation: Treatment of acute attacks of bronchospasm;
3. Prevention of exercise-induced bronchospasm;
CONTRAINDICATIONS
1. Contraindicated with hypersensitivity to albuterol; tachyarrhythmias, tachycardia caused by digitalis intoxication; general anesthesia with halogenated hydrocarbons or cyclopropane (these sensitize the myocardium to catecholamines); unstable vasomotor system disorders; hypertension; coronary insufficiency, CAD; history of stroke; COPD patients with degenerative heart disease.
2. Use cautiously with diabetes mellitus (large IV doses can aggravate diabetes and ketoacidosis); hyperthyroidism; history of seizure disorders; psychoneurotic individuals; labor and delivery (oral use has delayed second stage of labor; parenteral use of beta2-adrenergic agonists can accelerate fetal heart beat and cause hypoglycemia, hypokalemia, pulmonary edema in the mother and hypoglycemia in the neonate); lactation; the elderly (more sensitive to CNS effects).
ADVERSE EFFECTS
CNS: Restlessness, apprehension, anxiety, fear, CNS stimulation, hyperkinesia, insomnia, tremor, drowsiness, irritability, weakness, vertigo, headache
CV: Cardiac arrhythmias, tachycardia, palpitations, PVCs (rare), anginal pain
Dermatologic: Sweating, pallor, flushing
GI: Nausea, vomiting, heartburn, unusual or bad taste in mouth
GU: Increased incidence of leiomyomas of uterus when given in higher than human doses in preclinical studies
Respiratory: Respiratory difficulties, pulmonary edema, coughing, bronchospasm, paradoxical airway resistance with repeated, excessive use of inhalation preparations
INTERACTIONS
Drug-drug
1. Increased sympathomimetic effects with other sympathomimetic drugs;
2. Increased risk of toxicity, especially cardiac, when used with theophylline, aminophylline, oxtriphylline;
3. Decreased bronchodilating effects with beta-adrenergic blockers (eg, propranolol);
4. Decreased effectiveness of insulin, oral hypoglycemic drugs; and
5. Decreased serum levels and therapeutic effects of digoxin
NURSING CONSIDERATIONS
Assessment
History: Hypersensitivity to albuterol; tachyarrhythmias, tachycardia caused by digitalis intoxication; general anesthesia with halogenated hydrocarbons or cyclopropane; unstable vasomotor system disorders; hypertension; coronary insufficiency, CAD; history of stroke; COPD patients who have developed degenerative heart disease; diabetes mellitus; hyperthyroidism; history of seizure disorders; psychoneurotic individuals; lactation
Physical: Weight; skin color, T, turgor; orientation, reflexes, affect; P, BP; R, adventitious sounds; blood and urine glucose, serum electrolytes, thyroid function tests, ECG
Interventions1. Use minimal doses for minimal periods; drug tolerance can occur with prolonged use.
2. Maintain a beta-adrenergic blocker (cardioselective beta-blocker, such as atenolol, should be used with respiratory distress) on standby in case cardiac arrhythmias occur.
3. Prepare solution for inhalation by diluting 0.5 mL 0.5% solution with 2.5 mL normal saline; deliver over 5–15 min by nebulization.
4. Do not exceed recommended dosage; administer pressurized inhalation drug forms during second half of inspiration, because the airways are open wider and the aerosol distribution is more extensive.
Teaching points
1. Do not exceed recommended dosage; adverse effects or loss of effectiveness may result. Read the instructions that come with respiratory inhalant.
2. You may experience these side effects: Dizziness, drowsiness, fatigue, headache (use caution if driving or performing tasks that require alertness); nausea, vomiting, change in taste (eat frequent small meals); rapid heart rate, anxiety, sweating, flushing, insomnia.
3. Report chest pain, dizziness, insomnia, weakness, tremors or irregular heart beat, difficulty breathing, productive cough, failure to respond to usual dosage.
REFERENCES:
Albuterol Image. http://medicalsupplies.rxsolutions.com/store/products/albuterol2_lg.jpg
Karch, Amy M. Lippincott Williams & Wilkins. 2007 Nursing Drug Guide.
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