salbutamol-drug-study

Generic name: salbutamol
Brand name: Proventil, Vospira ER, Accuneb, Ventodisk, Ventolin
Pregnancy Category: C
Drug Classes: Bronchodilator, Adrenergics

Therapeutic action:
It relaxes the smooth muscles of the bronchioles allowing maximum passage of air. It decreases intracellular calcium which will relax the smooth muscles of the lungs by mobilizing kinase through activation of cyclic-3’5’-adenosine monophosphate (cAMP).

Indications:

  1. Quick relief of bronchospasm induced through both exercise and physiological alterations.
  2. To control and prevent reversible airway obstruction caused by bronchial asthma, chronic obstructive pulmonary diseases such as emphysema and chronic bronchitis as well as other obstructive pulmonary diseases.
  3. Inhalation: treatment of acute attacks of bronchospasm
  4. Unlabeled use: Adjunct in treating moderate to severe hyperkalemia in dialysis patients; seems to lower potassium concentrations when inhaled by patients on hemodialysis

Contraindications and cautions:

  1. Hypersensitivity to salbutamol ?  its in the site content
  2. Tachyarrhythmias and tachycardia caused by digitalis intoxication ?
  3. Cardiac disease including coronary insufficiency, a history of stroke, coronary artery disease and cardiac arrhythmias
  4. Hypertension
  5. Hyperthyroidism
  6. Use cautiously with patients who have diabetes as this can aggravate diabetes and ketoacidosis ?
  7. Glaucoma
  8. Geriatric patients – older individuals are at higher risk for adverse reactions and may require lower dosage
  9. Pregnancy especially near term
  10. Lactation
  11. Children less than 2 years of age because safety of its use has not been established
  12. Excess inhaler use which may lead to tolerance and paradoxical bronchospasm disease;
  13. Use cautiously in elderly because they are more sensitive to CNS effects
  14. Use extended-release tablets cautiously in patients with GI narrowing.

Available forms:

  1. Tablets – 2, 4 mg
  2. ER tablets – 4, 8 mg
  3. Syrup – 2 mg/5mL
  4. Aerosol – 90 mcg/actuation
  5. Solution for inhalation – 0.021%, 0.042%, 0.083%, 0.5%

Dosages:

(Adult)

  1. Oral – 2 or 4 mg (1-2 tsp syrup) three to four times a day
  2. ER tablets – 4-8 mg every 12 hours
  3. Inhalation – 1 or 2 inhalation/s every 4-6 hours (1 aerosol dispenser = 90 mcg)
  4. Prevention of exercise-induced bronchospasms – 2 inhalations 15 minutes prior to exercise

(Pediatric Clients)

  1. Oral – 2 mg three or four times a day
  2. Inhalation – 10-15 kg, use 1.25 mg twice or thrice a day by nebulisation; more than 15 kg, use 2.5 mg twice or thrice by nebulisation

Pharmacokinetics:

  1. Oral route: onset – 30 minutes; peak – 2-2.5 hours; duration – 4-8 hours
  2. Inhalation route: onset – 5 minutes; peak – 1.5-2 hrs; duration – 3-8 hours

Metabolism: Hepatic
Half-life: 2-4 hours
Distribution: Crosses placenta, enters breastmilk
Excretion: Urine

Side Effects and Adverse Reactions:

  1. CNS: Restlessness, apprehension, anxiety, fear, CNS stimulation, vertigo, headache, weakness, tremors, drowsiness,insomnia , hyperactivity, malaise
  2. CV: Cardiac arrhythmias, palpitations, tachycardia,chest pain, hypertension
  3. EENT: dry and irritated nose and throat with inhaled form, nasal congestion, epistaxis, hoarseness
  4. Dermatologic: Sweating, pallor, flushing
  5. GI: Nausea, vomiting, heartburn, unusual or bad taste in the mouth
  6. Metabolic: hypokalemia
  7. Musculoskeletal: muscle cramps
  8. Respiratory: Respiratory difficulties, pulmonary edema, coughing, bronchospasm, paradoxical airway resistance with repeated, excessive use of inhalation preparations,
  9. increased sputum production, dyspnea bronchitis

Drug Interactions

  • CNS stimulants: May increase CNS stimulation. Avoid using together
  • Digoxin: May decrease digoxin level. Monitor digoxin level closely.
  • MOA inhibitors tricycling antidepressants: May increase adverse CV effects. Monitor patient closely.
  • Propanolol and other beta-blockers: May cause mutual antagonism. Monitor patient carefully.

Effects on Laboratory Result

  • May decrease potassium level.

Nursing Responsibilities:

  • Check and verify with doctor’s order and Kardex.
  • Observe rights in medication administration such as giving the right drug to the right patient using the right route and at the right time.
  • Monitor ECG, serum electrolytes and thyroid function test results.
  • Administer accurately because adverse reactions and tolerance might occur.
  • Raise side rails up because client might be restless and drowsy because of this drug.
  • Keep room well-lit and see to it that client has a person with him closely in case of vertigo.
  • Assess lung sounds, PR and BP before drug administration and during peak of medication.
  • Assess pulse for rhythm.
  • Provide oral care or let patient gurgle after inhalation to get rid of the unpleasant aftertaste of the inhalation.
  • Auscultate lungs for presence of adventitious breath sounds that may signal pulmonary edema, airway resistance or bronchospasm.
  • Inspect client’s nail bed and oral mucosa for pallor.
  •  Place client in position of comfort to facilitate optimum rest and sleep.

Client and Family Teaching

  • Warn patient about risk of paradoxical bronchospasm and to stop drug immediately if it occurs.
  • Teach patent to perform oral inhalation correctly. Give the following instructions for using MDI:
    • Shake the inhaler
    • Clear nasal passages and throat
    • Breath out, expelling as much air from lungs as possible
    • Place mouthpiece well into mouth, seal lips around the mouthpiece, and inhale deeply as you release a dose from the inhaler. Or hold inhaler about 1 inch (two-finger widths) from open mouth; inhale while dose is released.
    • Hold breath for several seconds, remove mouthpiece and exhale slowly.
  • If prescriber order more than 1 inhalation, tell patient to wait at least 2 minutes before repeating procedure.
  • Tell patient that use of a spacer device may improve drug delivery to lungs
  • If patient is also using corticosteroid inhaler, instruct him to use the bronchodilators first then wait about 5 minutes before using corticosteroids open air passages for maximum effectiveness of the corticosteroids
  • Tell patient to remove canister and wash inhaler with warm, soapy water at least once a week
  • Advise patient not to chew or crush extended-release tablets or mix them with food.
  • Advise patient to seek assistance in performing activities of daily living because the risk of feeling weak as well as having vertigo, drowsiness, and headache is possible.
  • Educate client about avoiding stimulus that might precipitate vertigo such as too much light and too much noise both in forms of talking and loud music and television.
  • Instruct client to rise slowly from bed or when changing positions from lying to sitting to standing.
  • Advise client to have small frequent feedings to avoid increasing risk of vomiting and heartburn.
  • Emphasize with the family and the client the importance of wiping off sweat to avoid easy breakdown of skin integrity.
  • Instruct client to report palpitations and increasing difficulty of breathing.
  • Encourage family to provide opportunity for the client to express his or her feelings  as apprehension and anxiety are common side effects of the drug.
  • Instruct client to increase oral fluid intake to facilitate drug excretion.
  • Instruct client to avoid spicy and oily foods to prevent risk of developing heartburn.
  • Emphasize with the client the importance of gurgling after inhalation to prevent dry mouth.
  • Extended-release tablet should be swallowed-whole. It should not be crushed or chewed
  • Inform the patient that Albuterol may cause an unusual or bad taste

This page was last edited on 24 May 2020

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