SALBUTAMOL Ventolin, Asmalin CLASSIFICATION(S): Ther. Class: bronchodilators Pharm.

Class: adrenergics INDICATIONS Used as a bronchodilator in the management of reversible airway obstruction caused by asthma or COPD Inhaln: Used as a quick-relief agent for acute bronchospasm and for prevention of exercise-induced bronchospasm PO: Used as a long-term control agent in patients with chronic/persistent bronchospasm. ACTION Binds to beta2-adrenergic receptors in airway smooth muscle, leading to activation of adenylcyclase 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. Therapeutic Effects: o Bronchodilation. PHARMACOKINETICS Absorption: Well absorbed after oral administration but rapidly undergoes extensive metabolism. Distribution: Small amounts appear in breast milk. Metabolism and Excretion: Extensively metabolized by the liver and other tissues. Half-life: 3.8 hr. CONTRAINDICATIONS AND PRECAUTIONS Contraindicated in: Hypersensitivity to adrenergic amines Hypersensitivity to fluorocarbons (inhaler). Use Cautiously in:

 Cardiac disease Hypertension Hyperthyroidism Diabetes Glaucoma Geriatric patients (more susceptible to adverse reactions; may require dosage reduction) Pregnancy (near term), lactation, and children <2 yr (safety not established) Excessive use may lead to tolerance and paradoxical bronchospasm (inhaler). ADVERSE REACTIONS AND SIDE EFFECTS* *CAPITALS indicate life threatening; underlines indicate most frequent. CNS: nervousness, restlessness, tremor, headache, insomnia. CV: chest pain palpitations, angina, arrhythmias, hypertension. GI: nausea, vomiting. Endo: hyperglycemia. F and E: hypokalemia. Neuro: tremor. INTERACTIONS Drug-Drug: Concurrent use with other adrenergic agents will have additive adrenergic side effects Use with MAO inhibitors may lead to hypertensive crisis Beta blockers may negate therapeutic effect Risk of hypokalemia may be increased by concurrent use of potassium-losing diuretics Hypokalemia increases the risk of digoxin toxicity. DrugNatural: Use with ephedra and caffeine-containing herbs (cola nut, guarana, mate, tea, coffee) increases stimulant effect. ROUTE AND DOSAGE PO (Adults and Children 12 yr): 24 mg 34 times daily (not to exceed 32 mg/day) or 48 mg of extended-release tablets twice daily.

PO (Geriatric Patients): Initial dose should not exceed 2 mg 34 times daily, may be increased carefully (up to 32 mg/day). PO (Children 612 yr): 2 mg 34 times daily or 4 mg as extended-release tablets twice daily; may be carefully increased as needed (not to exceed 24 mg/day). PO (Children 26 yr): 0.1 mg/kg 3 times daily (not to exceed 2 mg 3 times daily initially); may be carefully increased to 0.2 mg/kg 3 times daily (not to exceed 4 mg 3 times daily). Inhaln (Adults and Children 4 yr): Via metered-dose inhaler2 inhalations q 46 hr or 2 inhalations 15 min before exercise (90 mcg/spray); some patients may respond to 1 inhalation. Inhaln (Adults and Children >12 yr): Via nebulization or IPPB2.5 mg 34 times daily. Inhaln (Children 212 yr): Via nebulization or intermittent or IPPB0.10.15 mg/kg/dose 34 times daily or1.25 mg 34 times daily for children 1015 kgor 2.5 mg 34 times daily for children >15 kg. Inhaln (Adults and Children 4 yr): Via Rotahaler inhalation device200 mcg (as Ventolin Rotacaps) q 46 hr (up to 400 mcg q 46 hr). May also be given 15 min before exercise. AVAILABILITY Tablets: 2 mgRx, 4 mgRx Cost: 2 mg $46.34/100; 4 mg $69.11/100 Extended-release tablets: 4 mgRx Cost: 4 mg $77.62/100 Oral solution (strawberry-flavored syrup): 2 mg/5 mlRx Cost: 2 mg/5 ml $11.29/120 ml Metered-dose aerosol: 90 mcg/sprayRx, 100 mcg/sprayRx, 80 inhalations/canisterRx, 200 inhalations/canisterRx Cost: 90 mcg/spray $17.66/6.8 g, $32.12/17g, $29.62/17 g refill Inhalation solution: 0.63 mg/3mlRx, 1.25 mg/3 mlRx, 0.5 mg/mlRx, 0.83 mg/ml in vials and 3 ml unit doseRx, 1 mg/mlRx, 2 mg/mlRx, 5 mg/mlRx Cost: 0.5 mg/ml $21.20/20 ml; 0.83 mg/ml $45.34/3ml 25's Powder for inhalation (Rotacaps): 200 mcgRx Cost: 200 mcg $32.15/100 Powder for inhalation (Ventodisk): 200 mcgRx, 400 mcgRx In combination with: ipratropium (Combivent, DuonNeb).

TIME/ACTION PROFILE (bronchodilation) ONSET PO POER Inhaln 1530 min 30 min 515 min PEAK 23 hr 23 hr 6090 min DURATION 8 hr or more 12 hr 36 hr

NURSING IMPLICATIONS 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 throughout course to determine effectiveness of medication. Observe for paradoxical bronchospasm (wheezing). If condition occurs, withhold medication and notify physician or other health care professional immediately. Lab Test Considerations: May cause transient decrease in serum potassium concentrations with nebulization or higher-thanrecommended doses. POTENTIAL NURSING DIAGNOSES Airway clearance, ineffective (Indications). Knowledge deficit, related to medication regimen (Patient/Family Teaching). IMPLEMENTATION PO: Administer oral medication with meals to minimize gastric irritation. o Extended-release tablets should be swallowed whole; do not break, crush, or chew. Inhaln: Allow at least 1 min between inhalations of aerosol medication. o For nebulization or IPPB, the 0.5- 0.83-, 1-, and 2-mg/ml solutions do not require dilution before administration. The 5 mg/ml solution must be diluted with 2.5 ml of 0.9% NaCl for inhalation. Diluted solutions are stable for 24 hr at room temperature or 48 hr if refrigerated.

o For nebulizer, compressed air or oxygen flow should be 610 L/min; a single treatment of 3 ml lasts about 10 min. o IPPB usually lasts 520 min. PATIENT/FAMILY TEACHING General Info: 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. Advise patient that not all agents should be used for acute attacks. o 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. Actuators should not be changed among products. o Instruct patient to prime unit with 4 sprays before using and to discard cannister after 200 sprays. Activators should not be changed among products. o Inform patient that these products contain hydrofluoralkane and the propellant and are described as non-CFC or CFCfree (contain no chlorofluorocarbons). o Advise patient to consult health care professional before taking any OTC medications or alcohol concurrently with this therapy. Caution patient also to avoid smoking and other respiratory irritants. o Inform patient that albuterol may cause an unusual or bad taste. Inhaln: Instruct patient in the proper use of the metered-dose inhaler, Rotahaler, or nebulizer. o 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. o Advise patient to rinse mouth with water after each inhalation dose to minimize dry mouth. o Instruct patient to notify health care professional if no response to the usual dose of albuterol or if contents of one canister are used in less than 2 wk. EVALUATION Effectiveness of therapy can be demonstrated by: Prevention or relief of bronchospasm.