Respiratory


Albuterol

Rapid Review

  • Mechanism of Action: Beta-2 agonist; relaxes smooth airway muscle and increases intracellular potassium uptake.
  • Indications: acute bronchospasm (asthma/COPD exacerbation); hyperkalemia. 
  • Contraindications: allergy, tachycardia, ischemic heart disease, hyperglycemia, hypokalemia
  • Dosage: Asthma/COPD: 5 mg nebulized q15 minutes; hyperkalemia: 15-20 mg nebulized
  • Onset: < 5 minutes
  • Duration: 2-4 hours
  • Adverse Reactions: hypertension, tachycardia, arrhythmias, tremors, nervousness

Pearls

  • Be cautious when administering albuterol in patients with cardiac disease, as the beta-1 agonist properties may cause palpitations/tachycardia and theoretically cause ischemia or arrythmias. 
  • Albuterol will cause serum glucose to increase and serum potassium to decrease.
Video Credit: Simple Nursing


Ipratropium

Rapid Review

  • Mechanism of Action: Anticholinergic; blocks acetylcholine at cholinergic receptors, causing dilation of bronchial smooth muscle and decreased serous/seromucous secretion. 
  • Indications: Asthma, COPD
  • Contraindications: Allergy to drug/class
  • Dosage: 0.3-0.5 mg nebulized q20 minutes (max 3 dosages)
  • Onset: 20 minutes
  • Duration: 60 minutes
  • Adverse Reactions: Urinary retention, dry throat/cough, increased intraocular pressure
  • Special Considerations: None

Pearls

  • Ipratropium should not be used as monotherapy for acute asthma/COPD, but can be a helpful adjunct when mixed with albuterol.
  • While ipratropium has been found to very beneficial in the acute setting, it does not appear to have any benefit for asthmatics in the admitted setting.
Video Credit: Simple Nursing

Brandon Simpson, PA-C
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