
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.
Deep Dive

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.