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.
Emergency Medicine Physician Assistant. Duke University Graduate. Army National Guard PA/Combat Medic. Former Paramedic. Devoted to learning and sharing evidence-based medicine.