Pharmacologic Profile

General Use

Used in the treatment of reversible airway obstruction due to asthma or chronic obstructive pulmonary disease (COPD). Recommendations for management of asthma recommend that rapid-acting inhaled beta-agonist bronchodilators (not salmeterol, formoterol, arformoterol, indacaterol, olodaterol, or vilanterol) be reserved as acute relievers of bronchospasm; repeated or chronic use indicates the need for additional long-term control agents, including inhaled corticosteroids, mast cell stabilizers, long-acting bronchodilators (oral theophylline, beta₂-agonists, or anticholinergics), and leukotriene modifiers (montelukast, zafirlukast).

General Action and Information

Beta₂-adrenergic agonists (albuterol, arformoterol, epinephrine, formoterol, indacaterol, levalbuterol, metaproterenol, olodaterol, salmeterol, terbutaline, and vilanterol) produce bronchodilation by stimulating the production of cyclic adenosine monophosphate (cAMP). Onset of action allows use in management of acute attacks except for arformoterol, formoterol, indacaterol, olodaterol, salmeterol, and vilanterol, which have delayed onset. Phosphodiesterase inhibitors (aminophylline and theophylline) inhibit the breakdown of cAMP. Aclidinium, glycopyrrolate, ipratropium and tiotropium are anticholinergic compounds that produce bronchodilation by blocking the action of acetylcholine in the respiratory tract.

Contraindications

Hypersensitivity to agents or preservatives (bisulfites) used in their formulation. Avoid use in uncontrolled cardiac arrhythmias.

Precautions

Use cautiously in patients with diabetes, cardiovascular disease, or hyperthyroidism.

Interactions

Therapeutic effectiveness may be antagonized by concurrent use of beta blockers. Additive sympathomimetic effects with other adrenergic (sympathetic) drugs, including vasopressors and decongestants. Cardiovascular effects may be potentiated by antidepressants and MAO inhibitors.

Nursing Implications

Assessment

• Assess BP, pulse, respiration, lung sounds, and character of secretions before and throughout therapy.
• Patients with a history of cardiovascular problems should be monitored for ECG changes and chest pain.

Potential Nursing Diagnoses

• Ineffective airway clearance (Indications)
• Activity intolerance (Indications)
• Deficient knowledge related to disease processes and medication regimen (Patient/Family Teaching)

Implementation

• Administer around the clock to maintain therapeutic plasma levels.

Patient/Family Teaching

• Emphasize the importance of taking only the prescribed dose at the prescribed time intervals.
• Encourage the patient to drink adequate liquids (2000 mL/day minimum) to ↓ the viscosity of the airway secretions.
• Advise patient to avoid OTC cough, cold, or breathing preparations without consulting health care professional and to minimize intake of xanthine-containing foods or beverages (colas, coffee, and chocolate), as these may ↑ side effects of theophylline.
• Caution patient to avoid smoking and other respiratory irritants.
• Instruct patient on proper use of metered-dose inhaler (see Medication Administration Techniques).
• Advise patient to contact health care professional promptly if the usual dose of medication fails to produce the desired results, symptoms worsen after treatment, or toxic effects occur.
• Patients using other inhalation medications and bronchodilators should be advised to use bronchodilator first and allow 5 min to elapse before administering the other medication, unless otherwise directed by health care professional.

Evaluation/Desired Outcomes

• Decreased bronchospasm. Increased ease of breathing.