Pharmacologic Profile

General Use

Used in the treatment of reversible airway obstruction due to asthma or chronic obstructive pulmonary disease. Rapid-acting inhaled beta-agonist bronchodilators (albuterol or levalbuterol) should 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

Contraindications

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

Precautions

Use beta₂ agonists cautiously in patients with diabetes, cardiovascular disease, or hyperthyroidism. Use anticholinergic agents cautiously in narrow-angle glaucoma, prostatic hyperplasia, or bladder-neck obstruction.

Interactions

Therapeutic effectiveness of beta₂ agonists may be antagonized by concurrent use of beta blockers. Beta₂ agonists may have additive sympathomimetic effects with other adrenergic drugs, including vasopressors and decongestants. Use of anticholinergic agents with other agents with anticholinergic activity may result in additive anticholinergic effects (dry mouth, dry eyes, blurred vision, constipation).

Nursing Implications

Assessment

• Assess BP, HR, respiratory rate, 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 with use of beta₂ agonists.

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 provider 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 provider 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 1st and allow 5 min to elapse before administering the other medication, unless otherwise directed by health care provider.

Evaluation/Desired Outcomes

• Decreased bronchospasm.
• Increased ease of breathing.