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Classification: Sympathomimetic

Action: Stimulates beta-2 receptors of bronchioles by increasing levels of cAMP which relaxes smooth muscles to produce bronchodilation. Also cause CNS stimulation, cardiac stimulation, increased diuresis, skeletal muscle tremors, and increased gastric acid secretion. Longer acting than isoproterenol.

Indication: Relief of bronchospasm in bronchial asthma, chronic bronchitis, emphysema and other reversible, obstructive pulmonary diseases. Also useful for treating bronchospasm in patients with co-existing heart disease of hypertension.

Adverse Reactions: Fine skeletal muscle tremor, leg ramps, palpitations, tachycardia, hypertension, headache, nausea, vomiting, dizziness, hyperactivity, insomnia, hypotension, peripheral vasodilation, flushing, feeling of tension or nervousness and other emotional upsets. Mouth and throat irritation. Serious hypokalemia. Bronchospasm, cough, bronchitits. Heartburn, epistaxis, cough, gastrointestinal (GI) discomfort, unusual taste, dyspepsia and rash.

Nursing Considerations

Assessment:

  • Assess cardio-respiratory function: BP, HR, and rhythm and breath sounds
  • Determine history of previous medication (theophylline), and ability to self medicate to prevent additive
  • Monitor for evidence of allergic reactions and paradoxical bronchospasm

Planning:

PO route

  • Give oral administration with meals to decrease gastric irritation; oral solution for children (no alcohol, sugar)
  • In elderly patients, a spacing device is advised
  • Do not crush, break, or chew extended release tablets

Aerosol route

  • Give after shaking metered dose inhaler; have patient exhale and place mouthpiece in mouth, inhale slowly while depressing inhaler, hold breath, remove inhaler, exhale slowly; allow at least 1 minute between inhalations
  • Store in light-resistance container do not expose to temperature over 86 F ( 30 C)

Nebulizer/IPPB

  • Dilute 5 mg/mL solution/2.5 mL 0.9% NaCl for inhalation, other solution do not require dilution for nebulizer O2 flow or compressed air 6-10 L/min

Implementation:

  • Instruct patient on dosage and not use more than prescribed. If regular oral dose is missed, do not double dose. Take dose when remembered and adjust other doses on a new time schedule
  • Teach patient to use inhaler; to avoid getting aerosol in eyes or blurring may result; to wash inhaler in warm water and dry 4 times daily; to rinse mouth after using
  • Tell patient not to use OTC medications before consulting physician; excess stimulation may occur
  • Instruct patient to use this medications and allow at least 5 minutes between each to prevent overstimlation
  • Instruct patient to limit caffeine products such as chocolate, coffee, tea, and cola, avoid smoking, smoke filled ┬árooms and persons w/ respiratory infection
  • Tell patient to stop drug immediately of paradoxic bronchospasm occurs and notify physician
  • In elderly patients, a spacing device is advised

Evaluation:

  • Relief of dyspnea and wheezing after 1 hour
  • Improved airway exchange
  • Improved ABGs