Adrenergic (Sympathomimetic) Bronchodilators Flashcards
Beta 2 stimulation?
Bronchi- relaxes smooth muscle
Beta 1 stimulation?
Heart- increases HR and force of contraction
alpha 1 stimulation?
peripheral blood vessels- vasoconstriction
alpha 2 stimulation?
CNS- relax
Epinephrine onset, peak effect, and duration?
Onset: 1-3 min
Peak effect: 15-20 min
Duration: 1-3 hrs
Epinephrine types?
Natural: Pure (R) isomer, parenteral, 1%
Synthetic: Racemic mixture, nebulized, 2.25%
What are clinical indications for racemic epinephrine?
Control airway bleeding during bronchoscopy
Reduce airway swelling (upper airway)
What can be used instead of epinephrine?
Isoproterenol: B1 and B2 stimulator
Available parenterally
Metaproterenol?
Brand name, onset, duration, peak effect?
This is an adrenergic bronchodilator. Aka: Alupent
Onset: 1-5 min
Duration: 4-6 hrs
Peak effect: 30-60 min
Albuterol?
Brand names, onset, duration, peak effect?
Dosages?
Proventil, Ventolin, ProAir, AccuNeb Onset: 15 min Duration: 4-6 hrs Peak effect: 30-60 min SVN: 2.5 mg, .63 1.25 2.5 mg or MDI: 2 puffs = 2.5 mg
Levalbuterol?
Brand name?
Dose?
Levalbuterol is the pure (R) isomer or racemic albuterol.
aka: xopenex
You only need 1/2 the dose of albuterol! (Because it is a pure isomer)
What are the short acting non-catecholamines?
Albuterol, metaproterenol, and levalbuterol.
What are the long acting non-catecholamines?
extended release albuterol, salmeterol, formoterol, and arformoterol
Extended release albuterol?
Brand name?
Activity time?
aka Vospire ER
lasts for 8-12 hours
available as 4mg or 8mg tablets
Salmeterol?
Brand name?
Onset, peak effect, and duration?
Aka: Severent (DPI diskus)
Onset: slower than albuterol (>15min)
Peak effect: 3-5 hrs
Duration: 12 hrs
Formoterol?
Brand names, onset, peak effect, duration?
aka: Performist or Foradil
Onset: 15 min
Peak effect: 30-60 min
Duration: 12 hrs
What is formoterol used for?
Formoterol (Performist or Foradil) is used for asthma, exercise induced bronchospasms, and COPD. MAINTENANCE therapy
Arformoterol?
Brand name and duration?
Aka: Brovana
Duration: 12 hrs
What is arformoterol used for?
Brovana: COPD!
What dosage do you typically use for nebulization?
10-15 mg/hr
What are long acting B-adrenergic agents used for?
- Maintenance therapy of asthma not controlled by corticosteroids
- COPD needing a daily bronchodilator (Formoterol/arformoterol)
- NOT recommended for rescue therapy
What are some potential complications of long acting B-adrenergics?
Tremors, cardiac effects, tolerance, loss of bronchoprotection, HYPOkalemia, HYPERglycemia
What is something you can try if long acting B-adrenergics become tolerated?
Try combining with a corticosteroid. Corticosteroids reverse desensitization of B-receptors.
What should the RT assess during B-agonist therapy?
Are the patient’s symptoms still present?
Before/after physical assessment
Monitor for 20% increase of HR
Monitor glucose/K+
