ALBUTEROL SULFATE

GENERIC NAME: albuterol sulfate

BRAND NAME: AccuNeb, Novo-Salmol, Proventil, Proventil HFA, Salbutamol,

Ventodisk, Ventolin HFA

DRUG CLASSES: Beta2-selective adrenergic agonist, Bronchodilator, Antasthmatic

Pregnancy Category C
In low doses, acts relatively selectively at beta2-adrenergic receptors to cause
bronchodilation and vasodilation; at higher doses, beta2 selectivity is lost, and the
drug acts at beta2 receptors to cause typical sympathomimetic cardiac effects.

INDICATIONS

1. Relief and prevention of bronchospasm in patients with reversible obstructive

airway disease;
2. Inhalation: Treatment of acute attacks of bronchospasm;
3. Prevention of exercise-induced bronchospasm;

CONTRAINDICATIONS

1. Contraindicated with hypersensitivity to albuterol; tachyarrhythmias, tachycardia

caused by digitalis intoxication; general anesthesia with halogenated hydrocarbons
or cyclopropane (these sensitize the myocardium to catecholamines); unstable
vasomotor system disorders; hypertension; coronary insufficiency, CAD; history of
stroke; COPD patients with degenerative heart disease.

2. Use cautiously with diabetes mellitus (large IV doses can aggravate diabetes and
ketoacidosis); hyperthyroidism; history of seizure disorders; psychoneurotic
individuals; labor and delivery (oral use has delayed second stage of labor;
parenteral use of beta2-adrenergic agonists can accelerate fetal heart beat and

cause hypoglycemia, hypokalemia, pulmonary edema in the mother and

hypoglycemia in the neonate); lactation; the elderly (more sensitive to CNS effects).

ADVERSE EFFECTS

CNS: Restlessness, apprehension, anxiety, fear, CNS stimulation, hyperkinesia,

insomnia, tremor, drowsiness, irritability, weakness, vertigo, headache
CV: Cardiac arrhythmias, tachycardia, palpitations, PVCs (rare), anginal pain
Dermatologic: Sweating, pallor, flushing
GI: Nausea, vomiting, heartburn, unusual or bad taste in mouth
GU: Increased incidence of leiomyomas of uterus when given in higher than human
doses in preclinical studies
Respiratory: Respiratory difficulties, pulmonary edema, coughing, bronchospasm,
paradoxical airway resistance with repeated, excessive use of inhalation
preparations

INTERACTIONS

Drug-drug

1. Increased sympathomimetic effects with other sympathomimetic drugs;

2. Increased risk of toxicity, especially cardiac, when used with theophylline,
aminophylline, oxtriphylline;
3. Decreased bronchodilating effects with beta-adrenergic blockers (eg,
propranolol);
4. Decreased effectiveness of insulin, oral hypoglycemic drugs; and
5. Decreased serum levels and therapeutic effects of digoxin

NURSING CONSIDERATIONS
Assessment
History: Hypersensitivity to albuterol; tachyarrhythmias, tachycardia caused by
digitalis intoxication; general anesthesia with halogenated hydrocarbons or
cyclopropane; unstable vasomotor system disorders; hypertension; coronary
insufficiency, CAD; history of stroke; COPD patients who have developed
degenerative heart disease; diabetes mellitus; hyperthyroidism; history of seizure
disorders; psychoneurotic individuals; lactation

Physical: Weight; skin color, T, turgor; orientation, reflexes, affect; P, BP; R,

adventitious sounds; blood and urine glucose, serum electrolytes, thyroid function
tests, ECG

Interventions1. Use minimal doses for minimal periods; drug tolerance can occur
with prolonged use.
2. Maintain a beta-adrenergic blocker (cardioselective beta-blocker, such as
atenolol, should be used with respiratory distress) on standby in case cardiac
arrhythmias occur.
3. Prepare solution for inhalation by diluting 0.5 mL 0.5% solution with 2.5 mL
normal saline; deliver over 515 min by nebulization.
4. Do not exceed recommended dosage; administer pressurized inhalation drug
forms during second half of inspiration, because the airways are open wider and the
aerosol distribution is more extensive.

Teaching points

1. Do not exceed recommended dosage; adverse effects or loss of effectiveness

may result. Read the instructions that come with respiratory inhalant.
2. You may experience these side effects: Dizziness, drowsiness, fatigue, headache
(use caution if driving or performing tasks that require alertness); nausea, vomiting,

change in taste (eat frequent small meals); rapid heart rate, anxiety, sweating,
flushing, insomnia.
3. Report chest pain, dizziness, insomnia, weakness, tremors or irregular heart beat,
difficulty breathing, productive cough, failure to respond to usual dosage.