Albuterol 3-agonist

Examples of sympathomimetic bronchodilators include albuterol (Ventolin), epinephrine (Adrenalin), salme-terol (Serevent), and terbutaline (Brethine). Many of the sympathomimetics used as bronchodilators have die subclassification of beta-2 ((32) receptor agonists (eg, albuterol, salmeterol, and terbutaline). Additional information concerning the various sympathomimetic dragp is given in the Summary Drug Table Bronchodilators. 

An inhaled sympathomimetic, such as albuterol, may be prescribed initially. Salmeterol, a long-acting (5-agonist, is contraindicated because of its slowed onset of action. During an acute bronchospasm, the nurse checks the blood pressure pulse, respiratory rate, and response to the drug every 15 to 35 minutes until the patient s condition stabilizes and respiratory distress is relieved. 

Albuterol (also known as salbutamol outside the United States), the most commonly used inhaled short-acting 132-agonist, is a racemic mixture (50 50) of albuterol enantiomers. The R-enantiomer is the active component whereas the S-enantiomer is inactive or may be associated with unwanted effects. Levalbuterol, the pure R-enantiomer of albuterol, is available as a solution for nebulization and as an MDI dosage form. Comparative studies show similar efficacy and safety between levalbuterol and albuterol, but the acquisition cost of levalbuterol is substantially higher. 

The addition of ipratropium bromide to inhaled p2-agonist therapy in acute severe asthma improves pulmonary function and decreases hospitalization rates in both adult and pediatric patients.31 The benefit of combining ipratropium and albuterol appears to be greatest in moderate to severe exacerbations, and the combination should be considered first-line therapy in severe exacerbations. 

In patients with mild intermittent asthma, long-term control medications are not necessary, and patients should use a short-acting inhaled P2-agonist t° prevent or treat symptoms.2 This classification includes patients with exercise-induced asthma, seasonal asthma, or asthma symptoms associated with infrequent trigger exposure. Patients can pre-treat with two puffs of cromolyn or nedocromil prior to exposure to a known trigger. The treatment of choice for exercise-induced asthma is two inhalations of albuterol 5 minutes prior to exercise.1 Cromolyn and nedocromil are less effective than albuterol for prophylaxis of exercise-induced asthma. 

A commonly prescribed class of bronchodilators is the P2-adr-energic receptor agonists (e.g., albuterol, metaproterenol) that... 

All pregnant patients with asthma should have access to a short-acting /J2-agonist (albuterol is the preferred agent). 

Albuterol and other inhaled short-acting selective / -agonists are indicated for treatment of intermittent episodes of bronchospasm and are the first treatment of choice for acute severe asthma and EIB. Regular treatment (four times daily) does not improve symptom control over as-needed use. 

May mix in same nebulizer with albuterol do not use as first-line therapy only add to / -agonist therapy Not recommended because dose in inhaler is low and has not been studied in acute asthma... 

Ipratropium bromide has a slower onset of action than short-acting /J2-agonists (15 to 20 minutes vs. 5 minutes for albuterol). For this reason, it may be less suitable for as-needed use, but it is often prescribed in this manner. Ipratropium has a more prolonged bronchodilator effect than short-acting /l2-agonists. Its peak effect occurs in 1.5 to 2 hours and its duration is 4 to 6 hours. The recommended dose via MDI is two puffs four times a day with upward titration often to 24 puffs/day. It is also available as a solution for nebulization. The most frequent patient complaints are dry mouth, nausea, and, occasionally, metallic taste. Because it is poorly absorbed systemically, anticholinergic side effects are uncommon (e.g., blurred vision, urinary retention, nausea, and tachycardia). 

P-Agonists Albuterol Sahneterol Formoterol P -adrenergic receptor ADRp2... 

Beta agonists (terbutaline, albuterol) Theophylline Antidepressants Bupropion Citalopram Escitalopram Duloxetine Fluoxetine Fluvoxamine... 

The majority of the marketed products are used for asthma and COPD. Typical agents that are used for these indications are fl2-agonists such as salbutamol (albuterol), Terbutalin or formoterol, corticosteroids such as budesonide, FUxotide or beclomethasone and mast-cell stabilizers such as sodium cromoglycate or nedocromil. 

It should be mentioned that the substituted ethanolamine group in the structure of )3-adrenobIockers is similar to that of many compounds with agonistic adrenergic activity (isoproterenol (II.1.9), albuterol (11.1.21), and others), and therefore it is possible that it may be responsible for high affinity of the examined adrenoblockers with )3-adrenergic receptors. 

One of the first 8-adrenoreceptor agonists used both currently and in the past as a bron-cholytic is epinephrine or adrenaline, isoproterenol, and especially ephedrine. In treatment and prevention of obstructive respiratory tract diseases, other j3-adrenoreceptor agonists also are used, such as isoetharine, terbutaUne, albuterol, metaproterenol, and also those described in this section—fenoterol (23.3.16), pirbuterol (23.3.22), and procaterol (23.3.25). 

This relatively selective jS -adrenergic receptor agonist is structurally very similar to albuterol, and it displays similar broncholytic properties. It is used as an inhaled drag for treating bronchial asthma. Synonyms of this drag are exirel and maxair. 

Parenteral /32-agonists such as albuterol (salbuta-mol) increase the activity of the membrane sodium-potassium ATPase, and so increase potassium entry into cells. Nebulized or infused albuterol (salbutamol) significantly lowers serum potassium concentration over 5 hours. A suitable initial dose of nebulized albuterol is 5 mg in adults. It can provoke tremor and tachyarrhythmia, and it is desirable to monitor cardiac rhythm during nebulization. The combination of nebulized albuterol (salbutamol) with infusion of insulin + glucose is more effective than the infusion alone. 

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