albuterol sulfate Nursing Considerations & Management

Drug Name

Generic Name : albuterol sulfate

Brand Name:  AccuNeb, Novo-Salmol (CAN), Proventil, Proventil HFA, Salbutamol (CAN), Ventodisk (CAN), Ventolin HFA

Classification: Sympathomimetic, Beta2-selective adrenergic agonist, Bronchodilator, Antiasthmatic

Pregnancy Category C

Dosages

ADULTS

Oral

  • Initially, 2 or 4 mg (1–2 tsp syrup) tid–qid PO; may cautiously increase dosage if necessary to 4 or 8 mg qid, not to exceed 32 mg/day.

Inhalation

  • Each actuation of aerosol dispenser delivers 90 mcg albuterol; 2 inhalations q 4–6 hr; some patients may require only 1 inhalation q 4 hr; more frequent administration or larger number of inhalations not recommended.
    • Prevention of exercise-induced bronchospasm: 2 inhalations 15 min prior to exercise.

Solution for inhalation

  • 2.5 mg tid to qid by nebulization.

Inhalation capsules

  • One 200 mcg capsule q 4–6 hr up to two 200 mcg capsules q 4–6 hr.
    • Prevention of exercise-induced asthma: One 200 mcg capsule inhaled 15 min before exercise.

PEDIATRIC PATIENTS

Oral, tablets

  • 6–12 yr: 2 mg tid–qid. Do not exceed 24 mg/day.
  • > 12 yr: Use adult dosage.

Oral, syrup

  • < 2 yr: Safety and efficacy not established.
  • 2–6 yr: Initially 0.1 mg/kg tid, not to exceed 2 mg (1 tsp) tid; if necessary, cautiously increase stepwise to 0.2 mg/kg tid. Do not exceed 4 mg (2 tsp) tid.
  • 6–14 yr: 2 mg (1 tsp) tid–qid; if necessary, cautiously increase dosage. Do not exceed 24 mg/day in divided doses.
  • 14 yr: Use adult dosage.

Inhalation

  • 2–12 yr: For child 10–15 kg, use 1.25 mg; for child > 15 kg, use 2.5 mg.
  • 12 yr: Use adult dosage.

Solution for inhalation

  • 10–15 kg: 1.25 mg bid or tid by nebulization.
  • 15 kg: 2.5 mg bid or tid by nebulization.

Inhalation capsules

  • > 4 yr: One 200 mcg capsule inhaled q 4–6 hr.
    • Prevention of exercise-induced asthma: One 200 mcg capsule inhaled 15 min before exercise.
Therapeutic actions
  • 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
  • Relief and prevention of bronchospasm in patients with reversible obstructive airway disease
  • Inhalation: Treatment of acute attacks of bronchospasm
  • Prevention of exercise-induced bronchospasm
  • Unlabeled use: Adjunct in treating serious hyperkalemia in dialysis patients; seems to lower potassium concentrations when inhaled by patients on hemodialysis
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
Contraindications and cautions
  • 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 CVA; COPD patients with degenerative heart disease.
  • 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).
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 CVA; 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
Interventions
  • Use minimal doses for minimal periods; drug tolerance can occur with prolonged use.
  • Maintain a beta-adrenergic blocker (cardioselective beta-blocker, such as atenolol, should be used with respiratory distress) on standby in case cardiac arrhythmias occur.
  • Prepare solution for inhalation by diluting 0.5 mL 0.5% solution with 2.5 mL normal saline; deliver over 5–15 min by nebulization.
  • 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
  • Do not exceed recommended dosage; adverse effects or loss of effectiveness may result. Read the instructions that come with respiratory inhalant.
  • 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.
  • Report chest pain, dizziness, insomnia, weakness, tremors or irregular heart beat, difficulty breathing, productive cough, failure to respond to usual dosage.
Announcement!! Our hottest nursing game is out now in the App Store. Many nurses are playing now!LEARN MORE
+