Albuterol (Proventil and Others)

class / description

Class: Sympathomimetic, bronchodilator, beta₂ agonist

Description: 

sympathomymetic selective for beta₂ - adrenergic receptors. 

Relaxes smooth muscles of the bronchial tree and peripheral vasculature by stimulating adrenergic resptors of the sympathetic nervous system.

Albuterol (Proventil and Others)

 indication / onset / duration

Onset:  5-8 min. after inhalation

Duration:  2-6 hrs. after inhalation

Indications:

Relief of bronchospasm in pts with reversible obstructive airway disease

Prevention of exercise-induced bronchospasm

Anaphylaxis

Hyperkalemia

Albuterol (Proventil and Others)

contraindications / adverse reactions

Contraindications: 

hypersensitivty to albuterol or levalbuteral

Cardiac dysrhythmias associated with tachycardia (precaution)

Adverse Reactions:

Usually dose-related, restlessness, apprehension, dizziness, palpitations, tachycardia, dysrhythmias, tremors

Albuterol (Proventil and Others)

drug interactions

Drug Interactions: 

Other sympathomimetics may exacerbate adverse cardiovascualar effects.  1 symapthomimetic @ a time.

MAO inhibitors and trysyclic andtidepressants may protentiate effects on the vasculature (vasodilation)

Beta blockers may antagonize albuterol

Albuterol may potentiate diuretic-induced hypokalemia.

Albuterol (Proventil and Others)

how supplied

How Supplied:  Metered-dose inhaler: 90 mcg/metered spray (17-g canister with 200 inhalations)

Solustion for Aerosolization:  0.5% (5 mg/mL);  0.083% (2.5 mg/mL) in 3-mL unit dose/nebulizer

Albuterol (Proventil and Others)

dosage and administration adult

Dosage & Administration: 

Bronchial Asthma / Anaphylaxis / Hyperkalemia

Adult:  MDI 1-2 inhalations (90-180 mcg) q 4-6 hrs

(wait 5 min between inhalations) 

MAX 12 inhalations/day

Solution 2.5 mg (0.5 mL or 0.5% solution) diluted to 3 mL w/ 0.9% NS (0.083% solution); administer over 5-15 min; 3-4 times/day by nebulizer

Note:  In settings of severe asthma exacerbation,

4 inhalations or 5 mg in 2.5-3 mL is indicated

Albuterol (Proventil and Others)

dosage and administration pediatrics

Pediatric:  MDI 4-8 puffs (inhalation) PRN,

w/ spacer if not intubated

Solution 0.01-0.03 mL (0.05-0.15 mg)/kg/dose to max of 0.5 mL/dose

diluted in 2 mL of 0.9% NS,

may be repeated q 20 min

Nebulized albuterol 

<20 kg:  2.5 mg/dose (inhalation);

>20 kg:  5 mg/dose (inhalation)

Albuterol (Proventil and Others)

special considerations

Special Considerations: 

Preganacy safety category C

Albuterol may precipitate angina petoris and dysrhythmias

Albuterol should be used w/ caution in patients with diabetes mellitus, hyperthyroidism, prostatic hypertrophy, seizure disorder, or cardiovascular disorder.

In prehospital emergency care, albuterol should be administered only via inhalation

Amiodarone (Cordarone)

class / description

Class:  Class III antidysrhythmic

Description:  antidysrhythmic agent w/ multiple mechanisms of action.  Prolongs the duration of the action potential and effective refractory periode, and when given short-term IV, probably includes noncompetitive beta-adrenergic receptor and calcium channel blocker activity.

Amiodarone (Cordarone)

onset / duration / indication

Onset:  Within minutes

Duration:  Variable

Indications:  Initial tx and prophylaxis of frequently recurring V-Fib & hemodynamically unstable V-Tach in pts unresponsive to shock delivery, CPR, and vasopressors

Recurrent hemodynamically unstable VT

Tx of some stable atrial and ventricular dysrhythmias

Amiodarone (Cordarone)

contraindications

Contraindications: 

Pulmonary congestion

Cardiogenic shock

2^nd or 3^rd degree AV block if no pacemaker is present

Bradycardia

Sensitivity to amiodarone or iodine

Amiodarone (Cordarone)

adverse reactions

Adverse Reactions:

Hypotension

Headache

Dizziness

Bradycardia

Atrioventricular conduction abnormalities

Flushing

Abnormal salivation

Pain at IV site

Liver function abnormalities

CHF

Abnormal thyroid function

Amiodarone (Cordarone)

drug interactions

May potentiate bradycardia and hypotension w/ beta

blockers and calsium channel blockers

May increase risk of atrioventricular block and hypotension

w/ calcium channel blockers

May increase anticoagulation effects of warfarin

May decrease metabolism and increase serum levels of

phenytoin, procainamide, quinidine, and theophyllines

Routine use in combination w/ drugs that prolong Q-T

interval is not recommended

Y-site incompatibilites w/ furosemide, heparin, and

sodium bicarbonate

Amiodarone (Cordarone)

how supplied / adult administration

Supplied:  50 mg/mL vials

Adult:  Pulseless arrest unresponsive to CPR, shock, &

vasopressors - 300 mg IV/IO push.  If needed, second

dose of 150 mg IV/IO

Life threatening dysrhythmias:  Max cumulative dose - 2.2 g IV/24 hr.  May be given as rapid infusion 150 mg IV over first 10 min (15 mg/min) repeated every 10 min PRN.  Slow infusion - 360 mg IV over 6 hrs (1 mg/min).  Maintenance infusion - 540 mg IV over 18 hrs (0.5 mg/min)

Amiodarone (Cordarone)

pediatric doseage & administration

Pediatric:  Refractory VF, pulseless VT - 5 mg/kg rapid

IV/IO bolus; can be repeated to total dose of 15 mg/kg (2.2 g in adolescents) IV per 24 hr;

Max single dose - 300 mg

Perfusing suprventricular and ventricular dysrhythmias - loading dose 5 mg/kg IV/IO over 20-60 min

(max single dose - 300 mg); can repeat to a max of 15 mg/kg (2.2 g in adolescents) per day IV

Amiodarone (Cordarone)

special considerations

Special Considerations:

Pregnancy safety category D

Rapid infusion may cause hypotension

Continuous electrocardiogram monitoring is required

Slow infusion or discontinue if bradycardia or atrioventricular block occurs

Do not give with other drugs that prologn Q-T interval

(e.g. procainamide)

Maintain at room temperature and protect from excessive heat