Albuterol: Bronchodilator Overview

Albuterol

• Bronchodilator with brand names Proventil, Ventolin, Proair, and Accuneb.
• It is classified as a sympathomimetic, bronchodilator, and short-acting beta-2 adrenergic agonist.
• Mechanism of action involves selectively stimulating beta-2 adrenergic receptors causing bronchial smooth muscle relaxation and inhibits mediator release from mast cells.
• Treats and prevents bronchospasm in patients with reversible obstructive airway disease, inhaled airway/respiratory irritant agents, and hyperkalemia.
• Contraindicated in individuals with known hypersensitivity and should be used cautiously with dysrhythmias or in conjunction with other sympathomimetics.

Albuterol Dosage and Administration (Adult)

• For respiratory distress, 2.5 to 5 mg via nebulizer or 1 to 2 inhalations (90 to 180 mcg) by MDI.
• For respiratory distress with bronchospasm signs, administer 5 mg via nebulizer or 6 puffs via MDI.
• For hyperkalemia, use 5 mg via nebulizer.

Albuterol Dosage and Administration (Pediatric)

• Administer 4 to 8 puffs with MDI every 20 minutes.
• If the child weighs less than 20 kg, give 2.5 mg/dose via nebulizer; if more than 20 kg, give 5 mg/dose via nebulizer.
• For respiratory distress with bronchospasm signs, administer 5 mg via nebulizer or 6 puffs via MDI.

Albuterol Duration of Action

• Has an onset of 5 to 15 minutes.
• Reaches peak effect in 30 minutes to 2 hours.

Ipratropium Bromide (Atrovent)

• Anticholinergic, bronchodilator, and short-acting antimuscarinic agent.
• It acts by antagonizing acetylcholine's effects on bronchial smooth muscle.
• Treats persistent bronchospasm, COPD exacerbation, and toxic inhalation (with albuterol).
• Should not be used when hypersensitive to ipratropium, atropine, alkaloids, or peanuts.
• Exercise caution in patients with urinary retention, narrow-angle glaucoma, cardiovascular disease, or hypertension.
• Common adverse effects include headache/dizziness, nervousness, tremor, dyspnea, worsening COPD symptoms, hypertension, tachycardia, palpitations, flushing, MI, dry mouth, nausea, vomiting, and GI distress .
• Potential for additive anticholinergic effects if administered with other antimuscarinic or anticholinergic medications.
• Adult and pediatric dose is 0.5 mg nebulized for up to three doses, which can be administered in conjunction with albuterol.
• Onset of action is 5 to 15 minutes, peak effect is 1.5 to 2 hours, and duration is 4 to 6 hours.
• Pregnancy safety category B, shake well before use, and avoid giving to children with bronchiolitis in the prehospital setting.

DiphenhydrAMINE (Benadryl)

• Antihistamine (H1 blocker).
• It blocks H1 receptors in the respiratory tract, blood vessels, and GI smooth muscle.
• It reverses extrapyramidal reactions.
• Indicated for symptomatic allergic reactions, symptomatic dystonia antiemetic, and extrapyramidal signs or symptoms caused by phenothiazines.
• Should not be used in individuals with hypersensitivity, newborns and premature infants, and breastfeeding mothers.
• Use with caution in patients with severe vomiting, asthma, narrow-angle glaucoma, benign prostatic hypertrophy, or alcohol intoxication, and use is controversial in patients with lower respiratory tract disease.
• Adverse effects include drowsiness, sedation, seizures, dizziness, headache, blurred vision, wheezing, thickening of bronchial secretions, palpitations, hypotension, dysrhythmias, dry mouth, diarrhea, nausea/vomiting, hallucinations, confusion, and paradoxical CNS excitation (especially in children).
• Potentiates the effects of alcohol and other CNS depressants, and MAOIs prolong and intensify anticholinergic effects.

DiphenhydrAMINE (Benadryl) Dosage and Administration

• For adults with urticaria or pruritus, anaphylaxis, or allergic reaction 1 mg/kg up to a maximum 50 mg dose IM, IV, or orally.
• The adult antiemetic dose is 12.5 to 25 mg IV/IM or orally.
• To treat dystonic/extrapyramidal symptoms, administer 25 to 50 mg IV/IM.
• Children with the same allergic ailments give 1 mg/kg up to a maximum 50mg IM, IV, or orally.
• For children older than age 2 and weight greater than 12 kg, the antiemetic dose is 0.1 mg/kg IV (maximum: 25 mg).
• For pediatric dystonic/extrapyramidal symptoms, give 1 to 1.25 mg/kg IV/IO or IM (25 mg maximum single dose).
• For chemical restraint, 1 mg/kg IM/IV or orally (25 mg maximum dose).
• Its onset is 10 to 15 minutes, peak effect at 1 hour, and duration of 6 to 8 hours, and it is designated as Pregnancy safety: Category B
• Can be given in conjunction with any H2-blocking antihistamine.

Diazepam (Valium, Diastat AcuDial)

• Schedule IV drug and is classified as a benzodiazepine, anticonvulsant, anxiolytic, sedative, and skeletal muscle relaxant.
• It affects the limbic system and the hypothalamus, inhibits GABA receptors in the CNS, raises the seizure threshold, and induces amnesia and sedation.
• Indications include uncontrolled shivering.
• Contraindications include documented hypersensitivity, neurologic or respiratory depression, narrow-angle glaucoma, myasthenia gravis, and head injury.
• Adverse effects: dizziness, drowsiness, confusion, headache, respiratory depression, hiccups, hypotension, reflex tachycardia, nausea/vomiting, muscle weakness, ataxia, thrombosis, and phlebitis.
• Interactions: incompatible with many drugs and fluids, and concomitant use with other CNS depressants.

Diazepam (Valium, Diastat AcuDial) Dosage and Administration

• Adult shivering: 2 mg IV/IO, may repeat once in 5 minutes.
• Adult chemical restrain: 5 mg IV or 10 mg IM.
• Pediatric seizure activity: 0.1 mg/kg slow IV or IO (4 mg maximum).
• Pediatric shivering: 0.1 mg/kg IV/IO (2.5 mg maximum dose).
• Pediatric chemical restrain: 0.05 to 0.1 mg/kg IV (5 mg maximum) or 0.1 to 0.2 mg/kg IM (10 mg maximum).
• Onset of action: 2 to 5 minutes IV; 15 to 30 minutes IM.
• Peak effect: 15 minutes IV; 30 to 45 minutes IM.
• Lasts as long as 15 to 60 minutes IV and IM, and is listed as a Pregnancy safety: Category D drug.
• The dose should be decreased by 50% older than 60 years patients.
• The Convulsive Antidote Nerve Agent (CANA) is a commercially available auto-injector.

Diazepam cont...

• Inhibits GABA receptors in the CNS, causing sedative, anxiolytic, amnesic, and hypnotic effects.
• Active seizures, uncontrolled shivering with hyperthermia due to heat exposure, chemical restraint, severe respiratory distress, sedation for medical procedures, and poisoning/overdose care are indicated.
• Contraindications include: Documented hypersensitivity, neurologic or respiratory depression, acute narrow-angle glaucoma, sleep apnea, shock, alcohol intoxication, overdose, depressed vital signs.
• Concomitant use with barbiturates, alcohol, opioids, or other CNS depressants.
• Adverse effects: headache, somnolence, respiratory depression/arrest, hypotension, cardiac arrest, nausea/vomiting, pain at the injection site.
• Interacts with other CNS depressants (may cause respiratory depression, hypotension, profound sedation, and death) and is potentiated by Motherwort.
• Conversely effectiveness is reduced by St. John's wort and green tea, and its effects may be potentiated by mango and grapefruit juice.

Diazepam cont...

• For adult shivering, administer 2.5 mg IV/IN/IO, may repeat once in 5 minutes; or 5 mg IM, may repeat once in 10 minutes.
• Seizures (vascular access available): 0.1 mg/kg IV/IO slowly over 2 minutes (maximum single dose: 4 mg); if access is not available, 0.2 mg/kg (maximum: 10 mg) IM or IN.
• Chemical restraint: 5 mg IV, IM, or IN with severe respiratory distress: 2 to 5 mg IV.
• The dose for procedural sedation is: 0.1 to 0.3 mg/kg IV (maximum single dose: 10 mg).
• For poisoning/overdose 0.1 mg/kg in 2 mg increments via slow IV push over 1 to 2 minutes (maximum single dose: 5 mg).
• Pediatric shivering: 0.1 mg/kg IV/IO or 0.2 mg/kg IN/IM (maximum single dose: 1 mg), a 5 mg/mL concentration is recommended for IN/IM administration.
• Pediatric seizure activity: if vascular access is available, 0.1 mg/kg IV/IO slowly over 2 minutes (maximum single dose: 4 mg); if access is not available, 0.2 mg/kg (maximum: 10 mg) IM or IN.
• Pediatric chemical restrain: 0.05 to 0.1 mg/kg IV, or 0.1 to 0.15 mg/kg IM, or 0.3 mg/kg IN (maximum dose: 5 mg).
• The dose for poisoning/overdose care is 0.1 mg/kg in 2 mg increments via slow IV push over 1 to 2 minutes (maximum single dose: 5 mg) or 0.2 mg/kg IN (maximum single dose: 4 mg).
• Its onset is immediate IV/IN or 15 minutes IM with a peak effect in 3 to 5 minutes IV/IN or 30 to 60 minutes IM
• The duration of effects is less than 2 hours IV/IN or 1 to 6 hours IM with pregnancy safety: Category D
• Careful monitoring of respiratory and cardiac function is required and the dose should be reduced by 50% in older than 60 years patients.