Beta2-Adrenergic Agonists: Usage and Monitoring

• Beta2-adrenergic agonists relieve bronchospasms and prevent exercise-induced bronchospasm (EIB).
• Medication selection depends on whether fast relief or long-term management is needed.
• These agonists are classified as either short-acting or long-acting.

Prototype and Other Medications

• Albuterol is the prototype for short-acting beta2-adrenergic agonists (SABA).
• Levalbuterol is another example of a SABA.
• Long-acting beta2-adrenergic agonists (LABAs) include formoterol, salmeterol, terbutaline, vilanterol, and olodaterol.

Expected Pharmacologic Action

• Adrenergic medications stimulate beta2-adrenergic receptors to cause bronchodilation.
• Stimulation of the sympathetic system opens the airways wider.
• They can increase ciliary motility and depress histamine release in the lungs.
• SABAs such as albuterol help the airways of the lungs stay open and last 4 to 6 hr, valuable in the treatment of asthma.
• LABAs such as salmeterol are used in the treatment of clients who have stable COPD and can last up to 12 hr.

Adverse Drug Reactions

• Side effects include tachycardia, heart palpitations, and tremors.
• Angina can occur in clients with compromised cardiac blood vessels.
• Paradoxical bronchospasm can occur.
• Monitor for increased bronchoconstriction manifestations after treatment.
• Overuse of short-acting rescue inhalers (more often than twice a week) needs to be reported to a healthcare provider.

Interventions

• Monitor for tachycardia, heart palpitations, and chest pain.
• Report any findings to the healthcare provider.

Administration

• Beta2-adrenergic agonists can be given orally or by inhalation.
• Short-acting preparations are administered for acute exacerbations.
• Long-acting preparations are given for long-term control.
• For short-acting preparations, it is recommended to give 30 min before exercising to prevent exercise-induced bronchospasm.
• If also taking inhaled glucocorticoids, use the beta2-adrenergic agonists medication first.
• Inhaler medications are dispensed either in a pressurized metered dose inhaler (MDI), inhaled dry powder, a fine mist inhaler, or a nebulizer.
• When storing the MDIs, avoid extremes of temperature.

Safety Alert

• Follow the manufacturer’s instructions when using inhalation devices to ensure the correct medication amount is delivered.

Client Instructions

• Avoid caffeine.
• Report tremors that interfere with activities of daily living to their provider.
• Watch for manifestations and triggers of impending exacerbations of asthma.
• Notify their provider of changes in the pattern of exacerbations of their asthma.
• Keep a log of the frequency and intensity of exacerbations for asthma.

Safety Alert

• Notify their provider if they experience chest pain, heart palpitations, or increase in pulse rate, especially with a history of cardiovascular disease or hypertension, or are taking a digitalis-type medication.

Contraindications and Precautions

• Do not give to clients who are allergic to albuterol.
• Use caution in clients with an allergy to beta2-adrenergic agonists, a history of tachydysrhythmias, or tachycardia due to digitalis toxicity.
• Monitor clients with diabetes mellitus, hyperthyroidism, cardiovascular disease, hypertension, and angina pectoris closely.

Interactions

• Beta-adrenergic blockers reduce the effectiveness of beta2-adrenergic agonists.
• Monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants increase the risk of hypertension, tachycardia, and angina.
• Hypoglycemic or antidiabetic medications may require increased dosing.

Explore the use of beta2-adrenergic agonists in managing respiratory conditions, including COPD and bronchospasm. Learn about appropriate medications for long-term management, mechanisms of action, and potential adverse effects, especially in patients with cardiac issues. Understand the importance of monitoring and patient education for effective treatment.