Pulmonology Book

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Inhaled Beta Adrenergic AgonistAka: Inhaled Beta Agonist, Ventolin, Proventil, Inhaled Terbutaline, Brethaire, Pirbuterol, Maxair, Levalbuterol, Xopenex, Short-acting Beta Agonist, Inhaled Bronchodilator, Bronchodilator, Albuterol

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  1. See Also
    1. Long Acting Beta Agonist
    2. Nebulized Albuterol
  2. Indications
    1. Short acting agents for rescue use only
  3. Adverse Effects: Scheduled short acting MDI use
    1. Loss of indicator for worsening Asthma
    2. Delays use of Inhaled Corticosteroid
    3. Increases airway hyper-reactivity
    4. Greater allergen exposure
      1. Treats only acute phase reaction
    5. Regular use associated with increased mortality
      1. Terbutaline may be more risk than other preparations
    6. Acute Coronary Syndrome risk in those with CAD risk
      1. Au (2002) Chest 121:846
  4. Monitoring Use
    1. Most Metered Dose Inhalers supply 100-120 two spray doses
    2. Four times daily dosing will last one month
    3. In well controlled Asthma, inhaler will last one year
  5. Efficacy
    1. Albuterol HFA is at least as effective as CFC
      1. HFA replaces CFC inhalers due to ozone depletion
      2. Less force and smaller plume than CFC inhaler
      3. However small particle allows 2-3x lung deposition
      4. Less coordination needed in HFA firing and inhaling
      5. Spacer devices should still be used with HFA inhalers
    2. Albuterol MDI as effective as Nebulizer in ER and home
      1. Used with spacer (and mask in younger children)
      2. See Spacer Devices for Asthma Inhalers
    3. Albuterol MDI has significant advantages over Nebulizer
      1. No special equipment or maintenance
      2. Uses only 10% of the amount albuterol nebulized
      3. Minimal risk of contamination
    4. Reduced efficacy of bronchodilators in the 20% of patients with arginine genotype
      1. Israel (2001) Int Arch Allergy Immunol 124:183
      2. Wechsler (2005) Am J Respir Crit Care Med 172(1):12
    5. References
      1. Delgado (2003) Arch Pediatr Adolesc Med 157:76
      2. Mandelberg (1997) Chest 112:1501
      3. Newman (2002) Chest 121:1036
  6. Technique: Hydrofluoroalkane Inhaler (HFA Inhaler)
    1. Prior to first use
      1. Shake new inhaler for 45 seconds
      2. Prime inhaler by spraying 3-4 puffs into air (do not inhale)
    2. Later uses
      1. Same technique as with CFC inhalers
      2. Breath out, spray, and inhale deeply
      3. Hold breath for 10 seconds
      4. Wait one minute, while shaking inhaler
      5. Repeat one more puff as above
    3. Other pointers
      1. Do not use "float test" (placing inhaler in water) to see if has any medicine remaining
      2. Tally on the package the number of 2-puff doses used (expect about 100, 2-puff doses)
  7. Preparations: Short Acting
    1. Terbutaline (Brethaire)
      1. Cost: $14.68 per 30 days
      2. Dose: 2 puffs q4-6 hours
      3. Not as potently dosed as others
      4. Use for patients sensitive to adrenergic effects
    2. Pirbuterol (Maxair)
      1. Maxair Autohaler will be only CFC inhaler on U.S. market
      2. Cost: $19.53 per 30 days
      3. Dose: 2 puffs q4-6 hours
    3. Albuterol (Ventolin, Proventil)
      1. Cost: Expensive - no generic HFA inhalers
      2. Dose
        1. Standard: 2 puffs q4-6 hours
        2. Severe COPD exacerbation: 6-8 puffs q1-2 hour (max)
    4. Levalbuterol (Xoponex): Active R-isomer of albuterol
      1. Cost: $50 per month
      2. Dose: 2 puffs up to every 4-6 hours
      3. Benefit
        1. No benefit over albuterol in most patients
        2. Less FEV1 decline with chronic use than albuterol
        3. Hilaire (2007) Am fam Physician 75:247
    5. Isoproterenol
      1. Dose: 2 puffs q3-4 hours
    6. Isoetharine
      1. Dose: 2 puffs q4 hours
    7. Metaproterenol
      1. Dose: 2 puffs q4-6 hours
    8. Bitolterol
      1. Dose: 2 puffs q4-6 hours

Adrenergic beta-Agonists (C0001644)

Definition (MSH)Drugs that selectively bind to and activate beta-adrenergic receptors.
ConceptsPharmacologic Substance (T121)
MSHD000318
EnglishADREN BETA AG, ADREN BETA AGON, ADREN BETA RECEPT AG, ADREN BETA RECEPT AGON, ADRENERGIC AGONISTS BETA, Adrenergic beta Agonist, Adrenergic beta Agonists, Adrenergic beta Receptor Agonist, Adrenergic beta Receptor Agonists, Adrenergic beta-Agonist, Adrenergic beta-Agonists, Adrenergic beta-Receptor Agonist, Adrenergic beta-Receptor Agonists, ADRENERGIC RECEPTOR AGONISTS BETA, BETA ADREN AG, BETA ADREN AGON, BETA ADREN RECEPT AG, BETA ADREN RECEPT AGON, beta Adrenergic Agonist, beta Adrenergic Agonists, beta Adrenergic Receptor Agonist, beta Adrenergic Receptor Agonists, beta-Adrenergic Agonist, beta-Adrenergic Agonists, beta-Adrenergic Receptor Agonist, beta-adrenergic receptor agonists, Beta-adrenoceptor agonist, Betamimetics, RECEPT AGON ADREN BETA, RECEPT AGON BETA ADREN
Spanishagonista beta adrenergico, agonista betadrenergico
Parent ConceptsAdrenergic Agonists (C0001648), Adrenergic Agents (C0001637), Sympathomimetics (C0039052)
SourcesAOD, MSH, NCI, NDFRT, SCTSPA, SNOMEDCT, USPMG
Derived from the NIH UMLS (Unified Medical Language System)


Albuterol (C0001927)

Definition (MSH)A racemic mixture with a 1:1 ratio of the r-isomer, levalbuterol, and s-albuterol. It is a short-acting beta2-adrenergic agonist with its main clinical use in ASTHMA.
Definition (CSP)short-acting beta2-adrenergic agonist with its main clinical use in asthma.
Definition (NCI)A racemic mixture of the r-isomer levalbuterol and s-albuterol, a short-acting sympathomimetic agent with bronchodilator activity. Albuterol stimulates beta2-adrenergic receptors in the lungs, thereby activating the enzyme adenylate cyclase that catalyzes the conversion of adenosine triphosphate (ATP) to cyclic-3',5'-adenosine monophosphate (cAMP). Increased cAMP concentrations relax bronchial smooth muscle, relieve bronchospasms, and reduce inflammatory cell mediator release, especially from mast cells. Albuterol although to a lesser extent, also stimulates beta1-adrenergic receptors, thereby increasing the force and rate of myocardial contraction.
ConceptsOrganic Chemical (T109) , Pharmacologic Substance (T121)
MSHD000420
EnglishAlbuterol, ALBUTEROL PREPARATION, Salbutamol, Salbutamol product
Spanishalbuterol, salbutamol
Parent ConceptsEthanolamines (C0014983), Bronchodilator Agents (C0006280), Phenethylamines (C0031399), Adrenergic beta-Agonists (C0001644), [AU100] SYMPATHOMIMETICS (ADRENERGICS) (C0973492), [RE102] BRONCHODILATORS, SYMPATHOMIMETIC,INHALATION (C0973617), [RE103] BRONCHODILATORS, SYMPATHOMIMETIC,ORAL (C0973618), Albuterol (C0001927), Selective beta-2 adrenoceptor stimulants (C0354671), Respiratory sympathomimetic agent (C1272573), Bronchodilators, Sympathomimetic (C1579392)
SourcesAOD, CSP, LCH, LNC, MSH, MTHSPL, NCI, NDFRT, RXNORM, SCTSPA, SNOMEDCT, USPMG, VANDF
Derived from the NIH UMLS (Unified Medical Language System)


Bronchodilator Agents (C0006280)

Definition (MSH)Agents that cause an increase in the expansion of a bronchus or bronchial tubes.
Definition (CSP)agent that causes an expansion of the lumen of a bronchus or bronchiole.
ConceptsPharmacologic Substance (T121)
MSHD001993
EnglishBronchial Dilating Agents, Bronchial-Dilating Agents, bronchodilator, Bronchodilator Agents, Bronchodilator preparations, Bronchodilators, lumen dilator
Spanishagentes broncodilatadores, broncodilatador, preparaciones con broncodilatadores
Parent ConceptsPeripheral Nervous System Agents (C0243049), Autonomic Agents (C0004382), Anti-Allergic Agents (C0282555), Anti-Asthmatic Agents (C0282556), Respiratory System Agents (C0282686), Duplicate concept (C1274013)
SourcesAOD, CSP, LCH, MSH, NCI, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)


Ventolin (C0033744)

ConceptsOrganic Chemical (T109) , Pharmacologic Substance (T121)
MSHD000420
EnglishVentolin
SourcesCSP, MSH, NCI, PDQ, RXNORM
Derived from the NIH UMLS (Unified Medical Language System)


pirbuterol (C0071129)

Definition (NCI)A short-acting, beta-adrenergic receptor agonist with bronchodilator activity. Pirbuterol selectively binds to beta-2 adrenergic receptors in bronchial smooth muscle, thereby activating intracellular adenyl cyclase, an enzyme that catalyzes the conversion of adenosine triphosphate (ATP) to cyclic-3',5'-adenosine monophosphate (cAMP). Increased cAMP levels cause relaxation of bronchial smooth muscle, relieve bronchospasms, improve mucociliary clearance and inhibit the release of mediators of immediate hypersensitivity from cells, especially from mast cells.
ConceptsOrganic Chemical (T109) , Pharmacologic Substance (T121)
MSHC009118
Englishpirbuterol, PIRBUTEROL PREPARATION, pyrbuterol
Spanishpirbuterol
Parent ConceptsAdrenergic beta-Agonists (C0001644), Bronchodilator Agents (C0006280), Ethanolamines (C0014983), [RE102] BRONCHODILATORS, SYMPATHOMIMETIC,INHALATION (C0973617), Selective beta-2 adrenoceptor stimulants (C0354671), Respiratory sympathomimetic agent (C1272573), Bronchodilators, Sympathomimetic (C1579392)
SourcesMSH, NCI, NDFRT, RXNORM, SCTSPA, SNOMEDCT, USPMG, VANDF
Derived from the NIH UMLS (Unified Medical Language System)


Proventil (C0699770)

ConceptsOrganic Chemical (T109) , Pharmacologic Substance (T121)
MSHD000420
EnglishProventil
SourcesCSP, MSH, NCI, PDQ, RXNORM
Derived from the NIH UMLS (Unified Medical Language System)


Brethaire (C0701015)

ConceptsOrganic Chemical (T109) , Pharmacologic Substance (T121)
MSHD013726
EnglishBrethaire
SourcesMSH, NCI, RXNORM
Derived from the NIH UMLS (Unified Medical Language System)


Maxair (C0721597)

ConceptsOrganic Chemical (T109) , Pharmacologic Substance (T121)
MSHC009118
EnglishMaxair
SourcesMSH, NCI, RXNORM
Derived from the NIH UMLS (Unified Medical Language System)


Levalbuterol (C0772501)

Definition (MSH)The R-isomer of albuterol.
ConceptsOrganic Chemical (T109) , Pharmacologic Substance (T121)
MSHD000420
EnglishLevalbuterol, LEVALBUTEROL PREPARATION
Spanishlevalbuterol, levo-salbutamol
Parent ConceptsAlbuterol (C0001927), [RE102] BRONCHODILATORS, SYMPATHOMIMETIC,INHALATION (C0973617), Selective beta-2 adrenoceptor stimulants (C0354671), Respiratory sympathomimetic agent (C1272573), Bronchodilators, Sympathomimetic (C1579392)
SourcesMSH, NDFRT, RXNORM, SCTSPA, SNOMEDCT, USPMG, VANDF
Derived from the NIH UMLS (Unified Medical Language System)


Xopenex (C0876218)

ConceptsOrganic Chemical (T109) , Pharmacologic Substance (T121)
MSHD000420
EnglishXopenex
SourcesMSH, NCI, RXNORM
Derived from the NIH UMLS (Unified Medical Language System)


[RE102] BRONCHODILATORS, SYMPATHOMIMETIC,INHALATION (C0973617)

ConceptsPharmacologic Substance (T121)
Parent Concepts[RE100] ANTIASTHMA/BRONCHODILATORS (C0973616)
SourcesNDFRT
Derived from the NIH UMLS (Unified Medical Language System)



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