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Thursday, March 4, 2021

Bronchodilators: Types, Uses, Routes, Side effects


Types Bronchodilators
  • β2 agonist, e.g. salbutamol, epinephrine, terbutaline.
  • Anticholinergics, e.g. ipratropium.
  • Theophyllines, e.g. aminophylline.
  • Other, e.g. magnesium, ketamine, isoflurane.
Bronchodilators Uses
  • Relief of bronchospasm.
Routes of administration
  • Inhaled (salbutamol, epinephrine, terbutaline, ipratropium, isoflurane)
  • Nebulised ( salbutamol, epinephrine, terbutaline, ipratropium)
  • IV (  salbutamol, epinephrine, terbutaline, ipratropium)
  • PO (aminophylline)
 Main Side Effects
  • CNS stimulation ( salbutamol, epinephrine, terbutaline, aminophylline)
  • Tachycardia ( salbutamol, epinephrine, terbutaline, aminophylline)
  • Hypotension ( salbutamol, terbutaline, aminophylline, isoflurane)
  • Hyperglycaemia ( hydrocortisone, prednisolone, epinephrine)
  • Hypokalaemia ( salbutamol, epinephrine terbutaline)
Nurses Notes
  • Selective ß2 agonists are usually given by inhalation via a pressurised aerosol or a nebuliser. Inhalation often gives rapid relief of bronchospasm. The aerosol is of less benefit in severe asthma unless used with a spacer device. They can be given by IV infusion.
  • Nebulised drugs require a minimum volume of 4mL and driving gas flow of 6-8L/min (higher or lower flow creates the wrong particle size for drug delivery).
  • In extremis, epinephrine may be used IV, SC, or injected down the endotracheal tube. As epinephrine is not selective, arrhythmias are more likely. However, the ∝ agonist effect may reduce mucosal swelling by vasoconstriction, further improving airflow.
  • Ipratropium bromide dose not depress mucociliary clearance, but thicken sputum due to its anticholinergic effect. It is synergistic with ß2 agonists, but has a slower onset of action. It is use in critical care is poorly studied.
  • Aminophylline is synergistic with ß2 agonists.  Dosages must be adjusted according to plasma levels (range 10-20mg/L) since toxic effects may be severe. Dose requirements are lower with heart failure, liver disease, chronic airflow limitation, fever, erythromycin, and higher in children, smokers, and those with a moderate to high alcohol intake.
  • Magnesium is a useful adjunctive therapy for severe asthma.
  • Ketamine or isoflurane may be useful for sedation and bronchodilatation in the ventilated asthmatic.

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