Table of Contents
Short Acting Adrenergic Bronchodilator Agents
These medications are also known as short-acting beta-agonists (SABAs). SABAs are used primarily for the treatment of asthma and other lung diseases. The mechanism of SABAs is through dilating the smooth muscles of bronchial tubes making it easier to breathe by increase airflow (Cazzola, Page, Calzetta, & Matera, 2012). They are “rescue” medicine by providing quick relief to asthma through minimizing asthmatic symptoms preventing asthma attacks. The SABAs are used before exercises to prevent asthma condition particularly exercise-induced bronchoconstriction. Lastly, there are used for the treatment of asthmatic symptoms in intermittent asthma (Cazzola & Matera, 2014). However, these medications do not control inflammation. For shortness of breath, SABAs should be used for more than twice a week since they are used for quick relief. If the symptoms persist, this is an indication of poorly controlled asthma, and allergist / immunologist should be consulted to adjust prescription for the long acting bronchodilator since they are suitable for constant regulation and control of asthma symptoms (“Short-Acting Beta2-Agonists for Quick Relief of Asthma Symptoms”, 2015). Moreover, a combination of short and long acting bronchodilator can be prescribed, but that is the decision of the physician. The short acting adrenergic bronchodilator agents are available in four forms namely pills, injectable, inhaler, and liquids (Cazzola & Matera, 2014; Cazzola, Page, Calzetta, & Matera, 2012). The paper is geared at the compressive analysis of three short acting adrenergic bronchodilator agents namely Metaproterenol, Albuterol, and Levalbuterol.
Metaproterenol
Classification
Metaproterenol sulfate belongs to a class of medication known as bronchodilator which functions to relax the smooth muscles of bronchial opening up the airways into the lung (“Alupent (Metaproterenol Sulfate): Side Effects, Interactions, Warning, Dosage & Uses”, 2017). In particular, the drug belongs to beta-adrenergic agonist class which is a group of medications which work the same way and treats the similar medical problem.
The Clinical Indications of Use
The medication should be used as a bronchodilator for bronchial asthma and emphysema and bronchitis which occurs due to reversible bronchospasm. During the use of inhalation aerosol, one should be careful not spray into the eyes by enclosing the mouthpiece completely with lips and exhaling deeply and inhaling slowly (“DailyMed – Metaproterenol Sulfate- metaproterenol sulfate tablet”, 2017). The medication is used differently for different age group. In the treatment of both asthma and COPD, the oral form is prescribed as 20mg to be taken three to four times a day for the age of above 9 years old. For the age group of six to nine years, 10mg should be taken three to four times a day. However, the physician can adjust this dosage based on how it is working (“Alupent (Metaproterenol Sulfate): Side Effects, Interactions, Warning, Dosage & Uses”, 2017). For children below the age of six, the medication is not recommended.
The Clinical Pharmacology and Mechanism of Actions
Metaproterenol acts like any other beta adrenergic agonist through beta-2 adrenergic receptors which are predominant in bronchial smooth muscles. In the smooth muscle, it causes relaxation by acting on intracellular adenyl cyclase beta-2 adrenergic receptors that cause increases in cyclic AMP through the conversation of ATP (“Metaproterenol: Indications, Side Effects, Warnings – Drugs.com”, 2017). Additionally, there is inhibition of releases of mediators which are involved in immediate hypersensitivity especially those of mast cells.
Side Effects and Adverse Reactions
The side of Metaproterenol includes headache, insomnia, tremor, and dizziness. The chronic side effects are allergic reactions depicted by difficulties breathing and swelling of face, tongue and lips and irregular heartbeats (“Alupent (Metaproterenol Sulfate): Side Effects, Interactions, Warning, Dosage & Uses”, 2017). When a patient experiences these side effects, they should stop taking the medication and consult a doctor or seek medical attention. The Metaproterenol should not be used with other beta adrenergic aerosol bronchodilators as it can result in additive effects. It should be with cyclic antidepressant or monoamine oxidase inhibitors as it will affect the vascular system (“DailyMed – Metaproterenol Sulfate- metaproterenol sulfate tablet”, 2017). As a result, it should not be used with people with cardiovascular disorders. The drug can cause adverse reactions through interacting with others mainly respiratory drugs and antidepressants. Pregnant women and nursing women should be careful before using this medication by consulting a healthcare practitioner to prevent the effects of medication on a child (“Metaproterenol: Indications, Side Effects, Warnings – Drugs.com”, 2017). Also, people with diabetes, allergies, history of heart diseases, problems with thyroid, children and senior individuals should not take this medication with consult a physician to prevent adverse side effects.
Most Pertinent Clinical Applications
The medication is used in the treatment of asthma symptoms and breathing problems caused by chronic obstructive pulmonary disease (COPD) which are emphysema and bronchitis. The drug can be used singly or in a combined therapy with other asthma or COPD medications.
Respiratory Care Assessments Before and After Therapy
Before the use of the drug an individual should be asked of age, history of other medications, and the severity of the diseases. Then they should be observed after first medication to see if there is an indication of any side effects or adverse reaction. After treatment an individual should be examined to ensure there no adverse reactions or side effects and if the symptoms have been effectively controlled.
Most Common Routes of Administration
The medication is administrated orally through either syrup or tablet since these are the only form of the drug.
Newer Forms of the Drug (Or New Drugs within the Same Classification)
The drug is available only in the generic form and there no new classification of the drug.
Albuterol
Classification
Albuterol belongs to a class of medication known as beta-agonist short acting. As a bronchodilator, the medication is used for quick relief of breathing problem namely shortness of breath and wheezing.
The Clinical Indications of Use
Albuterol, salbutamol, is available in different generic forms which have varied application for use. Albuterol Sulfate which is available under two different brand names RespiClick and ProAir are used for the age above 12 years to prevent exercise-induced asthma and other asthma symptoms (“Albuterol Sulfate (Albuterol Sulfate Inhalation Solution): Side Effects, Interactions, Warning, Dosage & Uses”, 2017). The dosage for the drug is two puffs every four to six hours. Albuterol Sulfate HFA comes in three different brand names Ventolin HFA, ProAir HFA and Proventil HFA and applicable above the age of four relieve of asthma symptoms and prevention of asthma induced by exercise. For the relief of asthma symptoms, one or two inhalations is recommended in four to six hours (“Albuterol Oral Inhalation: MedlinePlus Drug Information”, 2017). In case, of reducing exercise-induced asthma, two puffs are taken before fifteen minutes before exercising.
Additionally, before the use of the medication, one should follow the instructions as prescribed by the doctor and read the instructions provided in the sheet. The Albuterol device should be shaken before use, and the children should not be allowed to use Albuterol with the aid of an adult.
The Clinical Pharmacology and Mechanism of Actions
The predominant receptors in the bronchial smooth muscles are beta2-adrenergic receptors. Thus, Albuterol acts through their preferential effects on these receptors. The pharmacological action of Albuterol is through stimulation of intracellular adenyl cyclase beta-adrenergic receptors (“Albuterol – FDA prescribing information, side effects and uses”, 2017). The enzyme, intracellular adenyl cyclase, catalyzes the conversion of ATP (adenosine triphosphate) to cyclic AMP (cyclic-3′, 5’-adenosine monophosphate). With increased cyclic AMP level there is relaxation of the bronchial smooth muscle. Moreover, the releases of immediate hypersensitivity mediators is inhibited especially from mast cells (“Albuterol – FDA prescribing information, side effects and uses”, 2017). Since the medication is not a substrate for catechol-O-methyl transferase, it has longer effects and reduced cardiovascular effects as compared to isoproterenol which is an anticholinergic. The drug has a high oral absorption reaching a blood plasma concentration of 18 ng/mL in two hours (“Albuterol Sulfate (Albuterol Sulfate Inhalation Solution): Side Effects, Interactions, Warning, Dosage & Uses”, 2017). The excretion is within three days and in feces. Notably, the drug can cross blood brain barrier.
Side Effects and Adverse Reactions
It is vital that an asthmatic patient have Albuterol at all time and when the prescription reduces get a refill. However, if the medication seems not to work and more than recommended doses is required within 24 hours this is an indication that it is not effective in prevention or treatment of asthma attacks. Markedly, this is a sign of an acute asthma attack, and a doctor should be consulted (“Albuterol Oral Inhalation: MedlinePlus Drug Information”, 2017). To ensure there are no adverse reactions one should not take Albuterol if they are allergic to it. For instance, those allergic to protein milk should not use ProAir RespiClick. Moreover, those with chronic heart diseases such as congestive heart failure, high blood pressure as well as other diseases such as epilepsy, diabetes, reactive thyroid and hypokalemia should not use the medication (“Albuterol Sulfate (Albuterol Sulfate Inhalation Solution): Side Effects, Interactions, Warning, Dosage & Uses”, 2017). The above cautions are stated to prevent adverse reactions. However, the drug is associated with a number of side effects namely headache, sore throat, diarrhea, back pain, and nervousness. The chronic side effects are low potassium, chest pain, burning sensation when urinating, choking, high blood sugar and fast heart rate (“Albuterol – FDA prescribing information, side effects and uses”, 2017). The medication can cause adverse drug reactions if used with other inhaled medications, antidepressants, digoxin, MAO inhibitors, antidepressant to mention but a few.
Most Pertinent Clinical Applications
Albuterol increases the flow of air into the lungs through relaxation of bronchial smooth muscles. The medication has two specific use. One, bronchospasm prevention or treatment in people with reversible obstructive airway disease. Secondly, prevention of exercise-induced bronchospasm (“Albuterol Sulfate (Albuterol Sulfate Inhalation Solution): Side Effects, Interactions, Warning, Dosage & Uses”, 2017). Therefore, there will be no wheezing, coughing, shortness of breath, chest tightness,
Respiratory Care Assessments Before and After Therapy
The patient should be assessed for an allergic reaction to the medication, presence of other diseases or medications which will cause adverse reactions to the drug. The vulnerable population should be considered before using the medication such as a child, the elderly, mothers in labor and delivery, nursing mothers and the pregnant women (“Albuterol Oral Inhalation: MedlinePlus Drug Information”, 2017). After, therapy the patient for any cases of adverse reactions or chronic sides effects. If there are indications should be stopped. Moreover, if the drug is not effective another form of medication should be considered to relief the symptoms.
Most Common Routes of Administration
The tablet form of the drug is taken through administration. The inhaled form is taken through nebulizer or inhaler by nasal administration.
Newer Forms of the Drug (Or New Drugs within the Same Classification)
Currently, there is no new form of the drug in the same classification.
Levalbuterol
Classification
The drug belongs to a class of drug known as beta-adrenergic agonist which acts through relaxation of airways to increase the passage of air freely into the lungs (“Levalbuterol Oral Inhalation: MedlinePlus Drug Information”, 2017).
The Clinical Indications of Use
The medication is used for the treatment of reversible obstructive airway disease through prevention or treatment of bronchospasm for people over the age of six years old. The medication in inhalation solution or inhalation aerosol should be used as per given patient instructions (“Levalbuterol (Inhalation Route) Proper Use – Mayo Clinic”, 2017). The inhaler should be well cleaned. The medication is used differently depending on whether it is a solution or aerosol. For the inhalation aerosol, it should be used for a child over the age of six six years and other adults through one or two puffs in six to eight hour. The medication should be used under the age of four unless determined and recommended by a doctor. On the other hand, inhalation solution is used as 0.63mg in a nebulizer for those above the age of twelve years three times a day between six to eight hours (“Levalbuterol Oral Inhalation: MedlinePlus Drug Information”, 2017). In the age of six to eleven 0.31 mg should be used three times a day and below that age, it should be determined by a doctor.
The Clinical Pharmacology and Mechanism of Actions
The drug acts through activation of beta2-adrenergic receptors in the smooth muscles of bronchial leading to activation of adenylcyclase that increases the concentration of intracellular cyclic AMP. The increases in the of cyclic AMP leads to relaxation of smooth muscles through a sequence of events. First, there is activation protein kinase A that prevents phosphorylation of myosin and reduce the concentration of intracellular calcium (“Levalbuterol – FDA prescribing information, side effects and uses”, 2017). Levalbuterol is effective in the treatment of bronchoconstriction challenges as it relaxes all the airways irrespective of the involved spasmogen. Moreover, the mediators are inhibited from being released especially those from mast cell.
Side Effects and Adverse Reactions
The side effects are a headache, diarrhea, dizziness, heartburn, weakness, nervousness and fever. The chronic side effects are shown by hives, pounding heartbeat, difficulty breathing, chest pain, itching, swelling of the tongue, lips, face, neck, hands and lower legs (“Levalbuterol Oral Inhalation: MedlinePlus Drug Information”, 2017). To prevent the side effects, an individual should not take the medication more or less than instructed and they should take the medication without consulting a physician. The medication can have deleterious cardiovascular effects through interactions which other drugs causing adverse drug reactions some of the drugs which should be avoided are monoamine oxidase inhibitors or tricyclic antidepressants, digoxin, diuretics, and beta-blockers (“Levalbuterol – FDA prescribing information, side effects and uses”, 2017).
Most pertinent clinical applications
The drug treatment or prevention of asthma or COPD symptoms which include wheezing, coughing, shortness of breath and chest tightness.
Respiratory care assessments before and after therapy
Several considerations must be assessed before the drug is prescribed and they include the age of the patient such as young and senior people, the health condition such as those with a cardiovascular disorder, health conditions such allergies, seizures , thyroid reactivity and . The nursing mother and the pregnant women are also considered this is to prevent adverse side effects and adverse reactions (“Levalbuterol Oral Inhalation: MedlinePlus Drug Information”, 2017). The patients should be assessed after treatment to ensure that the symptoms have subsidized.
Most Common Routes of Administration
The route of administration is orally through levalbuterol inhalation solution.
Newer forms of the drug (or new drugs within the same classification)
The new form of the drug in this classification is the use of inhalation aerosol as the inhalation was the only form which was being used. The approval was in 2005 by the FDA (“Levalbuterol – FDA prescribing information, side effects and uses”, 2017).
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