GROUP MEMBERS

VIDA KWOFIE MONIQUE VENEY LYLIANE MBAH NATASHA LOMAX REGGIE DEGRAF

Introduction: Name and Classification of Medication

Generic (nonproprietary) drug name: albuterol

Trade/Brand name: Proventil, Ventolin, ProAir

Drug Classification: Bronchodilator, Beta-adrenergic agonist

Routes of Administration

PO 2mg, 4mg tablets; 4mg, 8mg extended

release tablets; 2mg/5ml syrup

Inhalation 200mcg capsules; 0.083%, 0.5% inhalation

solution; 90mcg actuation

PHARMACODYNAMICS

Bronchialdilation – relaxes smooth muscles in the respiratory tract

Selective short-acting beta2 adrenergic agonist

Inhibits histamine release

INDICATION Asthma COPD Bronchitis Bronchospasm

CONTRAINDICATION

Allergy or hypersensitivity to albuterol or levalbuterol or any of their components

Congenital long QT syndrome

Oral syrup use in children < 2y.o.

PRECAUTION Administer w/ caution in patients w/

cardiovascular diseases, diabetes mellitus, hyperthyroidism, seizure disorders, elderly

Increased sympathomimetic effects when taking other sympathomimetic drugs

Enhanced toxicity in patients taking methylxanthines

Therapeutic effectiveness should be monitored closely as well as

May cause hyper-excitability and insomnia

REVIEW OF THE LITERATURE

Albuterol can induce exacerbation of hypokalemic periodic paralysis (HPP) (Tucker & Villanueva, 2013).

HPP is a rare event, which can also be due to other drugs or factors (Brosch, Sant, & Galomb, 2011).

Literatures suggest that there is controversy on the cause of elevated serum lactate levels in patients with acute asthma exacerbation (Lewis et al., 2014). Some studies attribute the elevated serum lactate level to increase work of breathing, while others attribute it to albuterol (Lewis et al., 2014). In one study, it was concluded that hyperlactemia was likely caused by albuterol than the disease severity (Lewis et al., 2014).

REVIEW OF THE LITERATURE

Lactic acidosis can occur as a result of inadequate oxygenation during an acute severe asthma episode (Ganaie & Hughes, 2011).

The treatment for albuterol intoxication is mostly supportive and symptomatic (Akta, Kostu, Unal, & Caksen, 2013). Gastric lavage is done if drug was ingested within a 4-6 hour period, also activated charcoal, lactulose, and intravenous fluid can also be administered (Akta et al., 2013).

Another study pointed that a reversible obstruction during spirometry testing 15-20minutes post albuterol is consistent with asthma (Broder, Desai, & Wilson, 2013).

IMPLEMENTATION PLAN INCLUDING CULTURAL CONSIDERATIONS, AGE, ETHNICITY

Ethnicity/Gender/Age

Number of noninstitutionalized adults who currently have asthma: 18.9 million

Number of children who currently have asthma: 7.1 million

From 2001 through 2009 asthma rates rose almost 50% among black children.

IMPLEMENTATION PLAN INCLUDING CULTURAL CONSIDERATIONS, AGE, ETHNICITY

African Americans have the highest asthma rates compared to other racial/ethnic groups.

African American women have the highest age-adjusted mortality rates due to asthma compared to any gender and racial/ethnic groups.

Death rate due to asthma was three times higher in the African American population.

Reference: CDC and American Academy of Allergy Asthma & Immunology websites

IMPLEMENTATION PLAN INCLUDING CULTURAL CONSIDERATIONS, AGE, ETHNICITY Assessment:

Patients should have an initial asthma severity assessment to determine the type and level of initial therapy needed.

Clinicians should review patient’s exposure to allergens and irritants.

Implementation Teaching:

Patients should be able to identify and avoid triggers.

Patient education regarding warning signs of an attack.

Patients should receive a written asthma action plan to guide their self-management.

Proper administration techniques for albuterol with different devices such as nebulizers, inhalers and spacers.

SPECIAL CONSIDERATION Pregnancy Category C

Albuterol may produce significant hypokalemia in some patients possibly through intracellular shunting. (Elderly)

Changes in systolic and diastolic blood pressure have been seen in individual patients.

Heath care providers should be aware if patients are taking certain medications. Drugs that will affect Albuterol Inhalation:

Diuretic Digoxin  Beta-blockers Antidepressant Other Bronchodilators

EVIDENCE-BASED GUIDELINES Albuterol is indicated in the treatment of

Asthma and bronchiolitis. Research suggest safe for use in adults

and children in the primary care setting. Management of first time episode

Bronchiolitisin infants less than 1 year of age .

EVIDENCE-BASED GUIDELINES Recommendations: Inhaled short-acting beta2 agonists

should be used on an ‘as required’ basis to relieve symptoms (B).

They should be used before exercise in patients who have exercise-induced bronchospasm (A).

EVIDENCE-BASED GUIDELINES As there is no good evidence of clinically

important differences between different inhaled short-acting beta2 agonists, patients should be treated with the cheapest preparation that they can effectively use (D).

GROUP COHESION AND GROUP EFFORT SECTIONS 1-5: CLASSIFICATION- MONIQUE SECTION 6: REVIEW OF LITERATURE - LYLIANE SECTION 7 & 8: IMPLEMENTATION PLAN/SPECIAL

CONSIDERATIONS- NATASHA SECTION 9: EVIDENCE BASED GUIDELINES-

REGGIE POWER POINT: VIDA

GROUP COHESION AND GROUP EFFORT

http://www.mayoclinic.org/condition/asthma-attack/multimedia/asthma/VID-20084746

REFERENCE

S

Aktar, F., Köstü, M., Ünal, M., & Çaksen, H. (2013). Albuterol Intoxication in a Child. Journal Of Emergency Medicine, 45(1), 98-99. doi:10.1016/j.jemermed.2012.09.146

Broders, J. A., Desia,(2013). Help patients control their asthma. Journal Of Family Practice, 62(4), 184-190.

Brosch, J. R., Sant, R. V., & Golomb, M. R. (2011). Subacute Onset of Abnormal Gait and Head Drop in a 3-Year-Old With History of Extreme Prematurity. Journal Of Child Neurology, 26(3), 373-376. doi:10.1177/0883073810382142

Ganaie, M., & Hughes, R. (2011). An unusual case of Lactic Acidosis. British Journal Of Medical Practitioners, 4(2), 23-25.

Lewis, L. M., Ferguson, I., House, S. L., Aubuchon, K., Schneider, J., Johnson, K., & Matsuda, K. (2014). Albuterol Administration Is Commonly Associated With Increases in Serum Lactate in Patients With Asthma Treated for Acute Exacerbation of Asthma. Chest, 145(1), 53-59. doi:10.1378/chest.13-0930

TUCKER, C., & VILLANUEVA, L. (2013). Acute hypokalemic periodic paralysis possibly precipitated by albuterol. American Journal Of Health-System Pharmacy, 70(18), 1588-1591. doi:10.2146/ajhp130086