Transcript File
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 Proventil, Ventolin, ProAir Drug name: 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 agonist Inhibits short-acting beta2 adrenergic histamine release INDICATION Asthma COPD Bronchitis Bronchospasm CONTRAINDICATION Allergy or hypersensitivity to albuterol or levalbuterol or any of their components Congenital Oral long QT syndrome 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 Bronchiolitis in 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/ast hma-attack/multimedia/asthma/VID20084746 REFERENCES 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), 15881591. doi:10.2146/ajhp130086