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Dr. Ajith Kumar J MD
Dept. of Emergency Medicne
Travancore Medicity, Kollam
India
editor
SALBUTAMOL
Salbutamol is a selective β-2 adrenoceptor agonist. At therapeutic doses it acts on the β-2 adrenoreceptors of pulmonary bronchial muscle with little or no action on the β-1 adrenoreceptors of cardiac muscle.
Salbutamol stimulates the production of intracellular cyclic AMP, enhancing the binding of intracellular calcium to the cell membrane and endoplasmic reticulum, resulting in bronchodilation. Also enhances mucociliary clearance.
Activation of the β-2 adreno-receptors opens ATPase channels and drives potassium from the extracellular to the intracellular space. Thus decreases extracellular pottasium and increases intracellular potassium, so decreasing the chance of arrhythmias
Bronchodilation usually starts within 3-5 minutes with peak at 15-20 minutes. The duration of effect is approximately 4 hours.
MDI
Acute bronchospasm : 100 or 200 mcg (1-2 puff) 3-4 times daily.
Acute severe asthma : For asthma attacks 4-8 puffs q2-4h, may administer q20min x 3 with medical supervision .
TRADE NAME : Ventrolin 100mcg/puff
NEBULISATION
2.5 – 5mg may repeat upto 4 times a day.
Endotracheal: 0.02 mg/kg/dose 4 hourly as nebulised solution. May be repeated 2 hourly.
Via face mask: 0.05-0.15 mg/kg/dose 4 hourly as nebulised solution. May be repeated 2 hourly.
For hyperkalaemia: 4 micrograms/kg IV over 10 minutes .
TRADE NAME : Salbair Resp. 2.5mg/2.5 ml
SIDE EFFECTS OF INHALANTS : tachycardia, skeletal muscle tremor, headache, and irritability. At very high dose hyperglycemia, hypokalemia.
TAB
Adult : 2-4 mg tid (max 8gm/day)
Childrens : 100mcg/kg
Notes:
The Driving Gas in acute asthma should be oxygen otherwise air.
• The Gas Flow Rate should be 8 litres per minute.
• The Delivery Time should be 10 minutes and any remaining solution should then be discarded .
• Drugs should be diluted with normal saline to a min. volume of 4ml and a maximum of 10 ml.
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emmedonline
Dr. Ajith Kumar J MD
Dept. of Emergency Medicne
Travancore Medicity, Kollam
India
editor