Salbutamol

• Salbutamol 

• Ventolin, Albuterol, Airomir, Apo-salvent

Classification:

• Bronchodilator, beta-2 adrenergic agonist

Mechanism of Action:

• Binds to beta 2-adrenergic receptors on airway smooth muscle activating adenyl cyclase and leading to an increase in intracellular cyclic-3’,5’-adeosine monophosphate (cAMP). This increase leads to activation of protein kinase A which inhibits the phosphorylation of myosin and lowers intracellular ionic calcium causing smooth muscle relaxation.

Indications:

•  Bronchoconstriction

Contraindications:

•  Hypersensitivity

Precautions:

• Patients with/taking: Tachycardia, cardiovascular disorders, cardiac ischemia or infarction
• May cause:  Hypertension

Adverse Effects:

• Tachycardia, palpitations
• Arrhythmia
• Hypertension
• Tremor
• Headache
• Muscle cramps

Dose:

• Bronchoconstriction:
  • MDI: 4-8puffs PRN
  • NEB: 2.5-5.0mg PRN
• Hyperkalemia: NEB: 10-20mg

•  ≥20kg:
  • MDI: 10puffs q 20mins up to 3 doses then q 1hr PRN
  • NEB: 1.25-5.0mg q 20mins up to 3 doses then q 1hr PRN
• <20kg:
  • MDI: 5puffs q 20mins up to 3 doses then q 1hr PRN
  • NEB: 2.5mg q 20mins up to 3 doses then q 1hr PRN 

• May be given by metered dose inhaler (MDI)
• MDI can be administered via CPAP or BVM utilizing either a built in MDI port or an MDI adapter.

• Metered dose inhaler (canister with plastic inhaler device)
  • 100 mcg per metered dose (puff)

• A spacer (holding chamber) should be used when administering by MDI directly to the patient (i.e., when not administering through the MDI adapter or port).
• Salbutamol works to reduce bronchoconstriction in the lower airways; it is not indicated for patients with stridor, which is a sign of upper airway pathology.
• When a patient has severe shortness of breath with hypoxia due to signs of bronchoconstriction (e.g., wheezing, or decreased air entry), there is no maximum dose of salbutamol.
• Salbutamol may be used when a patient is wheezing with anaphylaxis AFTER the epinephrine is given.
• Salbutamol often does not work in infants who are less than 1 year of age and should not be trialed unless the patient has life threatening distress.
• If a patient has access to an MDI in the home, use the patient’s own supply.
• Pregnancy category C [if the patient will benefit from a Category C drug, it is generally used]

• Compendium of Pharmaceuticals and Specialties (CPS)
• Translating Emergency Knowledge for Kids (TREKK) Asthma Pediatric Packages
• Salbutamol HFA drug monograph