Ipratropium salbutamol (Duavent) nebule, 1 nebule PRN for dyspnea DRUG MECHANISM OF ACTION INDICATION ADVERSE EFFECT NAME

Ipratropium Anticholinergic / Beta,-agonist Management Gastrointestinal: Salbutamol Ipratropium bromide of Nausea. reversible bro Respiratory: Bronchitis, Duavent Antiasthmatic & COPD Preparations nchospasm ass dyspnea, coughing, 500 mcg / Pharmacology: Ipratropium bromide: ociated with pneumonia, 2.5 mg per Ipratropium bromide is a quaternary obstructive bronchospasm, 2.5 ml ammonium compound with airway pharyngitis, sinusitis, pulmoneb anticholinergic (parasympatholytic) diseases (eg, rhinitis. properties. Similar to atropine, it is a bronchial Additional adverse Solunon for nonselective competitive antagonist asthma). reactions, reported in nebulizano of muscarinic receptors present in For patients <2% of patients include n airways and other organs. Ipratropium with edema, fatigue, bromide relaxes smooth muscles of chronic obstru hypertension, dizziness, FORMULA bronchi and bronchioles by blocking ctive nervousness, TION: acetylcholine-induced stimulation of pulmonary paresthesia, tremor, Each 2.5 guanyl cyclase, thus reducing disease (COP dysphonia, insomnia, mL formation of cyclic guanosine D) on a diarrhea, dry mouth, pulmoneb monophosphate (cGMP), a mediator regular dyspepsia, vomiting, contains: of bronchoconstriction. inhaled arrhythmia, palpitation, Ipratropium bronchodilator tachycardia, arthralgia, bromide Salbutamol: Salbutamol stimulates who continue angina, increased (anhydrous adenyl cyclase, the enzyme which to have sputum, taste ) 500 mcg catalyzes the formation of cyclic-3', evidence perversion and urinary Salbutamol 5'-adenosine monophosphate (cAMP) of bronchospa tract infection/dysuria. (as sulfate) from adenosine triphosphate (ATP). sm and who Allergic-type reactions 2.5 mg The cAMP thus formed mediates the require a eg, skin rash, cellular response eg, bronchial second angioedema of the smooth muscle relaxation. In bronchodilator tongue, lips and face, vitro and in vivo pharmacologic . urticaria, laryngospasm studies have demonstrated that and anaphylactic salbutamol has a preferential effect on reaction have also been -adrenergic receptors that are reported. especially found in respiratory tract compared with isoproterenol.

OVERDOSAGE CONTRA INDICATION These include Hypersensitivi extensions of ty to soya salbutamol's lecithin or common related food undesirable products eg, effects (eg, soybeans or angina, peanuts; and hypertension or to any hypotension, component of arrhythmias, Duavent or to palpitation, atropine and tachycardia, its derivatives. nervousness, Hypertrophic dizziness, obstructive tremor, cardiomyopat headache, hy or sleeplessness or tachyarrhythm insomnia, dry ia. mouth and nausea). Hypokalemia has also been reported; thus, plasma potassium concentrations should be monitored.

NURSING RESPONSIBILITY >Instruct client to Discontinue the use of Duavent and institute appropriate symptomatic therapy in cases of overdosage. > Ipratropium bromide-salbutamol combination can produce paradoxical bronchospasm that can be lifethreatening. If it occurs, discontinue the preparation immediately and institute alternative therapy.