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INTRODUCTION

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pirbuterol (peer-byoo-ter-ole)

Maxair

Classification

Therapeutic: bronchodilators

Pharmacologic: adrenergics

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Indications
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Management of reversible airway disease due to intermittent asthma or COPD (quick-relief agent).

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Action
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Results in the accumulation of cyclic adenosine monophosphate (cAMP) at beta-adrenergic receptors. Produces bronchodilation. Inhibits the release of mediators of immediate hypersensitivity reactions from mast cells. Relatively selective for beta2 (pulmonary)–adrenergic receptor sites with less effect on beta1 (cardiac)–adrenergic receptors. Therapeutic Effects: Bronchodilation.

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Adverse Reactions/Side Effects
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CNS: nervousness, restlessness, tremor, headache, insomnia. Resp: PARADOXICAL BRONCHOSPASM. CV: angina, arrhythmias, hypertension, tachycardia. GI: nausea, vomiting. Endo: hyperglycemia.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Watch for signs of paradoxical bronchospasm, including wheezing, cough, dyspnea, shortness of breath, and tightness in chest and throat. These signs are more common at higher doses or during excessive use of the inhaler. If condition occurs, advise patient to withhold medication and notify physician or other health care professional immediately.

  • Assess pulmonary function at rest and during exercise (See Appendices I, J, K) to document effectiveness of medication in controlling bronchospasm.

  • Assess blood pressure (BP) periodically and compare to normal values (See Appendix F). Report a sustained increase in BP (hypertension).

  • Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report a rapid heart rate (tachycardia) or signs of other arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

  • Monitor and report signs of CNS toxicity, including nervousness, restlessness, or tremor. Sustained or severe CNS signs may indicate overdose or excessive use of this drug.

  • Be alert for signs of hyperglycemia, including confusion, drowsiness, flushed/dry skin, fruit-like breath odor, rapid/deep breathing, polyuria, loss of appetite, and unusual thirst. Patients with diabetes mellitus should check blood glucose levels frequently.

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Interventions
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  • When implementing airway clearance techniques or respiratory muscle training, attempt to intervene when the airway is maximally bronchodilated. Peak responses typically occur about 1.5 hr after inhalation.

  • Because of the risk of cardiovascular stimulation, use caution during aerobic exercise and endurance conditioning. Cardiac effects should be minimal at lower doses or occasional inhaled use. Cardiovascular effects such as arrhythmias, angina pectoris, or increased BP may occur at higher doses or during excessive use, and are caused by inadvertent stimulation of beta receptors on the heart.

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Patient/Client-Related Instruction
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  • Advise patient not to exceed the recommended dose or frequency of inhalations. Contact physician immediately if bronchospasm is not relieved by medication or is accompanied by diaphoresis, dizziness, or other symptoms.

  • Counsel patient on proper use of inhaler; observe use of this device whenever possible to ensure proper technique.

  • Instruct patient and family/caregivers to report other troublesome side effects such as severe or prolonged ...

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