Arformoterol

INTRODUCTION

Indications

Long-term management of bronchospasm associated with chronic obstructive pulmonary disease (COPD).

Action

Produces accumulation of cyclic adenosine monophosphate (cAMP) at beta-adrenergic receptors, resulting in relaxation of airway smooth muscle. Relatively specific for beta₂ (pulmonary) receptors. Therapeutic Effects: bronchodilation.

Adverse Reactions/Side Effects

CNS: headache, insomnia, nervousness, weakness. Resp: PARADOXICAL BRONCHOSPASM. CV: ECG changes, tachycardia. GI: vomiting. Derm: rash. F and E: hypokalemia. Hemat: leukocytosis. MS: cramps. Neuro: tremor. Misc: hypersensitivity reactions including anaphylaxis, fever.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor signs of paradoxical bronchospasm (wheezing, cough, dyspnea, tightness in chest and throat), especially at higher or excessive doses. 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.

• Monitor signs of hypersensitivity reactions and anaphylaxis, including pulmonary symptoms (bronchospasm, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician immediately if these reactions occur.

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

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

• Monitor and report any muscle weakness, aches, or cramps that might indicate low potassium levels (hypokalemia).

Interventions

• When implementing airway clearance techniques or respiratory muscle training, attempt to intervene when the airway is maximally bronchodilated. Peak responses typically occur 30 min 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.

Patient/Client-Related Instruction

• Advise patient to not 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 severe or prolonged headache, fatigue, vomiting, fever, or skin rash.

Pharmacokinetics

Absorption: Some systemic absorption occurs from pulmonary sites.

Distribution: Unknown.

Metabolism and Excretion: Mostly metabolized by the ...