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INTRODUCTION

salmeterol (sal-met-er-ole)

Serevent

Classification

Therapeutic: bronchodilators

Pharmacologic: adrenergics

Indications

Long-term control of reversible airway obstruction due to asthma and for maintenance treatment of asthma and prevention of bronchospasm. Prevention of exercise-induced asthma. Maintenance treatment to prevent bronchospasm in COPD, including chronic bronchitis and emphysema.

Action

Produces accumulation of cyclic adenosine monophosphate (cAMP) at beta2-adrenergic receptors. Relatively specific for beta (pulmonary) receptors. Therapeutic Effects: Bronchodilation.

Adverse Reactions/Side Effects

CNS: headache, nervousness. CV: palpitations, tachycardia. GI: abdominal pain, diarrhea, nausea. MS: muscle cramps/soreness. Neuro: trembling. Resp: paradoxical bronchospasm, cough.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

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

  • Watch for signs of paradoxical bronchospasm (wheezing, cough, dyspnea, tightness in chest and throat), especially 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 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 or trembling. Sustained or severe CNS signs may indicate overdose or excessive use of this drug.

  • Assess any muscle cramps or soreness. Report severe or prolonged musculoskeletal symptoms.

Interventions

  • When implementing airway clearance techniques or respiratory muscle training, attempt to intervene when the airway is maximally bronchodilated. Peak responses typically occur about 3–4 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 blood pressure (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 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 severe or prolonged headache or GI problems (nausea, diarrhea, abdominal pain).

Pharmacokinetics

Absorption: Minimal systemic absorption follows inhalation.

Distribution: Action is primarily local.

Metabolism and Excretion: Unknown.

Half-life: 3–4 hr.

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TIME/ACTION PROFILE (bronchodilation)

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