Authors: Maria Emfietzoglou, MD, Authors: Ashley Mauldin, MSN, APRN, FNP-BC,

Illustrators: Robyn Hughes, MScBMC

BRONCHODILATORS

albuterol
ipratropium
(Ventolin)
bromide
- short acting, theophylline
DRUG NAME (Atrovent),
salmeterol (Theo-Dur)
tiotropium bromide
(Serevent)
(Spiriva)
- long acting

CLASS β-2 agonists Anticholinergics Methylxanthine

Bind to β2- Bind to M3 Enters smooth

adrenergic muscarinic muscles of the
receptors on receptors on airways and inhibits
bronchial smooth tracheal and the enzyme
MECHANISM OF muscle cells to bronchial smooth phosphodiesterase,
ACTION cause smooth muscles and block leading to smooth
muscle relaxation acetylcholine from muscle relaxation
binding, ultimately
decreasing smooth
muscle contraction

Acute asthma COPD (treatment of Asthma and COPD

attacks (short choice); asthma
acting); prophylactic (less effective)
INDICATIONS or maintenance
therapy for asthma
and COPD (long
acting)

ROUTE(S) OF INH (inhalers or nebulizers) PO

ADMINISTRATION IV

Muscle Pupil dilation Insomnia

tremors Dry mouth Nausea and
Restlessness Tachycardia vomiting
SIDE EFFECTS Insomnia Restlessness Seizures
Tachycardia Arrhythmias
Palpitations Gastric pain
:
 Palpitations Gastric pain
Arrhythmias Hyperreflexia

Heart or renal Narrow angle Seizure

disease glaucoma disorder
Hyperthyroidism Heart disease Heart, renal,
Diabetes Hyperthyroidism or liver
mellitus Hypersensitivity disease
Pregnancy / allergic Drug
reaction interactions
with beta
blockers,
phenytoin,
CONTRAINDICATIONS
beta
AND CAUTIONS
adrenergic
agonists,
antidepressants,
and certain
antibiotics can
lead to
synergistic
effects and
cardiac
dysrhythmias

NURSING CONSIDERATIONS: BRONCHODILATORS

albuterol (Ventolin)
ipratropium bromide
- short acting,
(Atrovent), tiotropium theophylline (Theo-Dur)
salmeterol (Serevent)
bromide (Spiriva)
- long acting

Assessment and monitoring: all bronchodilators

Assess respiratory status, vital signs, and lung sounds before and after
administration
Monitor for side effects
Evaluate therapeutic response
:
 Client education Client education Assessment and
Proper technique; use Proper technique; use monitoring
a spacer with MDI a spacer with MDI Signs of theophylline
If prescribed more If prescribed more toxicity; serum
than one puff, wait than one puff, wait theophylline level;
one minute between one minute between therapeutic range: 10–
puffs puffs 20 mcg/ml
With concurrent use Administer IV
of other inhaled theophylline slowly
medications, with an IV pump
administer β-2 Never crush the
agonists first, then enteric coated or
wait five minutes and sustained release
administer other tablets
inhaled medications
Client education
Avoid smoking,
caffeine, and alcohol
use
: