Isoetharine

A to Z Drug Facts

 Action Produces bronchodilation by relaxing bronchial smooth muscle through beta-2 adrenergic receptor stimulation.

 Indications Relief of bronchial asthma and reversible bronchospasm associated with bronchitis and emphysema.

 Contraindications Hypersensitivity to any components; cardiac arrhythmias associated with tachycardia; tachycardia or heartblock caused by digitalis intoxication; narrow-angle glaucoma.

 Route/Dosage

Individualize dosage.

HAND NEBULIZER

ADULTS & CHILDREN ³ 12 YR: Inhalation 3 to 7 inhalations undiluted q 4 hr prn.

INTERMITTENT POSITIVE PRESSURE BREATHING ADMINISTRATION

ADULTS & CHILDREN ³ 12 YR: Inhalation 0.5 ml of 1% solution diluted 1:3 with saline. Inspiratory flow rate of 15 L/min at cycling pressure of 15 cm H₂O, but can be adjusted according to patient needs.

OXYGEN AEROSOLIZATION

ADULTS & CHILDREN ³ 12 YR: Inhalation 0.5 ml of 1% solution diluted 1:3 with saline. Adjust oxygen flow to 4 to 6 L/min over 15 to 20 min.

 Interactions

Epinephrine, other sympathomimetics: May cause excessive tachycardia.

 Lab Test Interferences None well documented.

 Adverse Reactions

CV: Palpitations; tachycardia; elevated BP. CNS: Tremor; vertigo; anxiety; nervousness; weakness; restlessness; hyperactivity; headache; insomnia. GI: Nausea; vomiting.

 Precautions

Pregnancy: Category C. Lactation: Undetermined. Children: Safety and efficacy in children £ 12 yr not established. Elderly patients: Lower doses may be required. Special risk patients: Dosage needs to be carefully adjusted in patients with hyperthyroidism, hypertension, acute coronary disease and patients sensitive to sympathomimetic amine to prevent tachycardia, palpitations, and headache. Cardiovascular effects: Toxic symptoms in patients with cardiovascular disorders may occur. CNS effects: CNS stimulation may occur; use drug with caution in patients with history of seizures or hyperthyroidism. Diabetes mellitus: Dosage adjustment of insulin or oral hypoglycemic agent may be required. Excessive use: Paradoxical bronchospasm and cardiac arrest have been associated with excessive inhalant use. Sulfite sensitivity: Some products contain sulfites that may cause allergic-type reactions including anaphylactic symptoms. Tolerance: If previously effective dose fails to provide relief, therapy may need to be reassessed. Combined therapy: Do not use ³ 2 beta-adrenergic aerosol bronchodilators simultaneously because of potential of additive effects. Do not use as a substitute for oral or inhaled corticosteroids.

 Administration/Storage

• Dilute 1% nebulizer/intermittent positive pressure breathing solution 1:3 with normal saline.
• Nebulizer use: Find location where patient can sit comfortably for 10 to 15 min. Do not mix different types of medications without permission from doctor or pharmacist. Instruct patient to take slow, deep breaths and, if possible, to hold breath for 10 seconds before slowly exhaling. Continue until medication chamber is empty.
• Administer inhaled bronchodilator before giving other inhaled agents (eg, cromolyn, steroids).
• Do not use if solution is discolored or contains precipitate.
• Store at room temperature and protect from light.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies.
• Monitor respiratory and cardiac status, including BP and pulse, before and after therapy.
• Observe for paresthesias and coldness of extremities and decreased peripheral blood flow.
• Notify physician of failure to respond to usual dosage and of dizziness and chest pain.
• Monitor respiratory functions (eg, vital capacity, forced expiratory volume, arterial blood gases).
• Observe for therapeutic response as demonstrated by adequate breathing.

 Patient/Family Education

• Instruct patient on proper use of inhaler. Explain value of using spacing device.
• Instruct patient on proper method of determining when metered dose inhaler is empty and when it needs to be replaced.
• Advise patient to use bronchodilator before taking other inhaled agents (eg, cromolyn, steroids).
• Advise patient not to exceed or adjust recommended dosage and not to change brands without consulting physician.
• Caution patient to avoid spraying aerosol in eyes.
• Encourage patient to increase fluid intake, which helps in liquefying secretions.
• Instruct patient to notify physician if signs of paradoxical airway resistance (eg, sudden increase in shortness of breath) occur.
• Advise patient to notify physician of failure to respond to usual dosage and of dizziness and chest pain.
• Advise patient to avoid smoking, being in smoke-filled rooms, and having contact with people who have respiratory infections.

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Copyright © 2003 Facts and Comparisons
David S. Tatro
A to Z Drug Facts