Formoterol

INTRODUCTION

Indications

Long-term maintenance treatment of asthma. Prevention of bronchospasm in reversible obstructive airways disease, including long-term management of bronchoconstriction associated with COPD, including chronic bronchitis and emphysema. Acute prevention of exercise-induced bronchospasm, when used on an occasional, as needed, basis. Maintenance treatment of emphysema and chronic bronchitis.

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: dizziness, fatigue, headache, insomnia, malaise, nervousness. Resp: PARADOXICAL BRONCHOSPASM. CV: angina, arrhythmias, hypertension, hypotension, palpitations, tachycardia. GI: dry mouth, nausea. F and E: hypokalemia. Metab: hyperglycemia, metabolic acidosis. MS: muscle cramps. Neuro: tremor. Misc: ALLERGIC REACTIONS, INCLUDING ANAPHYLAXIS.

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.

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

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

• Assess blood pressure periodically and compare to normal values (See Appendix F). Report a sustained increase in blood pressure (BP) (hypertension) or a fall in BP (hypotension) that causes dizziness or fainting.

• 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.

• Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

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

• Monitor signs of metabolic acidosis, including confusion, lethargy, stupor, shallow rapid breathing, tachycardia, hypotension, nausea, and vomiting. Notify physician immediately if these signs occur.

• 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.

• 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 ...