Question

While administering 3.5 mg of albuterol to a patient with asthma in the ICU, the respiratory therapist notes that the patient's heart rate increases from 120 to 150 beats/minute. What is the appropriate modification for the next treatment for this patient?

1) Reduce the dose of albuterol.
2) Discontinue the treatment.
3) Change to 3 puffs of beclomethasone dipropionate (Vanceril®).
4) Change to 0.63 mg of levalbuterol (Xopenex®).

Answer 1

Reducing the risk of tachycardia in the ICU patient, switching to 0.63 mg of levalbuterol, a medication similar to albuterol but with potentially fewer cardiac side effects, could be an appropriate next step.

Step-by-step explanation:

When administering 3.5 mg of albuterol to a patient with asthma in the ICU, an increase in heart rate from 120 to 150 beats/minute was observed, which is a known side effect of albuterol due to its beta-agonist activity. The appropriate modification for the next treatment could involve several strategies,but considering safety and the need to address the tachycardia while still providing relief for the asthma, one possible action would be to opt for an alternative medication with a potentially lower impact on heart rate.

The options provided changing to 0.63 mg of levalbuterol (Xopenex®) may be the appropriate choice. Levalbuterol is the R-enantiomer of albuterol and has been suggested to have fewer cardiac side effects at equivalent bronchodilating doses. This could potentially reduce the risk of inducing tachycardia while still providing effective treatment for the patient's asthma. Medication adjustments in a critical care setting should involve close monitoring and consultation with a pharmacist and the rest of the healthcare team.