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Suggest Dosage For Albuterol
Question: Hi, I am a Nurse Practitioner Student working on a class post for exercise induced bronchospasm. I am looking for ordering information for short acting and long acting medications for my patient. My case study takes place in a low income clinic so I need the most cost effective medication for this "make believe" patient.
I am looking for the actual Rx information. I can't find how to write the prescription for Albuterol inhaler and also what do you recommend for long acting?
I am looking for the actual Rx information. I can't find how to write the prescription for Albuterol inhaler and also what do you recommend for long acting?
Brief Answer:
Some information:
Detailed Answer:
Hello and welcome:
For albuterol, a typical script would be:
Sig:
Albuterol MDI
2 puffs up to q 4-6 hrs prn
Regarding the long acting beta agonist - this part gets tricky. The reason is because LABAs used on their own are no longer approved in the US. They are only approved for combination use with an inhaled corticosteroid. So this would alter your study because you would be introducing the effects of steroids.
In terms of price, while albuterol is a generic, there are no generics available for combination LABA with steroid. Probably the cheapest would be Advair and Symbicort, which are brand names.
If you redesign your study to include combo LABA + corticosteroid, you will also need to decide if you want a low, medium, or high dose. While albuterol is a standard dose, these combos come in varying dosages.
It can take up to 24 hours to get a reply, depending on how many doctors are answering questions at a time. But I will be online for most of the afternoon and can respond to you.
Some information:
Detailed Answer:
Hello and welcome:
For albuterol, a typical script would be:
Sig:
Albuterol MDI
2 puffs up to q 4-6 hrs prn
Regarding the long acting beta agonist - this part gets tricky. The reason is because LABAs used on their own are no longer approved in the US. They are only approved for combination use with an inhaled corticosteroid. So this would alter your study because you would be introducing the effects of steroids.
In terms of price, while albuterol is a generic, there are no generics available for combination LABA with steroid. Probably the cheapest would be Advair and Symbicort, which are brand names.
If you redesign your study to include combo LABA + corticosteroid, you will also need to decide if you want a low, medium, or high dose. While albuterol is a standard dose, these combos come in varying dosages.
It can take up to 24 hours to get a reply, depending on how many doctors are answering questions at a time. But I will be online for most of the afternoon and can respond to you.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you so much:
This is my case study: Part one and two. Do you think I'm on the right track as long as I rule out any cancer due to her family history?
Discussion Part One (graded)
Setting: A free medical clinic that provides health care for the underinsured.
Part 1: The days at the free clinic are always full. People have waited patiently to get an appointment.
Your next patient, XXXXXXX R., age 48, is a regular of the clinic. The chart states she is here for increased difficulty breathing with exercise.
You enter the room and XXXXXXX is standing up looking at a health poster on the wall. She warmly greets you as you introduce yourself. You ask what brings her into the clinic today. “I’m so glad I could get this appointment. I have had more problems breathing this spring than usual. Two months ago I was running 5 miles every day without any problems. Now I can barely run a mile. I am not wheezing, but I feel kind of breathless and just don’t have the energy to keep running.”
HPI: Reports she has gotten over a spring cold that lasted over 2 weeks. She had lots of congestion and a bad cough, which is resolving. It has been hard to catch her breath when running, even after using two puffs of albuterol. No chest tightness but has not tried to run without using inhaler. She states her endurance is low, and she has to push herself to keep running but ends up walking at least half of her route that she used to run without difficulty. Her husband says she is snoring at night and she has woken up once or twice in the past 2 weeks because of coughing.
PMHx: XXXXXXX R. reports her overall health as good.
Childhood/previous illnesses: chickenpox and mumps as a child.
Chronic illnesses: Has seasonal allergies, spring is her worst season. Was seen by an allergy and asthma specialist 10 years ago who told her she had allergic asthma after summer, fall, and winter PFTs were normal. Tried asthma meds but hated the side effects. Took allergy shots for 5 years with great results, now only takes Zyrtec when needed. Still has a rescue inhaler, which she uses only as needed with exercise.
Surgeries: cholycystectomy, Cheilectomy right great toe.
Hospitalizations: childbirth x 3.
Immunizations: UTD on all vaccinations.
Allergies: erythromycin: severe GI upset.
Blood transfusions: none
Drinks alcohol socially, smoked for 10 years in her 20's; quit at age 35. Denies illicit drug use.
Sleeps 6 to 7 hours a night. Exercises 4 to 5 days per week.
Current medications: Multivitamin, Vit E (takes for hot flashes), CoQ10, fish oil, Zyrtec
Social Hx: Married, lives with husband and 3 children and 3 dogs that sleep in their bedroom. Works as a cashier at Walmart.
Family Hx: Children are healthy. Parents are deceased. Mother at age 51 from brain tumor, also had breast cancer at age 32. Father died from lung CA, diagnosed when metastasized to brain. PGM: died from pancreatic CA, PGF: Alzheimer’s, died at 82. MGM: died at 83, had HTN, atherosclerosis and many heart attacks. PGF: dies at 71 from pleurisy.
Part 2:
Discussion Part Two (graded)
Further questioning for Cathy: Uses < 1 albuterol inhaler/year. Has noticed chest feels a little tight upon waking, has had increased morning headaches and white thin nasal discharge. She denies sputum. No new allergy triggers noted. She denies heartburn.
PE: ht 5’5”, wt 148
VS : BP 126/70, T 98.0, P 62, R 16 Sao2 95%
General: 48-year-old Caucasian female appears stated age in no apparent distress. Alert, oriented, and cooperative. Able to speak in full sentences and does not appear breathless. Skin: Skin warm, dry, and intact. Skin color is pale pink, no cyanosis or pallor.
HEENT: Head normocephalic. Hair thick and distribution even throughout scalp.
Eyes: Sclera clear. Conjunctiva: white, PERRLA, EOMs intact.
Ears: Tympanic membranes gray and intact with light reflex noted. Pinna and tragus nontender
Nose: Nares patent with thin white exudate noted. Mucosa appears boggy and pale. Deviated septum noted. Sinuses nontender to palpation.
Throat: Oropharynx pink, moist, no lesions or exudate. Tonsils 1+ bilaterally. Teeth in good repair, no cavities noted. Tongue smooth, pink, no lesions, protrudes in midline. Neck supple. No cervical lymphadenopathy or tenderness noted.. Thyroid midline, small and firm without palpable masses.
Lungs: Lungs clear to auscultation bilaterally. Respirations unlabored. Slight wheezing noted on forced expiration.
CV: Heart S1 and S2 noted, RRR, no murmurs, noted. Peripheral pulses equally bilaterally
Abdomen: Abdomen round, soft, with bowel sounds noted in all four quadrants. No organomegaly noted.
Labs:
PEF> 80%, FEV1/FVC >75%
This is my case study: Part one and two. Do you think I'm on the right track as long as I rule out any cancer due to her family history?
Discussion Part One (graded)
Setting: A free medical clinic that provides health care for the underinsured.
Part 1: The days at the free clinic are always full. People have waited patiently to get an appointment.
Your next patient, XXXXXXX R., age 48, is a regular of the clinic. The chart states she is here for increased difficulty breathing with exercise.
You enter the room and XXXXXXX is standing up looking at a health poster on the wall. She warmly greets you as you introduce yourself. You ask what brings her into the clinic today. “I’m so glad I could get this appointment. I have had more problems breathing this spring than usual. Two months ago I was running 5 miles every day without any problems. Now I can barely run a mile. I am not wheezing, but I feel kind of breathless and just don’t have the energy to keep running.”
HPI: Reports she has gotten over a spring cold that lasted over 2 weeks. She had lots of congestion and a bad cough, which is resolving. It has been hard to catch her breath when running, even after using two puffs of albuterol. No chest tightness but has not tried to run without using inhaler. She states her endurance is low, and she has to push herself to keep running but ends up walking at least half of her route that she used to run without difficulty. Her husband says she is snoring at night and she has woken up once or twice in the past 2 weeks because of coughing.
PMHx: XXXXXXX R. reports her overall health as good.
Childhood/previous illnesses: chickenpox and mumps as a child.
Chronic illnesses: Has seasonal allergies, spring is her worst season. Was seen by an allergy and asthma specialist 10 years ago who told her she had allergic asthma after summer, fall, and winter PFTs were normal. Tried asthma meds but hated the side effects. Took allergy shots for 5 years with great results, now only takes Zyrtec when needed. Still has a rescue inhaler, which she uses only as needed with exercise.
Surgeries: cholycystectomy, Cheilectomy right great toe.
Hospitalizations: childbirth x 3.
Immunizations: UTD on all vaccinations.
Allergies: erythromycin: severe GI upset.
Blood transfusions: none
Drinks alcohol socially, smoked for 10 years in her 20's; quit at age 35. Denies illicit drug use.
Sleeps 6 to 7 hours a night. Exercises 4 to 5 days per week.
Current medications: Multivitamin, Vit E (takes for hot flashes), CoQ10, fish oil, Zyrtec
Social Hx: Married, lives with husband and 3 children and 3 dogs that sleep in their bedroom. Works as a cashier at Walmart.
Family Hx: Children are healthy. Parents are deceased. Mother at age 51 from brain tumor, also had breast cancer at age 32. Father died from lung CA, diagnosed when metastasized to brain. PGM: died from pancreatic CA, PGF: Alzheimer’s, died at 82. MGM: died at 83, had HTN, atherosclerosis and many heart attacks. PGF: dies at 71 from pleurisy.
Part 2:
Discussion Part Two (graded)
Further questioning for Cathy: Uses < 1 albuterol inhaler/year. Has noticed chest feels a little tight upon waking, has had increased morning headaches and white thin nasal discharge. She denies sputum. No new allergy triggers noted. She denies heartburn.
PE: ht 5’5”, wt 148
VS : BP 126/70, T 98.0, P 62, R 16 Sao2 95%
General: 48-year-old Caucasian female appears stated age in no apparent distress. Alert, oriented, and cooperative. Able to speak in full sentences and does not appear breathless. Skin: Skin warm, dry, and intact. Skin color is pale pink, no cyanosis or pallor.
HEENT: Head normocephalic. Hair thick and distribution even throughout scalp.
Eyes: Sclera clear. Conjunctiva: white, PERRLA, EOMs intact.
Ears: Tympanic membranes gray and intact with light reflex noted. Pinna and tragus nontender
Nose: Nares patent with thin white exudate noted. Mucosa appears boggy and pale. Deviated septum noted. Sinuses nontender to palpation.
Throat: Oropharynx pink, moist, no lesions or exudate. Tonsils 1+ bilaterally. Teeth in good repair, no cavities noted. Tongue smooth, pink, no lesions, protrudes in midline. Neck supple. No cervical lymphadenopathy or tenderness noted.. Thyroid midline, small and firm without palpable masses.
Lungs: Lungs clear to auscultation bilaterally. Respirations unlabored. Slight wheezing noted on forced expiration.
CV: Heart S1 and S2 noted, RRR, no murmurs, noted. Peripheral pulses equally bilaterally
Abdomen: Abdomen round, soft, with bowel sounds noted in all four quadrants. No organomegaly noted.
Labs:
PEF> 80%, FEV1/FVC >75%
Brief Answer:
Some thoughts:
Detailed Answer:
Ok, at least the way this history is written there are some symptoms that are not typical of exercise induced asthma. This patient does likely have exercise induced asthma, based on her history of asthma and allergies that were dxd by an allergist, and that she has albuterol for exercise, with apparent reversibility of bronchoconstriction (I am assuming the latter because why else would she continue to use the albuterol). However, exercise induced asthma gives tightness of breathing and wheezing or cough rather than fatigue as presenting symptoms. It is also unusual for the exercise induced asthma to come on rather abruptly in an adult.
It is interesting that the thyroid was not examined. I check that any time I hear a patient complain of lack of energy, regardless of what else is going on.
Also, I wonder what is meant by "tied asthma meds but hated the side effects". Which asthma meds?
My differential list would include:
1. Exercise induced asthma in an atopic patient with history of asthma.
2. R/O lung cancer
3. R/O subclinical respiratory infection
Some thoughts:
Detailed Answer:
Ok, at least the way this history is written there are some symptoms that are not typical of exercise induced asthma. This patient does likely have exercise induced asthma, based on her history of asthma and allergies that were dxd by an allergist, and that she has albuterol for exercise, with apparent reversibility of bronchoconstriction (I am assuming the latter because why else would she continue to use the albuterol). However, exercise induced asthma gives tightness of breathing and wheezing or cough rather than fatigue as presenting symptoms. It is also unusual for the exercise induced asthma to come on rather abruptly in an adult.
It is interesting that the thyroid was not examined. I check that any time I hear a patient complain of lack of energy, regardless of what else is going on.
Also, I wonder what is meant by "tied asthma meds but hated the side effects". Which asthma meds?
My differential list would include:
1. Exercise induced asthma in an atopic patient with history of asthma.
2. R/O lung cancer
3. R/O subclinical respiratory infection
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
That was also my thoughts. I would treat the exercise induced asthma while I ruled out the lung cancer and waited on lab results, chest xray, etc... I just wanted to be sure I'm on the right track. Its very hard when you only have written information from the case study and can't really ask the patient open ended questions. Thank you so much for your time.
Brief Answer:
Thoughts:
Detailed Answer:
Yes, I think you are on the right track.
It would be great to find out what her "pack year" smoking history is. It says smoked 10 years but does not list number of cigarettes or packs per day. This history is what more concerning regarding lung cancer than her family history (although when a person has been a smoker and there is a fhx of lung cancer, good chance she was exposed to tobacco in the house growing up).
Good luck with your assignment!
Thoughts:
Detailed Answer:
Yes, I think you are on the right track.
It would be great to find out what her "pack year" smoking history is. It says smoked 10 years but does not list number of cigarettes or packs per day. This history is what more concerning regarding lung cancer than her family history (although when a person has been a smoker and there is a fhx of lung cancer, good chance she was exposed to tobacco in the house growing up).
Good luck with your assignment!
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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