The Core of Asthma Management: Adrenergic Agents

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Adrenergic Agents (i.e. Albuterol, Ephinephrine, Terbutaline):

 

Mechanism of Action (MOA):

  • Analogues of naturally occurring sympathomimetics
  • Acts on beta-2 adrenergic receptors which promote bronchodilation
  1. Stimulates adenyl cyclase which converts intracellular ATP into cAMP
  2. Enhances intracellular calcium binding to cell membrane
  3. Results in bronchial smooth muscle relaxation

Side Effects: Skeletal muscle tremor, nervousness, anxiety, insomnia, headache, hyperglycemia, palpitations, tachycardia, hypertension. Dysrhythmia and myocardial ischemia are rare but caution should be used in patients with coronary artery disease.

Aerosol therapy favored over oral and parenteral routes.

  • This allows for smaller drug doses producing local effects, limits systemic absorption, and causes fewer side effects.
  • Delivery via MDI w/ spacing device or nebulizer
  • Short-acting beta agonists are mainstay of therapy  (albuterol)
  • Long acting beta agonists (salmeterol) has no role in acute exacerbations
  • Epinephrine or terbutaline can be given systemically via SC route

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