Brovana

arformoterol

(al-fer-mo-te-rol) ,

Brovana

(trade name)

Classification

Therapeutic: bronchodilators
Pharmacologic: adrenergics

Pregnancy Category: C

Indications

Maintenance treatment to prevent bronchospasm in chronic obstructive pulmonary disease (COPD) including chronic bronchitis and emphysema.

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.

Pharmacokinetics

Absorption: Some systemic absorption occurs from pulmonary sites.

Distribution: Unknown.

Metabolism and Excretion: Mostly metabolized by the liver; 1% excreted unchanged in urine.

Half-life: 26 hr.

Time/action profile

ROUTE	ONSET	PEAK	DURATION
inhaln	unknown	30 min	12 hr

Contraindications/Precautions

Contraindicated in: Hypersensitivity; Acutely deteriorating COPD (onset of action is delayed); Pediatric: Safety not established; Concurrent use of other long-acting beta₂ agonist bronchodilators.

Use Cautiously in: Cardiovascular disorders including coronary insufficiency, arrhythmias and hypertension; Hepatic impairment; Geriatric: May be more sensitive to drug effects; Obstetric / Lactation: Safety not established; use only when maternal benefit outweighs fetal risk, may inhibit contractions during labor.

Adverse Reactions/Side Effects

Central nervous system

• headache
• insomnia
• nervousness
• weakness

Respiratory

• asthma-related death (life-threatening)
• paradoxical bronchospasm (life-threatening)

Cardiovascular

• ECG changes
• tachycardia

Gastrointestinal

• vomiting

Dermatologic

• rash

Fluid and Electrolyte

• hypokalemia

Hematologic

• leukocytosis

Musculoskeletal

• cramps

Neurologic

• tremor

Miscellaneous

• hypersensitivity reactions including anaphylaxis
• fever

Interactions

Drug-Drug interaction

Concurrent use with MAO inhibitors, tricyclic antidepressants or other agents that may prolong the QTc interval may result in serious arrhythmias and should be undertaken with extreme caution.↑ risk of hypokalemia with theophylline, corticosteroids, potassium-losing diuretics.Beta blockers may ↓ therapeutic effects.↑ adrenergic effects may occur with concurrent use of adrenergics.

Route/Dosage

Inhalation (Adults) 15 mcg twice daily via nebulization.

Availability

Inhalation solution for nebulization: 15 mcg/2 mL

Nursing implications

Nursing assessment

• Assess lung sounds, pulse, and BP before administration and periodically during therapy.
• Monitor pulmonary function tests before initiating therapy and periodically during therapy to determine effectiveness of medication.
• Observe for paradoxical bronchospasm (wheezing, dyspnea, tightness in chest) and hypersensitivity reaction (rash; urticaria; swelling of the face, lips, or eyelids). If condition occurs, withhold medication and notify physician or other health care professional immediately.

Potential Nursing Diagnoses

Ineffective airway clearance (Indications)

Implementation

• Inhalation: Administer twice daily, approximately 12 hrs apart. Solution is colorless; do not administer discolored solutions. Do not administer beyond expiration date. Do not mix with other drugs in nebulizer. Administer by inhalation only; do not inject or swallow medication.

Patient/Family Teaching

• Instruct patient on proper technique use and advise patient to take arformoterol as directed. Do not use more than the prescribed dose. If a regularly scheduled dose is missed, skip the dose and resume regular schedule. Do not double doses. If symptoms occur before next dose is due, use a rapid-acting inhaled bronchodilator (e.g. albuterol). See for nebulizer instructions.
• Inform patient that arformoterol may increase the risk of asthma-related death.
• Advise patients who have been taking short-acting beta₂ agonists regularly to discontinue regular use and use only for symptomatic relief of acute respiratory symptoms.
• Caution patient not to use arformoterol to treat acute symptoms. A rapid-acting inhaled beta-adrenergic bronchodilator should be kept on hand and used for relief of acute asthma attacks.
• Advise patient to notify health care professional immediately if difficulty in breathing persists after use of arformoterol, if condition worsens, if more inhalations of rapid-acting bronchodilator than usual are needed to relieve an acute attack.
• Advise female patients to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

Evaluation/Desired Outcomes

• Decreased dyspnea.
• Improved breath sounds.

Brovana

a trademark for arformoterol.