Short-acting agents include albuterol, levalbuterol, and pirbuterol, although these agents at one time were considered longer acting in comparison with the ultrashort-acting catecholamines such as
isoetharine. The action of salmeterol in providing sustained protection from bronchoconstriction differs to a degree from that of the previously described adrenergic bronchodilators.
Potential interfering substances such as isoproterenol, isoetharine, and labetalol were purchased from Sigma Aldrich, and 4-hydroxy-3-methoxymethamphetamine (HMMA) was from Lipomed.
Previous studies have reported interferences in plasma metanephrine LC-MS/MS assays arising from prescription medications isoproterenol, isoetharine, and labetalol and from illicit substances and metabolites 3, 4-methylenedioxy-A^-methylamphetamine, 3, 4methylenedioxyamphetamine, and HMMA (5, 6).
We searched MEDLINE (1966-2000), EMBASE (1974-2000), and The Cochrane Library (through August 2000) using the key words "bronchitis" or "cough", together with the terms "adrenergic beta-agonist (exp)," "bronchodilator agents (exp)," "sympathomimetic (exp)," "albuterol," "salbutamol," "bitolterol," "
isoetharine," "metaproterenol," "pirbuterol," "salmeterol," "terbutaline," "fenoterol," "formoterol," or "procaterol" (note that albuterol and salbutamol are the same compound).
Evaluated compounds were acetaminophen, caffeine, cimetidine, diazepam,
isoetharine, isoproterenol, labetalol, levodopa, 3-methoxytyramine, metachlopromide, metanephrine, methyldopa, normetanephrine, salsolenol, serotonin, and theophylline.
Therapeutic Agents Available in Metered Dose Inhaler Duration Average Peak of Cost per Pregnancy Effect(*) Effect(*) Inhaler(**) Category Drug (minutes) (hours) ($) (FDA) [beta]-Adrenergic Isoproterenol 5-15 1-2 23.63 C Isoetharine 15-60 2-3 26.98 C Metaproterenol 30-60 3-4 20.23 C Terbutaline 60 4 22.10 B Albuterol 30-60 4 24.16 C Bitolterol 30-60 5 18.00 C Pirbuterol 30-60 5 18.82 C Anticholinergic Ipratropium 60-120 3-6 26.80 B Biscromones Cromolyn 15-30 2-6 37.15 B (*)Data from Physicians' Desk Reference,[13] Drug Evaluations,[15] and Bar-Yish ay et al.[16] (**) Derived from pharmacy price quotes.
The newer aerosol [beta]-adrenergic drugs (albuterol, terbutaline, pirbuterol, bitolterol) are [[beta].sub.2] selective, producing bronchodilation with less cardiac stimulation than the older [beta]-adrenergic drugs (epinephrine, isoproterenol, isoetharine, mataproterenol).
The patient was very sensitive to Bronkosol[TM] (
isoetharine) but the prescribing physician felt that 0.5 ml of the drug in 3 ml of normal saline would be more than sufficient to provide adequate bronchodilation and help her carry out her activities of daily living (ADLs).
