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, Drug Evaluations, and Bar-Yish ay et al. (**) 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).