Daftar obat nebulizer

1. Budesonide
Budesonide is an oral inhalation medication used to manage such symptoms as wheezing,
shortness of breath and difficulty breathing. Asthma and lung problems such as chronic obstructive
pulmonary disease can lead to these symptoms, says MedlinePlus. Specifically, budesonide is a
corticosteroid medication that reduces the inflammation in the airways.
Budesonide's common effects include cough, stomach pain, neck pain, trouble falling asleep
and a dry mouth or throat. Other common symptoms include difficult speech and neck pain. Seek a
doctor's help when budesonide's effects last for more than 6 to 7 days.
Budesonide's serious effects include a sore throat, fever, strange bleeding or bruising,
muscle weakness and muscle aches. Its other symptoms include swelling of the ankles, legs or face,
difficulty urinating and white spots or sores in the mouth. Call a physician immediately when
budesonide causes these effects.
A change in dosage may be necessary if you are taking oral corticosteroids, oral
contraceptives, phenobarbital, estrogen and theophylline.

2. Ipatropium
Ipatropium is an inhalation medication used to prevent sudden constriction of the airways
called bronchospasms. Bronchospasms occur in such respiratory diseases as asthma, bronchitis and
chronic obstructive pulmonary disease.
Drugs.com says that ipatropium's common effects include headache, dizziness, a dry mouth
and a cough. Ipatropium can also lead to blurry vision, stomach problems, nausea and hoarseness.
Inform a physician if ipatropium's side effects persist for more than 5 to 7 days.

3. Albuterol and Ipatropium
Albuterol and ipatropium serve as bronchodilators to relax the airway and increase the air to
the lungs, says Drugs.com. Like ipatropium, this combination medication serves to prevent
bronchospasm.
Albuterol and ipatropium's common effects include a headache, drowsiness, trouble
sleeping, a cough, stuffy nose, vomiting, nausea and diarrhea. This medication can also lead to blurry
vision, constipation, nervousness and a dry mouth. Call a doctor if these effects last for more than 6 to
7 days.
This medication's serious effects include chest pain, a rapid or pounding heartbeat, swelling
of the ankles or feet and pain with urination. Sometimes, chest tightness, wheezing and difficulty
breathing can ensue soon after using albuterol and ipatropium. These drugs can also lead to high
blood pressure. Signs of high blood pressure include headache, difficulty concentrating, seizures and
numbness. Go to the hospital when these symptoms appear.
A change in dosage may be necessary when suffering from glaucoma, liver or kidney
disease, diabetes, an overactive thyroid and seizures.

Pulmonary Medications
Anticholinergics | Beta-2 agonists | Combination products | Corticosteroids | Leukotriene
Inhibitors | Mast cell stabilizers | Other
Anticholinergics [TOP]
ipratropium
Atrovent
Blocks the action of acetylcholine at parasympathetic sites in
bronchial smooth muscle causing bronchodilation.
Adult (usual): Nebulization: 500 mcg (one vial) 3-4 times/day with
doses 6-8 hours apart. Metered dose inhaler: 2 puffs 4 times/day - up
to 12 puffs /24 hours.

Supplied: Nebulization (soln): 0.02% (2.5 ml). MDI: 18
mcg/actuation.
tiotropium
Spiriva
Anticholinergic agent (bronchodilator).
Adult (usual): COPD: Oral inhalation: Contents of 1 capsule (18
mcg) inhaled once daily using HandiHaler device.
Beta-2 agonists (short acting) [TOP]
albuterol
Proventil
Beta-2 Agonist. Adult (usual): Asthma: 1-2 puffs every 4-6 hours as
needed. Maximum: 12 inhalations/day. Prophylaxis of exercise-
induced bronchospasm: MDI: 2 puffs 5-30 minutes prior to exercise.
Nebulized 2.5 mg 3-4 times daily. Tablets: 2-4 mg orally 3-4 times
daily. Sustained release tablets: 4-8 mg q12h (Maximum dose: 32
mg/day).

Acute treatment of bronchospasm: MDI (90 mcg/puff): 4-8 puffs
every 20 minutes for up to 4 hours, then every 1-4 hours as
needed. Nebulization: 2.5 mg (3ml) 3-4 times/day over 5-15
minutes.
Bronchospasm in ICU patients (acute): Nebulization: 2.5-5 mg every
20 minutes for 3 doses, then 2.5-10 mg every 1-4 hours as needed, or
10-15 mg/hour continuously.
bitolterol
Tornalate
(Beta-2 agonist): Adult (usual): Bronchospasm, acute: MDI 2 puffs
separated by 1-3 minutes, follow with third as
needed. Bronchospasm, prevention: MDI, 2 puffs q8h, Maximum
of 3 puffs q6h or 2 puffs q4h.
Bronchospasm, prevention: (intermittent flow nebulizer) 0.5-1 ml (1-
2 mg) 3-4 times per day (Maximum of 8 mg/day). Bronchospasm,
prevention: (continuous flow nebulizer) 1.25 ml (2.5 mg) 3-4
times/day. (Maximum of 14 mg/day).
Supplied [0.8% aerosol. 0.2% (2 mg/ml) inhalation Soln].
levalbuterol
Xopenex
Beta-2 agonist. Adult (usual): Bronchospasm: MDI: Aerosol: 1-2
puffs every 4-6 hours. Nebulization: 0.63 mg 3 times/day at intervals
of 6-8 hours. Dosage may be increased to 1.25 mg 3 times/day with
close monitoring for adverse effects. Most patients gain optimal
benefit from regular use.
Levalbuterol (R-enantiomer of albuterol) has
approximately 2-fold greater binding affinity
compared to racemic albuterol, and approximately
100-fold greater binding affinity than S-albuterol.
(Bronchodilatory effects of racemic albuterol are due
to R-albuterol).

pirbuterol
Maxair
Adult (usual): Asthma: 1-2 puffs every 4-6 hours (up to 12
puffs/day).
metaproterenol
Alupent
Adult (usual): Asthma, bronchospasm: 20 mg orally 3-4
times/day. Oral aerosol inhalation: 2-3 puffs q3-4 hours (Max of 12
puffs/day). Nebulizer: 0.3 ml (5%) in 2.5 ml NS q4-6 hours prn.
Beta-2 agonists (Long acting) [TOP]
formoterol
Foradil
(Long-acting Beta-2 agonist):
Adult (usual):
Asthma (maintenance therapy): Oral inhalation - 12 mcg (1 capsule)
q12h via aerolizer inhaler. (Maximum of 24 mcg/day).
COPD: Oral inhalation 12 mcg (1 capsule) q12h via aerolizer
inhaler.
Exercise-induced bronchospasm (EIB): 12 mcg (1 capsule) at least 15
min before exercise as needed.
Supplied: [12 mcg capsule]
salmeterol
Serevent
MDI: Inhale 2 puffs twice a day. (Do not exceed).

Serevent Diskus:
Asthma: usual dosage for adults and children 4 years of age and
older is 1 inhalation (50 mcg) twice daily (morning and evening,
approximately 12 hours apart). If symptoms arise in the period
between doses, an inhaled, short-acting beta 2 -agonist should be
taken for immediate relief.
COPD: usual dosage for adults is 1 inhalation (50 mcg) twice
daily (morning and evening, approximately 12 hours apart).
Prevention of Exercise-Induced Bronchospasm (EIB): One
inhalation at least 30 minutes before exercise. Additional doses
should not be used for 12 hours after the administration of this drug.
If regular, twice-daily dosing is not effective in preventing EIB, other
appropriate therapy for EIB should be considered.
Combination (Beta2 agonist + Anticholinergic) [TOP]
Combivent
albuterol + ipratropium
Adult (usual): COPD: (MDI): 2 inhalations 4 times daily (Max of
12 puffs/day). Inhalation solution: one 3 ml vial via nebulization 4
times daily (Max of 6 doses/day).
Combination (Beta2 agonist + Corticosteroid) [TOP]
Advair
fluticasone + salmeterol
Adult (usual): Asthma: 1 puff twice daily (morning and evening)
approximately 12 hours apart. More frequent administration (more
than twice daily) or a higher number of inhalations (more than 1 puff
twice daily) is not recommended.
[Supplied: Advair Diskus: 100/50, 250/50 ,500/50 ]
Symbicort
budesonide + formoterol
Adult (usual): 1-2 inhalations once or twice daily (Maximum daily
maintenance dose: 4 inhalations). Maximum dose during worsening
asthma: 4 inhalations twice daily. [Supplied: 100/6 and 200/6]
Inhaled Corticosteroids [TOP]
beclomethasoneVanceril Inhale 2 puffs 3 to 4 times daily or 4 puffs twice a day.
Beclovent
budesonide
Pulmicort
Adult (usual): Asthma: 1-4 puffs twice daily (Max of 4 puffs
bid). Note: patients with mild symptoms may be converted to once
daily administration (1-2 puffs qd). [Supplied: MDI 200
mcg/inhalation]
flunisolide
Aerobid
inhale 2-4 puffs twice a day.
fluticasone
Flovent
Inhale 2-4 puffs twice a day. Supplied: [44,110,220 mcg]
mometasone
furoate
Asmanex
In-vitro studies show that mometasone is similar in potency to
fluticasone and more potent than budesonide, beclomethasone, and
triamcinolone.

Adult (usual): Asthma:
Previous Therapy
Recommended
Starting Dose
Highest
Recommended Daily
Dose
Bronchodilators
alone
220 mcg QD PM* 440 mcg**
Inhaled
corticosteroids
220 mcg QD PM* 440 mcg**
Oral corticosteroids 440 mcg BID 880 mcg
When administered once daily ASMANEX should only be taken
in the PM. The 440 mcg daily dose may be administered in
divided doses of 220 mcg twice daily or as 440 mcg once daily.
NOTE: In all patients, it is desirable to titrate to the lowest
effective dose once asthma stability is achieved.

For Patients Currently Receiving Chronic Oral Corticosteroid
Therapy: Prednisone should be reduced no faster than 2.5
mg/day on a weekly basis, beginning after at least 1 week of
ASMANEX TWISTHALER therapy. Patients should be carefully
monitored for signs of asthma instability, including serial
objective measures of airflow, and for signs of adrenal
insufficiency. Once prednisone reduction is complete, the dosage
of mometasone furoate should be reduced to the lowest effective
dosage
HOW TO USE - Remove the ASMANEX TWISTHALER from its
foil pouch and write the date on the cap label. Its important to throw
away the inhaler 45 days after this date or when the dose counter
reads 00, whichever comes first.
Step 1. Open inhaler - Hold the inhaler straight up with the pink
portion (the base) on the bottom. It is important that you remove the
cap of the TWISTHALER while it is in this upright position to
make sure that you get the right amount of medicine with each dose.
Holding the pink base, twist the cap in a counterclockwise direction
to remove it. As you lift off the
cap, the dose counter on the base will count down by one. (If you
began with the dose counter reading 30, this action will cause it to
now read 29.) This action loads the device with the medicine that
you are now ready to inhale. IT IS IMPORTANT TO NOTE that the
indented arrow (located on the white portion of the TWISTHALER,
directly above the pink base) is pointing to the dose counter.
Step 2. Inhale dose - Exhale fully. Then bring the
TWISTHALERup to your mouth with the mouthpiece facing
toward you. Place it in your mouth, holding it in a horizontal position
as illustrated. Firmly closing your lips around the mouthpiece, take in
a fast, deep breath. Since the medication is a very fine powder, you
may not be able to feel or taste it after inhalation.
Remove the TWISTHALER from your mouth and hold your breath
for about 10 seconds, or as long as you comfortably can.
IMPORTANT: DO NOT BREATHE OUT THROUGH THE
INHALER. After you take your medicine, it is important that you
wipe the mouthpiece dry, if necessary, and immediately replace the
cap firmly closing the TWISTHALER.
This is the only way to be sure that your next dose is properly loaded.
Be sure that the arrow is in line with the dose-counter window. The
cap needs to be put back on and turned in a clockwise direction, as
you gently press down. Youll hear a distinctive click to let you
know that the cap is fully closed.

Supplied: Powder for oral inhalation: Asmanex Twisthaler: 220
mcg (14 units, 30 units, 60 units, 120 units)
triamcinoloneAzmacort inhale: 2 puffs 3 to 4 times a day or 4 puffs twice a day. Maximum:
16 puffs/day.
Leukotriene inhibitors [TOP]
montelukast Singulair Leukotriene Receptor Antagonist. Adult (usual): Asthma or allergic
seasonal rhinitis: 10 mg orally once daily in the evening.
Supplied: 10 mg tablet. 4mg, 5mg chewable tablet.
zafirlukast
Accolate
20 mg orally twice daily between meals.
zileuton
Zyflo
600 mg orally 4 times a day.
Mast Cell stabilizers [TOP]
cromolyn sodiumIntal Inhale 2 puffs 4 times a day.
nedocromil
Tilade
Inhale 2 puffs 4 times a day.
Other [TOP]
acetylcysteine
Mucomyst
Acetadote
Mucolytic agent.
Adult (usual):
Acetaminophen poisoning: 140 mg/kg orally, followed by 17 doses
of 70 mg/kg every 4 hours. Repeat dose if emesis occurs within 1
hour of administration. Therapy should continue until all doses are
administered even though the acetaminophen plasma level has
dropped below the toxic range. Alternatively: Give Acetadote :
Loading dose: 150 mg/kg IV over 60 minutes. Maintenance dose: 50
mg/kg infused over 4 hours followed by 100 mg /kg infused over 16
hours. Note: To avoid fluid overload in patients <40 kg and those
requiring fluid restriction, decrease volume of D5W proportionally.
Adjuvant therapy in respiratory conditions: Note: Patients should
receive bronchodilator 15 minutes prior to dose. Inhalation,
nebulization: 10% and 20% solution. Dilute 20% solution with
sodium chloride or sterile water for inhalation. 10% solution may be
used undiluted: 3-5 ml of 20% solution or 6-10 ml of 10% solution
until nebulized - given 3-4 times/day. Dosing range: 1-10 ml of 20%
solution or 2-20 ml of 10% solution every 2-6 hours. Into
tracheostomy: 1-2 ml of 10% to 20% solution every 1-4 hours.

Decrease risk of contrast-induced nephropathy: (4 doses total):
600 mg (3ml) po BID on the day before the contrast injection, then
600 mg (3ml) in a.m. on the day of the contrast injection
(immediately before) and 600 mg (3ml) in the evening. In all cases
the patient should be well hydrated. This is particularly important in
patients with underlying renal dx or diabetes mellitus. Hydrate patient
with saline concurrently.

Supplied: (Mucomyst soln): 10% [100 mg/ml] - 4 ml, 10 ml, 30
ml. 20% [200 mg/ml] - 4 ml, 10 ml, 30 ml. (Acetadote injection):
20% [200 mg/ml] (30 ml)
aminophylline
/theophylline:
Maximum rate: 25 mg/min. IV loading: 5 mg/kg TBW based on
theophylline or 6 mg/kg based on aminophylline.
Previous therapy: [Loading dose= 0.5 L/kg TBW x (desired level -
current level)] IV maintenance dose based on IBW and theophylline.
For aminophylline dosing divide result by 0.8.
Adult non-smoker: 0.4 mg/kg/hr
Adult (smoker): 0.7 mg/kg/hr
Elderly (smoker): 0.5 mg/kg/hr
Elderly (non-smoker)/ CHF/ Liver disease: 0.2 mg/kg/hr.

Obtain level 24-48 hours after initiation of therapy. Average half-life:
3 to 12 hrs. Vd: 0.5 L/kg. Therapeutic range: 5-20 mcg/ml. IVPB is
the least desirable route of admin. It is less effective than a continuous
infusion. IVPB-cyclic improvement is seen at the peak with a rapid
decline towards the trough.



Comparable Daily Doses for Inhaled Corticosteroids

A D U L T S
Drug Low Dose Medium Dose High Dose
Beclomethasone
dipropionate
168 504 mcg 504 840 mcg >840 mcg
42 mcg/puff (4-12 puffs 42
mcg)
(12-20 puffs 42
mcg)
(>20 puffs 42 mcg)
84 mcg/puff (2-6 puffs 84
mcg)
(6-10 puffs 84
mcg)
(>10 puffs 84 mcg)

Budesonide
DPI: 200 mcg/dose
200 400 mcg
(1-2 inhalations)
400 600 mcg
(2-3 inhalations)
>600 mcg
(>3 inhalations)

Flunisolide
250 mcg/puff
500 1000 mcg
(2-4 puffs)
1000 2000 mcg
(4-8 puffs)
>2000 mcg
(>8 puffs)

Fluticasone 88 264 mcg 264 660 mcg >660 mcg
MDI: 44, 110, 220
mcg/puff
(2-6 puffs 44
mcg OR 2 puffs
110 mcg)
(2-6 puffs 110
mcg)
(>6 puffs 110 mcg
OR >3 puffs 220
mcg)
DPI: 50, 100, 250
mcg/dose
(2-6 inhalations
50 mcg)
(3-6 inhalations
100 mcg)
(>6 inhalations 100
mcg OR >2
inhalations 250 mcg)

Triamcinolone
acetonide
100 mcg/puff
400 1000 mcg
(4-10 puffs)
1000 2000 mcg
(10-20 puffs)
>2000 mcg
(>20 puffs)

CHILDREN
Drug Low Dose Medium Dose High Dose
Beclomethasone
dipropionate
84 336 mcg 336 672 mcg >672 mcg
42 mcg/puff (2-8 puffs 42
mcg)
(8-16 puffs 42
mcg)
(>16 puffs 42 mcg)
84 mcg/puff (1-4 puffs 84
mcg)
(4-8 puffs 84
mcg)
(>8 puffs 84 mcg)

Budesonide
DPI: 200 mcg/dose
100 200 mcg 200 400 mcg
(1-2 inhalations)
>400 mcg
(>2 inhalations)

Flunisolide
250 mcg/puff
500 750 mcg
(2-3 puffs)
1000 1250 mcg
(4-5 puffs)
>1250 mcg
(>5 puffs)

Fluticasone 88 176 mcg 176 440 mcg >440 mcg
MDI: 44, 110, 220
mcg/puff
(2-4 puffs 44
mcg)
(4-10 puffs 110
mcg OR 2-4 puffs
110 mcg)
(>4 puffs 110 mcg,
OR >2 puffs 220
mcg)
DPI: 50, 100, 250
mcg/dose
(2-4 inhalations
50 mcg)
(2-4 inhalations
100 mcg)
(>4 inhalations 100
mcg OR >2 inhalations
250 mcg)

Triamcinolone
acetonide
100 mcg/puff
400 800 mcg
(4-8 puffs)
800 1200 mcg
(8-12 puffs)
>1200 mcg
(>12 puffs)

DPI = dry powder inhaler MDI = metered dose inhaler

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