Question

what are beta 2 drugs, indications, and adverse effects

Answer 1

BETA 2 DRUGS

            Beta 2 (β₂) drugs are used in pulmonology as bronchodilators, in obstetrics as tocolytic agents, and to manage patients with hyperkalemia. There are both short-acting and long-acting β₂ agonists, and their duration of action determines their clinical application.

            Beta 2 (β₂) adrenergic receptor agonists, also known as adrenergic β₂ receptor agonists, are a class of drugs that act on the β₂ adrenergic receptor. Like other β adrenergic agonists, they cause smooth muscle relaxation. They are primarily used to treat asthma and other pulmonary disorders, such as Chronic obstructive pulmonary disease (COPD).

Classification

Their onset of action and duration determines the classification of beta-2 agonists. The classes separate into:

1. Short-acting β₂ agonists (SABAs)

2. Long-acting β₂ agonists (LABAs)

3. Ultra-long-acting β₂ agonists

4. Unknown duration of action

Generic name—Trade name

Short-acting β₂ agonists (SABAs)

• bitolterol—Tornalate
• fenoterol—Berotec
• isoprenaline (INN) or isoproterenol (USAN)—Isuprel
• levosalbutamol (INN) or levalbuterol (USAN)—Xopenex
• orciprenaline (INN) or metaproterenol (USAN)—Alupent
• pirbuterol—Maxair
• procaterol
• ritodrine—Yutopar
• salbutamol (INN) or albuterol (USAN)—Ventolin
• terbutaline—Bricanyl
• albuterol—Ventolin/ Proventil

Long-acting β₂ agonists (LABAs)

• arformoterol—Brovana (some consider it to be an ultra-LABA)
• bambuterol—Bambec, Oxeol
• clenbuterol—Dilaterol, Spiropent
• formoterol—Foradil, Oxis, Perforomist
• salmeterol—Serevent

Ultra-long-acting β₂ agonists

• abediterol
• carmoterol
• indacaterol—Arcapta Neohaler (U.S.), Onbrez Breezhaler (EU, RU)
• olodaterol—Striverdi Respimat
• vilanterol

o with umeclidinium bromide—Anoro Ellipta

o with fluticasone furoate—Breo Ellipta (U.S.), Relvar Ellipta (EU, RU)

o with fluticasone furoate and umeclidinium bromide—Trelegy Ellipta

Unknown duration of action

• isoxsuprine
• mabuterol
• zilpaterol—Zilmax

INDICATIONS

• Bronchial asthma: used to achieve spasmolysis of the bronchi.

· Acute exacerbation: use short-acting selective β₂-agonists (e.g., albuterol)

· Prophylaxis (in chronic disease): use long-acting selective β₂-agonists (e.g., salmeterol)

• COPD: used to achieve spasmolysis of the bronchi.
• Preterm/undesired contractions in obstetrics: used for tocolysis
• Hyperkalemia: Beta-2 adrenergic agonists drive K⁺ intracellularly.

Salmeterol should not be used as monotherapy during an acute asthma attack! Bronchodilators: Indicated for the treatment of obstructive lung disease, such as asthma.

ADVERSE EFFECTS

Findings indicate that β₂ stimulants, especially in parenteral administration such as inhalation or injection, can induce adverse effects:

· Tachycardia secondary to peripheral vasodilation and cardiac stimulation (Such tachycardia may be accompanied by palpitations.)

· Tremor, excessive sweating, anxiety, insomnia, and agitation

· More severe effects include paradoxical bronchospasm, hypokalemia, and in rare cases a myocardial infarction. (More severe effects, such as pulmonary edema, myocardial ischemia, and cardiac arrhythmia, are exceptional.)

      Asthma aggravation has been observed in patients using large doses of β₂ agonists, but if it results from spontaneous course of the disease or adverse effect of the drugs is not known. The excipients, in particular sulfite, could contribute to the adverse effects. The possible loss of the bronchodilator activity of β₂ mimetics could be attenuated by inhaled corticosteroid intake.

Enhancing Healthcare Team Outcomes

There are many types of adrenergic agents and healthcare workers, including the nurse practitioner, physician assistants, and physicians who prescribe these agents, should be aware of their side effects and contraindications. It is essential to consult with a pharmacist if there is any question about the use of an adrenergic agent; this can include drug-drug interactions, appropriate dosing based on the condition treated, and adverse event profile. Nursing can also access this resource as they will often administer the drugs inpatient, and will need to know what signs to watch for in the event of an adverse reaction of any sort. An interprofessional team approach is vital to coordinate the care of patients taking these medications safely and effectively.