When would you use VENTOLIN vs. ATROVENT vs. COMBIVENT

[prmdc_girl91]

Perhaps this is a stupid question, but I am so confused as to the differences between the three.
Salbutamol is for respiratory distress with bronchospasm (bronchial asthma, chronic bronchitis, etc.) while Atrovent is for bronchospasm for asthma, chronic bronchitis and emphysema. So what exactly is the difference?
And as for combivent...when would you use that as opposed to just one of the others? In my notes it says to not use it after the max of Atrovent...I have the dosage as 250-500 mcg of Atrovent 2x if needed...does that mean I can give combivent to the max of 1500 or just 500?
Thanks :)

[EMS_Sask]

ventolin is a fast acting broncodialator, but has a very short effective period.
atrovent is a longer last broncodialator, but also decreases mucous secretions.


does that help?

[prmdc_girl91]

Yes, thank you!

[Gumballs]

Another way to look at this is....

Ventolin relaxes smooth airway muscle & Combivent produces bronchodilation (ipratropium) & also relaxes smooth airway muscles (albuterol).

[quater52]

If you need it some more specific:

Ventolin /albuterol is a beta2 receptor adreneric agent that causes bronchodilation by stimulating receptor sites in the smooth muscles of the bronchial tree. It has also some weak effect on beta1 receptors which are found in the cardiac muscle, therefor you may have a rise in HR and BP as side effects.
Due to its rapid onset (within 5 - 15 minutes) and minor side effects ventolin is considered to be the first line drug for bronchospasm treatment. The usual dosage in 5.0 mg nebulized which can be repeated several times if needed or continuous nebulization up to 15 mg/hour. Monitor HR and BP closely, especially in the elderly or patients with cardiovascular disorders (rhythm disturbance, hypertension, e.g.). Side effects will reverse shortly after ventolin is disconnected.

Atrovent (ipratropium bromide) is an anticholineric agent (related to atropine) that inhibits the actions of acetylcholine at parasympathic receptor sites in the bronchial smooth muscles resulting in bronchodilation. It also reduces the mucous production and increases the secretion viscosity which may be of benefit in patients with mucous pulmonary obstruction. Since atrovent does not cross the brain-blood-barrier (means it is not absorbed into the blood stream) its side effects are minimal. The usual dosage is 0.5 mg nebulized or 8 puffs by MDI. Do not repeat.
Due to its slow onset (> 20 minutes) and relative delayed peak effect (after approx. 60 - 90 minutes) atrovent is considered as a adjunctive therapy. It is not indicated in the acute bronchospasm in which rapid response is required. You rather should use ventolin in those situations. If you use both medications in combination give ventolin always first, 5 minutes prior to atrovent.

Combivent is more for regular usage in chronic patients to prevent bronchospasm from occure. As far as I know the dosage is 2 puff 4 times a day. (1 puff = 81 µg atrovent). Severe side effects have been reported in cases of overdosage.

Be aware that severe distressed patients may not be able to comply with instructions of MDI usage (seal lips thight to mouth piece, inhale slowly and deeply, hold breath for couple of seconds,...) therefor the MDI administration might be ineffective. You should rather go with continuous nebulization via face mask.

Hope, that helps, too. Feel free to ask if you need to know more.

[dentedhead]

If you need it some more specific:

Ventolin /albuterol is a beta2 receptor adreneric agent that causes bronchodilation by stimulating receptor sites in the smooth muscles of the bronchial tree. It has also some weak effect on beta1 receptors which are found in the cardiac muscle, therefor you may have a rise in HR and BP as side effects.
Due to its rapid onset (within 5 - 15 minutes) and minor side effects ventolin is considered to be the first line drug for bronchospasm treatment. The usual dosage in 5.0 mg nebulized which can be repeated several times if needed or continuous nebulization up to 15 mg/hour. Monitor HR and BP closely, especially in the elderly or patients with cardiovascular disorders (rhythm disturbance, hypertension, e.g.). Side effects will reverse shortly after ventolin is disconnected.

Atrovent (ipratropium bromide) is an anticholineric agent (related to atropine) that inhibits the actions of acetylcholine at parasympathic receptor sites in the bronchial smooth muscles resulting in bronchodilation. It also reduces the mucous production and increases the secretion viscosity which may be of benefit in patients with mucous pulmonary obstruction. Since atrovent does not cross the brain-blood-barrier (means it is not absorbed into the blood stream) its side effects are minimal. The usual dosage is 0.5 mg nebulized or 8 puffs by MDI. Do not repeat.
Due to its slow onset (> 20 minutes) and relative delayed peak effect (after approx. 60 - 90 minutes) atrovent is considered as a adjunctive therapy. It is not indicated in the acute bronchospasm in which rapid response is required. You rather should use ventolin in those situations. If you use both medications in combination give ventolin always first, 5 minutes prior to atrovent.

Combivent is more for regular usage in chronic patients to prevent bronchospasm from occure. As far as I know the dosage is 2 puff 4 times a day. (1 puff = 81 µg atrovent). Severe side effects have been reported in cases of overdosage.

Be aware that severe distressed patients may not be able to comply with instructions of MDI usage (seal lips thight to mouth piece, inhale slowly and deeply, hold breath for couple of seconds,...) therefor the MDI administration might be ineffective. You should rather go with continuous nebulization via face mask.

Hope, that helps, too. Feel free to ask if you need to know more.

That hurt, havent seen some of those words in years.Excellent explanation.

Another method if available in your service is the inline with the BVM in a status asthmaticus pt. You are supplementing respirations and delivering ventolin. It is also a good route for U/C smoke inhalation pts.

dentedhead

[EMS_Sask]

i like the inline CPAP neb.....sweet deal for all kinda of crap...pulmonary edema, asthma, copd etc etc

[fenders]

Usually you would use both in combination. Give the ventolin first to open the airway then followed by the atrovent to increase the dilating effect of the bronchi. Ventolin works almost imeddiately. Just watch the HR and be cautious of those who have allergies to atropine like medications with the atrovent (anticholinergic).

Just make sure you really know the medication before giving it. Best people to ask about this stuff are the RRT's. I've learned so much fromt hem working in the ICU.