When would you use VENTOLIN vs. ATROVENT vs. COMBIVENT

prmdc_girl91
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When would you use VENTOLIN vs. ATROVENT vs. COMBIVENT

Postby prmdc_girl91 » Tue Jan 05, 2010 1:31 pm

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 :)

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EMS_Sask
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Postby EMS_Sask » Tue Jan 05, 2010 2:18 pm

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
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Postby prmdc_girl91 » Wed Jan 06, 2010 10:27 pm

Yes, thank you!

Gumballs
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Postby Gumballs » Sun Jan 10, 2010 10:48 am

Another way to look at this is....

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

quater52
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Postby quater52 » Mon Jan 11, 2010 8:37 am

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.

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dentedhead
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Postby dentedhead » Mon Jan 11, 2010 8:02 pm

"quater52" wrote: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
Thousand a week for hide and seek on call when Im paid to be.

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EMS_Sask
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Postby EMS_Sask » Mon Jan 11, 2010 10:01 pm

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

fenders
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Postby fenders » Thu Apr 07, 2011 9:30 pm

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.

MikeB26
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Spacers

Postby MikeB26 » Sun Mar 13, 2016 2:33 pm

Hi Girl 91.

First, not a dumb question at all. Even more than being difficult to understand, all the inhaled meds are nearly impossible to remember. Really, quick-- what's the difference between Atrovent, Combivent and Ventolin?

That you're interested and invested is the most important thing. That's where the motivation to adhere to disease management and medication lies, not in the ability to recall a bunch of details.

Quater makes a bunch of great points.

He's absolutely right about the problems with incorrect administration with MDI's (metered dose inhalers). For some reason, people have an incredibly tough time using them right. After adjusting for incorrect administration, the adherence rate among patients who use MDIs is-- 10%.

You read right. Only 1 in 10 patients uses their MDIs correctly.

As Quaxxxxxxter suggests, nebulizers are a great alternative. Once you get the mask on, you'd have to make quite an effort to use them incorrectly.

But nebulizers aren't really portable. You pretty much have to do all your treatments at home. And nebulizers are time-consuming and difficult to assemble and clean. By the time you're done, realistically, you're looking at 20-30 minutes per treatment. While this is perfect for elderly patients who have home health workers, it can be a pain in the neck for someone who has an active life. Ultimately, for an active patient, a nebulizer might be so cumbersome that it's a deterrent to adherence.

Before going with a nebulizer, I encourage you to talk to your doctor about a SPACER. A spacer is a plastic tube, or chamber, that attaches to your MDI. You squeeze the dose into the chamber. You can actually see the medication mist in the spacer. Then inhale the medication, all at once, from the chamber. Then hold your breath for a while. And then you're done.

No more coordinating your inhalation with squeezing the MDI (which can take a lot of strength and coordination, especially if you're short of breath).

Just use it and put it away. (You only have to clean spacers once a month.)

NBFireguy
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Postby NBFireguy » Wed Apr 06, 2016 11:17 am

Mike,

I personally find your post a bit misleading. I have never had an issue with a Nebulizer, as they come in a little baggy, the same size as an NRB and we hook ours up to an O2 bottle. Perhaps your service is a bit different, I don't know.

Any time you are making use of an MDI in treatment of a pt, always use an Aerochamber. We have the disposable ones, which makes for easy clean up. MDI when used effectively is the best route to administration of either of the drugs.

In my personal experience the Neb is an awesome route for administration of Combivent as we mix Atrovent and Ventolin, our hands are free to start IVs, do 12 leads, etc while offering our pt O2, and the needed medication to deal with the Respiratory issue at hand.

The biggest thing to remember is follow your protocols as ever service is a little different on the admin of most drugs.


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