Bricanyl

terbutaline

Bricanyl

Indications

Action

Pharmacokinetics

Time/action profile (bronchodilation)

Contraindications/Precautions

Adverse Reactions/Side Effects

Central nervous system

• nervousness (most frequent)
• restlessness (most frequent)
• tremor (most frequent)
• headache
• insomnia

Respiratory

• pulmonary edema

Cardiovascular

• angina
• arrhythmias
• hypertension
• myocardial ischemia
• tachycardia

Gastrointestinal

• nausea
• vomiting

Endocrinologic

• hyperglycemia

Fluid and Electrolyte

• hypokalemia

Interactions

Drug-Drug interaction

Route/Dosage

Availability (generic available)

Nursing implications

Nursing assessment

• Bronchodilator: Assess lung sounds, respiratory pattern, pulse, and BP before administration and during peak of medication. Note amount, color, and character of sputum produced, and notify health care professional of abnormal findings.
• Monitor pulmonary function tests before initiating therapy and periodically throughout therapy to determine effectiveness of medication.
• Preterm Labor: Monitor maternal pulse and BP, frequency and duration of contractions, and fetal heart rate. Notify health care professional if contractions persist or increase in frequency or duration or if symptoms of maternal or fetal distress occur. Maternal side effects include tachycardia, palpitations, tremor, anxiety, and headache.
  • Assess maternal respiratory status for symptoms of pulmonary edema (increased rate, dyspnea, rales/crackles, frothy sputum).
  • Monitor mother and neonate for symptoms of hypoglycemia (anxiety; chills; cold sweats; confusion; cool, pale skin; difficulty in concentration; drowsiness; excessive hunger; headache; irritability; nausea; nervousness; rapid pulse; shakiness; unusual tiredness; or weakness) and mother for hypokalemia (weakness, fatigue, U wave on ECG, arrhythmias).
• Lab Test Considerations: May cause transient ↓ in serum potassium concentrations with higher than recommended doses.
  • Monitor maternal serum glucose and electrolytes. May cause hypokalemia and hypoglycemia. Monitor neonate’s serum glucose, because hypoglycemia may also occur in neonates.
Symptoms of overdose include persistent agitation, chest pain or discomfort, decreased BP, dizziness, hyperglycemia, hypokalemia, seizures, tachyarrhythmias, persistent trembling, and vomiting.
• Treatment includes discontinuing beta-adrenergic agonists and symptomatic, supportive therapy. Cardioselective beta blockers are used cautiously, because they may induce bronchospasm.

Potential Nursing Diagnoses

Implementation

• Do not confuse Brethine (terbutaline) with Methergine (methylergonovine).
• Oral: Administer with meals to minimize gastric irritation.
  • Tablet may be crushed and mixed with food or fluids for patients with difficulty swallowing.
• Subcutaneous: Administer subcut injections in lateral deltoid area. Do not use solution if discolored.

• Intravenous Administration

• pH: 3.0–5.0.
• Continuous Infusion: Diluent: May be diluted in D5W, 0.9% NaCl, or 0.45% NaCl.Concentration: 1 mg/mL (undiluted).
• Rate: Use infusion pump to ensure accurate dose. Begin infusion at 10 mcg/min. Increase dosage by 5 mcg every 10 min until contractions cease. Maximum dose is 80 mcg/min. Begin to taper dose in 5-mcg decrements after a 30–60 min contraction-free period is attained. Switch to oral dose form after patient is contraction-free 4–8 hr on the lowest effective dose.
• Y-Site Compatibility: insulin

Patient/Family Teaching

• Instruct patient to take medication as directed. If on a scheduled dosing regimen, take a missed dose as soon as possible; space remaining doses at regular intervals. Do not double doses. Caution patient not to exceed recommended dose; may cause adverse effects, paradoxical bronchospasm, or loss of effectiveness of medication.
  • Instruct patient to contact health care professional immediately if shortness of breath is not relieved by medication or is accompanied by diaphoresis, dizziness, palpitations, or chest pain.
  • Advise patient to consult health care professional before taking any OTC medications or alcoholic beverages concurrently with this therapy. Caution patient also to avoid smoking and other respiratory irritants.
• Preterm Labor: Notify health care professional immediately if labor resumes or if significant side effects occur.

Evaluation/Desired Outcomes

• Prevention or relief of bronchospasm.
• Increase in ease of breathing.
• Control of preterm labor in a fetus of 20–36 wk gestational age.