Article Contents ::

Details About Generic Salt ::  Bitolter

Main Medicine Class:: Bronchodilator, Sympathomimetic   

(by-TOLE-ter-ole MEH-sih-LATE)
Tornalate
Aerosol: 0.8% (delivers 0.37 mg/actuation)
Solution for inhalation: 0.2%
Class: Bronchodilator, Sympathomimetic

 Indications Prevention and treatment of reversible bronchospasm associated with asthma or other obstructive pulmonary diseases.

 Contraindications Standard considerations.

 Route/Dosage

Acute Bronchospasm

ADULTS AND CHILDREN > 12 yr: Oral inhalation: 2 inhalations at interval of 1 to 3 min, followed by third inhalation if necessary.

Prevention of Bronchospasm

ADULTS AND CHILDREN > 12 yr: Oral inhalation: 2 inhalations q 8 hr, not to exceed 3 inhalations q 6 hr or 2 inhalations q 4 hr. Solution for Inhalation Administer during a 10- to 15-min period. Continuous flow nebulization: 1.5 to 3.5 mg (0.75 to 1.75 mL volume) 3 to 4 times/day with an interval of ³ 4 hr between treatments. Max daily dose of 14 mg. Intermittent flow nebulization: 0.5 to 1.5 mg (0.25 to 0.75 mL volume) 3 to 4 times daily with an interval of ³ 4 hr between treatments. Max daily dose of 8 mg.

 Interactions None well documented.

 Lab Test Interferences May cause decreased potassium level.

 Adverse Reactions

CARDIOVASCULAR: Palpitations; tachycardia; irregular pulse; hypertension; angina. CNS: Tremor; lightheadedness; dizziness; nervousness; headache; tiredness. EENT: Throat and mouth irritation. GI: Nausea; vomiting. RESPIRATORY: Cough; increased chest discomfort; dyspnea; bronchospasm.

 Precautions

Pregnancy: Category C. Lactation: Undetermined. CHILDREN: Safety and efficacy in children < 12 yr not established. Elderly: Lower doses may be required. Cardiovascular Disorders: Toxic symptoms may occur. CNS Effects: Drug may cause CNS stimulation; cautious use is needed in patients with history of seizures or hyperthyroidism. Diabetes Mellitus: Dosage adjustment of insulin or oral hypoglycemic agent may be required. Excessive Use: Paradoxical bronchospasm and cardiac arrest have been associated with excessive inhalant use. Labor and Delivery: May inhibit uterine contractions and delay preterm labor. Tolerance: May occur. Combined Therapy: Do not use ³ 2 beta-adrenergic aerosol bronchodilators simultaneously because of the potential of additive effects. Do not use as a substitute for oral or inhaled corticosteroids.

PATIENT CARE CONSIDERATIONS


 Administration/Storage

  • To administer, instruct patient to tilt head back and put inhaler mouthpiece between lips or 2 inches from open mouth. Tell patient to inhale slowly, press down on canister, hold breath ³ 10 sec or as long as comfortable, remove mouthpiece, then exhale slowly.
  • Use spacing device (eg, Aero-changer) to enhance drug delivery.
  • Administer pressurized inhalation during second half of inspiration to achieve better distribution of medication because airways are opened wider at this time. If second inhalation is necessary, wait ³ 1 full min between inhalations.
  • Store metered-dose inhaler in pressurized container at room temperature; do not freeze. Keep away from extreme heat. Do not store or use near open flame or discard in incinerator.
  • For nebulizer use, find a location where patient can sit comfortably for 10 to 15 min. Do not mix different types of medications without permission from doctor or pharmacist. Have patient take slow, deep breaths and, if possible, hold breath 10 sec before slowly exhaling. Continue until medication chamber is empty.

 Assessment/Interventions

  • Obtain patient history, including drug history and any known allergies.
  • Review baseline ECG for cardiac dysrhythmias associated with tachycardia.
  • Take heart rate before administration of drug. If tachycardia, cardiac arrhythmia, or chest pain is present, hold medication and notify health care provider immediately.
  • Have epinephrine 1:1000 available for immediate or delayed hypersensitivity reaction.
  • Obtain baseline blood values and monitor during therapy. Notify health care provider of abnormal results.
OVERDOSAGE: SIGNS & SYMPTOMS
  Exaggerated side effects, such as tremors, tachycardia, seizures, hypokalemia, anginal pain, and hypertension

 Patient/Family Education

  • Ask patient to demonstrate correct use of inhaler. It may be necessary to repeat instructions and demonstrations more than once. Consider use of spacing device.
  • Explain that tolerance may occur with prolonged use, but temporary cessation of drug usually restores its original effectiveness. Instruct patient to notify health care provider if medication is ineffective.
  • Warn patient to avoid excessive use, which can lead to side effects or loss of effectiveness.
  • Instruct patient to rinse mouth with water or commercial mouthwash after use to remove residue and reduce irritation.
  • Tell patient to store inhaler at room temperature, away from excessive heat or cold.
  • Warn patient receiving concurrent corticosteroid therapy not to stop or reduce medication without consulting health care provider, even if patient feels better.
  • Instruct patient to wash inhaler daily with warm water and to dry thoroughly.
  • Caution patient to avoid getting aerosol spray in eyes.
  • Instruct patient to report the following symptoms to health care provider: palpitations, chest pain, muscle tremors, dizziness, increased nervousness, headache, flushing, breathing problems, difficult urination.
  • Instruct patient not to take otc medications without consulting health care provider.

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Drugs Class ::

(by-TOLE-ter-ole MEH-sih-LATE)
Tornalate
Aerosol: 0.8% (delivers 0.37 mg/actuation)
Solution for inhalation: 0.2%
Class: Bronchodilator, Sympathomimetic

Indications for Drugs ::

 Indications Prevention and treatment of reversible bronchospasm associated with asthma or other obstructive pulmonary diseases.

Drug Dose ::

 Route/Dosage

Acute Bronchospasm

ADULTS AND CHILDREN > 12 yr: Oral inhalation: 2 inhalations at interval of 1 to 3 min, followed by third inhalation if necessary.

Prevention of Bronchospasm

ADULTS AND CHILDREN > 12 yr: Oral inhalation: 2 inhalations q 8 hr, not to exceed 3 inhalations q 6 hr or 2 inhalations q 4 hr. Solution for Inhalation Administer during a 10- to 15-min period. Continuous flow nebulization: 1.5 to 3.5 mg (0.75 to 1.75 mL volume) 3 to 4 times/day with an interval of ³ 4 hr between treatments. Max daily dose of 14 mg. Intermittent flow nebulization: 0.5 to 1.5 mg (0.25 to 0.75 mL volume) 3 to 4 times daily with an interval of ³ 4 hr between treatments. Max daily dose of 8 mg.

Contraindication ::

 Contraindications Standard considerations.

Drug Precautions ::

 Precautions

Pregnancy: Category C. Lactation: Undetermined. CHILDREN: Safety and efficacy in children < 12 yr not established. Elderly: Lower doses may be required. Cardiovascular Disorders: Toxic symptoms may occur. CNS Effects: Drug may cause CNS stimulation; cautious use is needed in patients with history of seizures or hyperthyroidism. Diabetes Mellitus: Dosage adjustment of insulin or oral hypoglycemic agent may be required. Excessive Use: Paradoxical bronchospasm and cardiac arrest have been associated with excessive inhalant use. Labor and Delivery: May inhibit uterine contractions and delay preterm labor. Tolerance: May occur. Combined Therapy: Do not use ³ 2 beta-adrenergic aerosol bronchodilators simultaneously because of the potential of additive effects. Do not use as a substitute for oral or inhaled corticosteroids.

PATIENT CARE CONSIDERATIONS


Drug Side Effects ::

 Adverse Reactions

CARDIOVASCULAR: Palpitations; tachycardia; irregular pulse; hypertension; angina. CNS: Tremor; lightheadedness; dizziness; nervousness; headache; tiredness. EENT: Throat and mouth irritation. GI: Nausea; vomiting. RESPIRATORY: Cough; increased chest discomfort; dyspnea; bronchospasm.

Drug Mode of Action ::  

(by-TOLE-ter-ole MEH-sih-LATE)
Tornalate
Aerosol: 0.8% (delivers 0.37 mg/actuation)
Solution for inhalation: 0.2%
Class: Bronchodilator, Sympathomimetic

Drug Interactions ::

 Interactions None well documented.

Drug Assesment ::

 Assessment/Interventions

  • Obtain patient history, including drug history and any known allergies.
  • Review baseline ECG for cardiac dysrhythmias associated with tachycardia.
  • Take heart rate before administration of drug. If tachycardia, cardiac arrhythmia, or chest pain is present, hold medication and notify health care provider immediately.
  • Have epinephrine 1:1000 available for immediate or delayed hypersensitivity reaction.
  • Obtain baseline blood values and monitor during therapy. Notify health care provider of abnormal results.
OVERDOSAGE: SIGNS & SYMPTOMS
  Exaggerated side effects, such as tremors, tachycardia, seizures, hypokalemia, anginal pain, and hypertension

Drug Storage/Management ::

 Administration/Storage

  • To administer, instruct patient to tilt head back and put inhaler mouthpiece between lips or 2 inches from open mouth. Tell patient to inhale slowly, press down on canister, hold breath ³ 10 sec or as long as comfortable, remove mouthpiece, then exhale slowly.
  • Use spacing device (eg, Aero-changer) to enhance drug delivery.
  • Administer pressurized inhalation during second half of inspiration to achieve better distribution of medication because airways are opened wider at this time. If second inhalation is necessary, wait ³ 1 full min between inhalations.
  • Store metered-dose inhaler in pressurized container at room temperature; do not freeze. Keep away from extreme heat. Do not store or use near open flame or discard in incinerator.
  • For nebulizer use, find a location where patient can sit comfortably for 10 to 15 min. Do not mix different types of medications without permission from doctor or pharmacist. Have patient take slow, deep breaths and, if possible, hold breath 10 sec before slowly exhaling. Continue until medication chamber is empty.

Drug Notes ::

 Patient/Family Education

  • Ask patient to demonstrate correct use of inhaler. It may be necessary to repeat instructions and demonstrations more than once. Consider use of spacing device.
  • Explain that tolerance may occur with prolonged use, but temporary cessation of drug usually restores its original effectiveness. Instruct patient to notify health care provider if medication is ineffective.
  • Warn patient to avoid excessive use, which can lead to side effects or loss of effectiveness.
  • Instruct patient to rinse mouth with water or commercial mouthwash after use to remove residue and reduce irritation.
  • Tell patient to store inhaler at room temperature, away from excessive heat or cold.
  • Warn patient receiving concurrent corticosteroid therapy not to stop or reduce medication without consulting health care provider, even if patient feels better.
  • Instruct patient to wash inhaler daily with warm water and to dry thoroughly.
  • Caution patient to avoid getting aerosol spray in eyes.
  • Instruct patient to report the following symptoms to health care provider: palpitations, chest pain, muscle tremors, dizziness, increased nervousness, headache, flushing, breathing problems, difficult urination.
  • Instruct patient not to take otc medications without consulting health care provider.

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