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Miscellaneous Drugs during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Terbutaline was associated with maternal cardiovascular effects (including pulmonary edema) similar to those associated with ritodrine (Katz et al., 1981). One review of cardiopulmonary effects of low-dose continuous terbutaline infusion in 8709 women found 47 women (0.5 percent) developed one or more adverse cardiopulmonary effects. Twenty-eight women (0.3 percent) developed pulmonary edema (Perry et al., 1995). Among 1,000 women who were given intravenous terbutaline and magnesium sulfate tocolysis, side effects were negligible (Kosasa et al., 1994). Terbutaline hepatitis in pregnancy was reported in two cases (Quinn et al., 1994), but cited in multiple sources. ACOG recommends use of terbutaline inpatient and for no more than 48 hours. (ACOG, 2016). The FDA placed a Boxed Warning on use of terbutaline during pregnancy for treatment of preterm labor, citing significant maternal complications (cardiac arrhythmias, myocardial infarction, pulmonary edema, hypertension, and tachycardia) and risk for death.
Intrapartum Fetal Monitoring
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
Nandini Raghuraman, Alison G. Cahill
ACOG recommends the administration of tocolytic medications (e.g. terbutaline) when tachysystole is associated with FHR abnormalities [56]. Repetitive use of terbutaline is not recommended. There is insufficient evidence (no randomized trial) to assess the effect of labor stimulant discontinuation on fetal status. Nonetheless, labor stimulants such as oxytocin should be discontinued in cases of NRFHT, especially in the setting of tachysystole.
The diagnosis and management of preterm labor with intact membranes
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Roberto Romero, Tinnakorn Chaiworapongsa, Francesca Gotsch, Lami Yeo, Ichchha Madan, Sonia S. Hassan
With the introduction and widespread utilization of tocolytic agents, several definitions of preterm labor were proposed. Notably, in 1975, Ingemar Ingemarsson (154) proposed that the criteria for the diagnosis should include (i) painful regular uterine contractions occurring at intervals of less than 10 minutes for at least 30 minutes by external tocography, (ii) a cervix that is effaced or almost effaced and dilated at least 1 to 2cm, (iii) intact membranes, and (iv) a gestational age between 28 and 36 weeks. This definition was the basis for a randomized, double-blinded clinical trial of terbutaline in women with preterm labor and intact membranes (154). The gestational age limitation reflected neonatal survival at the time. Importantly, two components of the common pathway were required for the diagnosis (increased myometrial contractility and cervical change). Gonik and Creasy wrote a clinical opinion in 1986 (155), in which they proposed a definition of preterm labor that has been used subsequently in the literature. The definition is based on uterine contractility and cervical change, and was proposed to select patients for tocolytic treatment. A change in cervical status was required because of the concern about overtreating patients with painful Braxton-Hicks contractions without other evidence of preterm labor (156–158).
Commercial valved spacers versus home-made spacers for delivering bronchodilator therapy in pediatric acute asthma: a cost-effectiveness analysis
Published in Journal of Asthma, 2021
Carlos E. Rodríguez-Martínez, Monica P. Sossa-Briceño, Ian P. Sinha
Patient characteristics and details of interventions administered in the randomized controlled trials (RCTs) included in a Cochrane systematic review with a meta-analyses aimed at comparing the response to inhaled beta-2 agonists delivered through MDI using home-made spacers with that using commercially-produced spacers in children with acute exacerbations of wheezing or asthma (17) defined our reference population. Specifically, we analyzed patients aged 2 months to 18 years with mild to moderate asthma exacerbations requiring ED management. Children were excluded if they had a history of cardiac, hepatic, skeletal, neuromuscular, or pulmonary diseases other than asthma; if they had already received beta-2 agonists, xanthines, or oral corticosteroids before going to the hospital, if they were unable to use an MDI and spacer, or if they experienced a severe or life-threatening asthma exacerbation. The beta-2 agonists used were albuterol, terbutaline, and fenoterol hydrobromide. The doses of beta-2 agonists administered ranged from 1000 µg to 2400 µg of albuterol and from 400 µg to 600 µg of fenoterol hydrobromide. The dose of terbutaline was not stated.
Formulation, development, and in-vitro/ex-vivo evaluation of vaginal bioadhesive salbutamol sulfate tablets for preterm labor
Published in Pharmaceutical Development and Technology, 2020
Amal S. M. Abu El-Enin, Asmaa M. Elbakry, Rania El Hosary, Marwa Ahmed Fouad Lotfy
Africa showed minimal progress to overcome this problem. Egypt is ranked 144 amongst 162 countries with prematurity-related deaths comprising about 28.5% of all under-5 deaths in Egypt (Liu et al. 2012; Lawn et al. 2013). Tocolytic drugs function by prolonging pregnancy in case of preterm labor, allowing the fetus to be more mature in the uterus before being born (Roberts et al. 2017). β2 agonists as salbutamol sulfate and terbutaline sulfate have been used for the treatment of preterm labor in hospitals since 1980. They are given as intravenous infusion then treatment maintained via oral tablets. Parenteral and oral salbutamol may cause some side effects, such as tachycardia, anxiety, and chill. It has also a short half-life 4–6 h (Zulfiqar and Iftikhar 2016). It suffers from first-pass effect in the liver and gut wall. Salbutamol sulfate is a class I drug according to biopharmaceutical classification, it is a highly water-soluble drug with a pKa of 9.2 and a log p value of 0.11 (Prasanth et al. 2011).
Comparison of two continuous nebulized albuterol doses in critically ill children with status asthmaticus
Published in Journal of Asthma, 2020
Ada T. Lin, Melissa Moore-Clingenpeel, Todd J. Karsies
The choice of 10 or 25 mg/h albuterol was made by the treatment team based, in part, on their assessment of the patient and their personal experience with continuous albuterol. However, the primary driver for selection of a specific albuterol dosage appears to be clinical awareness of the lower dose option rather than disease severity. We did not have weight or body mass index data available for our analysis so we are unable to evaluate the impact of weight-based dosing on fluid resuscitation needs. Also, the addition of other therapies was also at the discretion of the clinical team managing the patient. While our unit has an asthma treatment guideline that was unchanged over the study period, the specific therapies prescribed were ultimately decided by the treating physician, and some practices did tend to shift over the study period. The use of terbutaline declined over the study period while the use of magnesium increased. This reduction in terbutaline use likely reflects increased attention to the cardiovascular side effects commonly associated with terbutaline, but the overall terbutaline use was very low (9 patients total out of 632) and not associated with overall fluid use. We also saw a rise in magnesium administration in the ED over time potentially due to growing evidence that magnesium may reduce hospitalization, although this seems unlikely to be related to differences in fluid resuscitation since this difference was primarily seen after ICU admission rather than in the ED (14–16).