Confessions from an insider
Peter C. Gøtzsche, Richard Smith, Drummond Rennie in Deadly Medicines and Organised Crime, 2019
At one time, we visited chest physicians and showed them a film of small white particles that had been placed in the mucus in the windpipe. The movement of these particles towards the mouth was recorded with and without giving the patients terbutaline, and the story was that the cilia moved the particles faster when patients were treated. The idea was to convince the doctors that they should not only use the drug for asthma, but also for smoker’s lungs (chronic bronchitis). These patients cough a lot, which is why a quicker transport of irritants out of the lungs was speculated to be beneficial. But yet again, a simple question would have revealed that the emperor had no clothes. There were no randomised trials that had shown that terbutaline was effective in patients with chronic bronchitis. Even today, terbutaline is only approved for asthma and other bronchospasm, not for chronic bronchitis.
Miscellaneous conditions affecting the genitalia
Shiv Shanker Pareek in The Pictorial Atlas of Common Genito-Urinary Medicine, 2018
The patient should be admitted to hospital immediately as it is a medical emergency requiring urgent treatment to prevent permanent damage to the penis. Pseudoephedrine – a decongestant drug that narrows blood vessels.Terbutaline – a beta agonist.Drain blood from the penis with a needle and syringe.Surgery may be needed to correct the blood flow to the penis and prevent permanent tissue damage and scarring.
Obstetric Hemorrhage II: Postpartum Hemorrhage
Lauren A. Plante in Expecting Trouble, 2018
The initial correction of uterine inversion may be accomplished through manual replacement. A cupped hand or a fist can be used to apply pressure to the exposed inverted uterine fundus to replace it into its anatomic location. Uterine relaxation may be needed and can be achieved using 100–200 mcg (or one to two sprays) nitroglycerin sublingual q2–3 min. Other tocolytics such as terbutaline or magnesium sulfate have been used if nitroglycerin is not available. However, terbutaline can cause tachycardia, which may be misinterpreted as deteriorating hemodynamic status due to hemorrhage. General anesthesia can also be used to relax the uterus. Once the uterus is replaced, uterotonic medications should be used to keep the uterus contracted. Laparotomy is a final option with techniques such as Huntington and Haultain procedures. The Huntington procedure involves the use of Babcock or Allis forceps to elevate the inverted corpus in a progressive and stepwise fashion (18). The Haultain procedure requires an incision in the posterior aspect of the cervical ring and then the elevation of the inverted corpus through that space, followed by closure of the posterior hysterotomy (19). These may also require uterine relaxation to allow inversion correction.
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).
Related Knowledge Centers
- Asthma
- Bronchodilator
- Tachycardia
- Tocolytic
- Uterine Contraction
- Preterm Birth
- Guaifenesin
- Beta2-Adrenergic Agonist
- Pregnancy Category
- Off-Label Use