Nurses Compass
Drug Guide
Arformoterol Tartrate
Classification
Therapeutic: Bronchodilator for COPD management
Pharmacological: Beta2-adrenergic agonist
FDA Approved Indications
- Long-term maintenance treatment of bronchoconstriction in patients with COPD, including chronic bronchitis and emphysema
Mechanism of Action
Arformoterol is a selective beta2-adrenergic agonist that stimulates beta2 receptors in the smooth muscle of the bronchi, leading to relaxation of bronchial smooth muscle and bronchodilation.
Dosage and Administration
Adult: Intravenous: 15 mcg twice daily via nebulization; doses may be adjusted by the healthcare provider.
Pediatric: Not approved for pediatric use.
Geriatric: Use with caution; dose adjustments based on tolerability and response.
Renal Impairment: No specific adjustment recommended; however, monitor for adverse effects.
Hepatic Impairment: No specific data; use caution and monitor patient response.
Pharmacokinetics
Absorption: Rapid absorption via inhalation administration.
Distribution: Widely distributed; extensive first-pass metabolism for oral equivalent routes (not used orally).
Metabolism: Primarily hepatic; via conjugation and oxidative pathways.
Excretion: Metabolites excreted mainly in the urine.
Half Life: Approximately 6 hours.
Contraindications
- Hypersensitivity to arformoterol or other components of the formulation.
Precautions
- Use with caution in patients with cardiac arrhythmias, hypertension, or others sensitive to beta-adrenergic stimulation. Use caution in patients with diabetes or hyperthyroidism. Monitor for paradoxical bronchospasm.
Adverse Reactions - Common
- Tremor (Very common)
- Increased heart rate (tachycardia) (Common)
- Muscle cramps (Uncommon)
Adverse Reactions - Serious
- Paradoxical bronchospasm (Rare)
- Cardiac arrhythmias (Uncommon)
- Hypokalemia (Uncommon)
Drug-Drug Interactions
- Other beta-agonists, beta-blockers (may diminish effect), MAO inhibitors, tricyclic antidepressants
Drug-Food Interactions
N/ADrug-Herb Interactions
N/ANursing Implications
Assessment: Monitor respiratory status, heart rate, rhythm, and blood pressure before and during administration. Watch for paradoxical bronchospasm.
Diagnoses:
- Ineffective airway clearance
- Ineffective breathing pattern
Implementation: Administer via nebulizer as prescribed. Ensure proper inhalation technique. Monitor for adverse reactions.
Evaluation: Assess for improved respiratory function and absence of adverse effects.
Patient/Family Teaching
- Use as prescribed; do not overuse. Report worsening symptoms or adverse effects. Keep medication out of reach of children.
- Wash nebulizer mouthpiece and chamber after each use.
Special Considerations
Black Box Warnings:
- None specifically for arformoterol, but long-acting beta2-agonists carry warnings about increased asthma-related mortality in asthma patients (not applicable for COPD).
Genetic Factors: None established.
Lab Test Interference: Possible effects on potassium levels and blood glucose.
Overdose Management
Signs/Symptoms: Severe tachycardia, hypokalemia, chest pain, tremors, severe hypertension or hypotension.
Treatment: Discontinue drug, provide supportive care, monitor cardiac and respiratory status, administer beta-blockers if necessary (cautiously).
Storage and Handling
Storage: Store at room temperature, away from moisture and heat.
Stability: Stable under recommended storage conditions for specified shelf life.