ABSTRACT
OBJECTIVES: To determine the clinical effects of intravenous terbutaline at >0.4 microg/kg/min in children with status asthmaticus; to describe the clinical findings associated with such therapy, including creatinine phosphokinase-myocardial band isoenzyme (CPK-MB) concentrations, electrocardiographic alterations, and decreased diastolic blood pressure (DBP) with terbutaline usage; and to assess the requirement for epinephrine to counteract the decrease in diastolic blood pressure. DESIGN: A retrospective review of children admitted with status asthmaticus who failed emergency room therapy and required intravenous terbutaline. SETTING: San Diego Children's Hospital Pediatric Intensive Care Unit. PATIENTS: Eighteen children with status asthmaticus, based on clinical and laboratory criteria, between September 1994 and July 1996. INTERVENTIONS: Epinephrine was added for below-normal decreases in diastolic blood pressure. MEASUREMENTS AND MAIN RESULTS: Continuous monitoring for arrhythmias, ST-segment changes, and DBP values during variations in the dose of intravenous terbutaline, with or without epinephrine. CPK-MB concentrations were determined in 15 of 18 patients. CONCLUSIONS: Intravenous terbutaline was well tolerated in asthmatic children for < or =305 continuous hours and at varying doses up to a maximum of 10 microg/kg/min. There was no relationship between the magnitude of CPK-MB concentrations and the terbutaline or epinephrine doses used. Arrhythmias were rare and not related to either terbutaline or epinephrine doses. However, ST-segment depression did occur in two patients requiring high-dose epinephrine. Terbutaline significantly lowered DBP when used between 0.4 and 1.0 microg/kg/min, which required epinephrine to be initiated. Epinephrine was not required at terbutaline doses of >2 microg/kg/min. There was no mortality.
Subject(s)
Bronchodilator Agents/therapeutic use , Status Asthmaticus/drug therapy , Terbutaline/therapeutic use , Adolescent , Arrhythmias, Cardiac/chemically induced , Blood Pressure/drug effects , Child , Child, Preschool , Creatine Kinase/blood , Drug Monitoring , Drug Therapy, Combination , Electrocardiography , Epinephrine/therapeutic use , Female , Humans , Infusions, Intravenous/methods , Isoenzymes , Male , Retrospective Studies , Status Asthmaticus/metabolism , Status Asthmaticus/physiopathology , Time FactorsABSTRACT
OBJECTIVE: Medications often are produced in a form that makes administration to pediatric patients difficult. Even when available in liquid forms, some medications can pose compliance problems in children. Various strategies and techniques are discussed which provide information on how to increase compliance in this special group of patients by providing preparations that can be rapidly formulated and easily administered. CONCLUSIONS: The pharmacist and pharmacy technician can benefit from an increased awareness of the special needs of the pediatric patient regarding drug therapy. With the increasing probability of an expanded scope of practice for technicians, this information can be of interest to both pharmacists and technicians.
