Question about Xopenex

allnurses Guide · Jan 12, 2010

I am a new nurse and have a question about a patient I had- she got up to the commode and her heart rate jumped up to the 150's, blood pressure was slightly higher than baseline at 130/80 and RR was 20 and she stated she could feel her heart pounding and felt like she could not catch her breath- Sp02 was 95% on 2L. She has chronic A-fib and she usually does tach up when she gets up. The charge nurse gave her a breathing tx of Xopenex which I did not think was necessary since her SOB was not from bronchial constriction, just and increase in 02 demands. Also I know Xopenex is not supposed to have the cardiac side effects of albuterol, but I have heard the it can increase HR. Was she just being on the safe side? Should you just give Xopenex with any breathing problem?
Any insight wold help, I have a lot to learn!:)

It sounds like the patient was having some orthostatic changes and probably is a little dry. Here is the side-effects of Xopenex compared to albuterol. http://www.rxlist.com/xopenex-drug.htm They have almost the same amount of HR changes.

The thing to remember about any receptor specific drug, whether it is Alpha/Beta 1 or 2, is that none of them are completely receptor specific and you will get some activation of the other receptors (1 or 2). In the case of Xopenex you are still going to get some Beta 1 stimulation even though it supposed to be only Beta 2.

In this particular case since the HR was already elevated I would probably have not given the Xopenex. The SOB could have been caused by the increased demand for O2 r/t the increase in HR.

JustEnuff2BDangerous, BSN, RN · Jan 12, 2010

She probably was doing it just to be on the safe side since the pt was c/o SOB. However it seems to me that the SOB in this case very well could have been caused by anxiety, which could have been related to the pt's c/o heart racing and associated changes. Since the pt's SpO2 was fine (>92%) I probably would not have given the breathing treatment just because, in my opinion, I would not have considered it to be necessary. I would have tried calming techniques ("Take deep breaths through your nose", for instance) before moving on to that.

amyann · Jan 12, 2010

Thanks for your insight, that is pretty much what I thought but the supervisor and charge nurse made me feel like an itiot when I questioned the idea of giving her Xopenex. I felt like we should get her back in bed from the commode and let her calm down a while and reassess before I called the doctor but they didn't. The doctor pretty much told me the same thing and then I was left feeling like an itiot on the phone to the doctor.

I'm going to bring it up to them, that maybe we shouldn't just give Xopenex out to anyone with SOB, but I thought I'd better do some research first- Thanks!!