A nurse cares for an older adult with COPD who develops palp… | MyMerci
Medical Emergencies PA
Question

A nurse cares for an older adult with COPD who develops palpitations and HR 130 after each albuterol nebulizer treatment. The provider switches to levalbuterol. Which client outcome is the most likely intended benefit?

Explanation
Correct (2): Albuterol is a racemic mixture of R-(active) and S-(inactive, may be pro-inflammatory) isomers. Levalbuterol is the purified R-isomer, marketed for similar bronchodilation with theoretically fewer beta-1 mediated side effects (tachycardia, tremor). Useful in clients with cardiac comorbidities. (1) Similar bronchodilation, not stronger. (3) Unrelated. (4) No antiarrhythmic effect.

In-depth explanation

Memory Tip Levalbuterol = "Lev-er a-Better-tolerated" pure R-isomer. Beware: cost is much higher than albuterol; clinical benefit modest.

Clinical scenario

Scenario 72-year-old male with COPD, atrial fibrillation. Albuterol nebulizer causes palpitations, HR 130. Provider switches to levalbuterol 1.25 mg nebulizer.

Key concepts

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