알부테롤 / 살부타몰

베타-아드레날린 작용제 (기관지 확장제)

알부테롤(국제 일반명: **살부타몰**)은 속효성 $\beta_2$-아드레날린 수용체 작용제(SABA)입니다. 수의학에서는 하부 호흡기 질환과 관련된 기관지 경련 및 기침을 완화하는 강력한 **기관지 확장제**로 널리 사용됩니다. 주요 임상 적용: * **고양이 천식**: 주로 급성 천식 발작 시 "응급(rescue)" 흡입기로 사용됩니다. * **개 만성 기관지염**: 기관지 경련의 증상 완화를 제공합니다. * **말 재발성 기도 폐쇄(RAO)**: 호흡 곤란의 급성 완화에 사용됩니다. > **임상 요점**: 급성 응급 치료에는 매우 효과적이지만, 라세믹 알부테롤의 만성적인 단독 사용은(특히 고양이에서) 권장되지 않습니다. 라세믹 혼합물의 S-거울상 이성질체는 시간이 지남에 따라 역설적으로 기도 염증을 증가시킬 수 있습니다. 장기 관리를 위해서는 이상적으로 흡입용 코르티코스테로이드(예: 플루티카손)와 병용해야 합니다.

작용 기전: Albuterol selectively binds to and stimulates **$\beta_2$-adrenergic receptors** on bronchial smooth muscle. **Mechanism Pathway**: $\beta_2$-receptor activation $\rightarrow$ stimulates **adenylyl cyclase** $\rightarrow$ increases intracellular **cyclic AMP (cAMP)** $\rightarrow$ activates **protein kinase A (PKA)** $\rightarrow$ decreases intracellular calcium concentrations $\rightarrow$ results in **smooth muscle relaxation** and bronchodilation. * **Secondary Effects**: It also stabilizes mast cell membranes (preventing inflammatory mediator release) and increases mucociliary clearance. * **Metabolic/Electrolyte Effects**: Beta-adrenergic stimulation activates the **$Na^+/K^+$-ATPase pump**, driving potassium from the serum into the intracellular space, which can cause temporary hypokalemia. * **Cardiac Effects**: At standard doses, it has minimal $\beta_1$ (cardiac) activity, but at high doses or in sensitive individuals, it can cause tachycardia.

동물 종별 용량

Cats

Feline asthma (mild symptoms) · one puff albuterol as needed with one puff of 110 micrograms fluticasone twice daily. · Inhalation · PRN · Using the 90 micrograms/puff aerosol albuterol inhaler and an appropriate spacer and mask.
Feline asthma (moderate symptoms) · albuterol one puff as needed with a 5 day course of prednisone at 1 mg/kg PO daily, and 220 micrograms of fluticasone twice daily. · Inhalation · PRN
Feline asthma (severely affected/emergency) · 90 micrograms (one puff) albuterol every 30 minutes as needed. · Inhalation · q30min PRN · Should be treated on an emergency basis with oxygen and an intravenous dose of a glucocorticoid.
Feline asthma (chronic therapy) · 90 micrograms albuterol as needed · Inhalation · PRN · Should include fluticasone 220 micrograms twice daily and 1 mg/kg prednisone every other day.
Feline asthma (intermittent signs) · two puffs into an appropriate spacer ( e.g., Aerokat ®) twice daily; cat should breathe through the mask and spacer for 7-10 seconds. Positive clinical effect should be seen within 5-10 minutes. Can be used every 1/2 hour for 2-4 hours in crisis. · Inhalation · BID or q30min in crisis · For intermittent signs (e.g., wheeze, increased cough or respiratory rate and effort at rest).

Horses

Rescue therapy (respiratory difficulty at rest) · 360 micrograms (4 puffs) inhaled; if severe airway obstruction, may give at 15 minute increments for up to 2 hours. Continue as needed every 4-6 hours. · Inhalation · q15min up to 2h, then q4-6h PRN · Beneficial effects may last approximately 1 hour in severely affected horses. ARCI UCGFS Class 3 Drug.
Moderate to severe respiratory disease · 360 micrograms followed in 5 minutes with aerosolized corticosteroid (beclomethasone or fluticasone) therapy. · Inhalation

투여 경로

InhalationPOInhalational

금기

Known hypersensitivity to albuterol
Use with extreme caution in patients with cardiac disease (especially concurrent arrhythmias)
Use with caution in patients with diabetes, hyperthyroidism, hypertension, or seizure disorders
Use during late stages of pregnancy (may inhibit uterine contractions)
Known hypersensitivity to salbutamol
Severe cardiac tachyarrhythmias

이상반응

Tachycardia
Tremors and trembling
CNS excitement, nervousness, and agitation
Dizziness
Hypokalemia (decreased serum potassium)
Paradoxical airway inflammation in cats (associated with chronic use of the S-enantiomer in racemic albuterol)
Muscle tremors
Restlessness or excitement
Hypokalemia (with high doses)

약물 상호작용

Beta-adrenergic blocking agents (e.g., propranolol) · May antagonize the bronchodilatory actions of albuterol
Digoxin · Albuterol may increase the risk of cardiac arrhythmias · moderate
Inhalation anesthetics (e.g., halothane, isoflurane, methoxyflurane) · May predispose the patient to ventricular arrhythmias, particularly in patients with preexisting cardiac disease
Other sympathomimetic amines · Concurrent use may increase the risk of developing adverse cardiovascular effects
Tricyclic antidepressants or Monoamine oxidase inhibitors (MAOIs) · May potentiate the vascular effects of albuterol
Propranolol (and other non-selective beta-blockers) · Antagonizes the bronchodilating effects of salbutamol · major
Loop or Thiazide Diuretics · May exacerbate hypokalemia · moderate

모니터링

Clinical symptom improvement (respiratory rate, effort)
Thoracic auscultation
Blood gases (if indicated in severe respiratory distress)
Cardiac rate and rhythm (especially in overdose or susceptible patients)
Serum potassium levels (early in therapy if animal is susceptible to hypokalemia)
Respiratory rate and effort
Heart rate and rhythm
Serum potassium levels (if used frequently or in high doses)

과용량

Significant overdose (often occurring when **dogs puncture an aerosol canister with their teeth**) leads to massive systemic absorption and severe sympathomimetic toxicity. **Clinical Signs**: * Severe tachycardia and arrhythmias (extrasystoles) * Hypertension * Tremors, agitation, and CNS stimulation * Panting, tachypnea, and fever * Vomiting * Mydriasis * **Hypokalemia** and hypophosphatemia (due to intracellular shifts) **Treatment**: * **Oral Ingestion (Tablets)**: If recent and asymptomatic, perform standard decontamination (emesis, activated charcoal, cathartic). * **Inhaler Puncture**: Decontamination is generally *not* effective as absorption across the oral mucosa is extremely rapid. * **Medical Management**: * Use **beta-blocking agents** (e.g., atenolol, metoprolol, or propranolol) to control severe tachycardia and arrhythmias. * Administer **diazepam** for severe tremors or agitation. * Monitor electrolytes closely; **potassium supplementation** via IV fluids is frequently required to correct hypokalemia. * Contact an animal poison control center for guided management.

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