A client is receiving isoetharine hydrochloride (Bronkosol) via a nebulizer. The nurse monitors the client for which side effect of this medication?
A. Constipation
B. Diarrhea
C. Bradycardia
D. Tachycardia
Correct Answer: D. Tachycardia
Side effects that can occur from a beta 2 agonist include tremors, nausea, nervousness, palpitations, tachycardia, peripheral vasodilation, and dryness of the mouth or throat. Due to the vasodilatory effect of peripheral vasculature and subsequent decrease in cardiac venous return, compensatory mechanisms manifest as tachycardia are relatively common, especially within the first weeks of usage.
Option A: Constipation is not a side effect of isoetharine. Beta-2 agonists have been shown to decrease serum potassium levels via an inward shift of potassium into the cells due to an effect on the membrane-bound Na/K-ATPase, which can potentially result in hypokalemia. Beta-2 agonists also promote glycogenolysis, which can lead to inadvertent elevations in serum glucose.
Option B: Adverse effects of beta-2 agonists most commonly involve the desensitization of the beta-2 adrenergic receptor to the beta-2 agonist. Due to the similar properties between the classes of adrenergic receptors, beta-2 agonists can create an “off-target” effect in stimulating either alpha-1, alpha-2, or beta-1 receptors. The most common side effects of beta-2 agonists involve the cardiac, metabolic, or musculoskeletal system.
Option C: Arrhythmias are seen more commonly in fenoterol usage versus albuterol, and arrhythmias have an increase in frequency in patients with underlying heart disease or concomitant theophylline use. Several studies have also indicated hypoxemia and hypercapnia as exacerbating factors to the cardiotoxic effects of beta-2 agonists.
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