pharmacology888

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I have always been confused regarding the use of nebulizer vs inhaler. So if a person has dexterity issues (kids, elderly), they would be a better candidate for the solution than the inhaler? So as a rescue, one would always use the inhaler (even if one has the nebulizer)?

Lastly, the days supply is really confusing. For the MDI, the days supply for 1 inhaler would be 15 days supply, assuming that the patient uses 2 inhalaions every 4 hours. However, how would one dose the inhalation solution (the databases state that it's dosed multiple times per day)? If it's dosed multiple times per day, how come the days supply for the premixed .083% (25 vials) would last for a month?

I have been trying to figure this out all morning, looking at the databases and researching online, but still can't find the answer. I really appreciate it if some1 can help me! Thanks!
 

StaviZFingerZ

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Use Xopenex instead. Sepracor rep said it was safer. [/priapism]
 

Praziquantel86

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I have always been confused regarding the use of nebulizer vs inhaler. So if a person has dexterity issues (kids, elderly), they would be a better candidate for the solution than the inhaler? So as a rescue, one would always use the inhaler (even if one has the nebulizer)?

Lastly, the days supply is really confusing. For the MDI, the days supply for 1 inhaler would be 15 days supply, assuming that the patient uses 2 inhalaions every 4 hours. However, how would one dose the inhalation solution (the databases state that it's dosed multiple times per day)? If it's dosed multiple times per day, how come the days supply for the premixed .083% (25 vials) would last for a month?

I have been trying to figure this out all morning, looking at the databases and researching online, but still can't find the answer. I really appreciate it if some1 can help me! Thanks!
Albuterol is supposed to be used exclusively on an as needed basis, with other medications (steroids, LABAs, etc.) doing the bulk of the work in controlling the long-term disease process. Directions on a prescription may say 1-2 puffs q4-6h, but no one should be doing that on a consistent basis. So to answer the days supply question, it's based on a worst-case scenario.

As far as choosing a nebulizer vs. inhaler goes, it depends on the scenario. Most people are able to use the inhaler with no problem. Severe attacks, the elderly and younger folks are an exception.
 

StaviZFingerZ

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^
^
^
^

what he said.
 
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pharmacology888

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So basically the albuterol inhalation solution is an option for the elderly/kids in cases of where rescue medication is needed? But I heard the nebulizer machine takes about 5-10 minutes to prepare, so the nebulizer is rarely used?

So just to make sure, the 25 vials (75ml) of .083% solution would have a days supply of 30 days? So why would the "worse case scenario" days supply apply to the inhaler and not to the solution?

THANK YOU again
 

DASicari

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Depending on the directions, the day supply will vary. For example, a single of box of 25 vials may not last a full 30 day supply with the directions of using one vial every 4 to 6 hours as needed. I would probably bill that single box as a one or two week supply.
 

Praziquantel86

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So basically the albuterol inhalation solution is an option for the elderly/kids in cases of where rescue medication is needed? But I heard the nebulizer machine takes about 5-10 minutes to prepare, so the nebulizer is rarely used?

So just to make sure, the 25 vials (75ml) of .083% solution would have a days supply of 30 days? So why would the "worse case scenario" days supply apply to the inhaler and not to the solution?

THANK YOU again
The nebulizer may take a while to get up and running (depending on the model), but it also delivers a more sustained dose of drug. Again, for most people, an inhaler is sufficient, but some will require nebulizer treatment. If you go to the ER in the midst of an asthma attack, they will, without a doubt, hook you up to a nebulizer.

The days supply is entirely dependent on the use and insurance restrictions. If you can get a box of nebulized albuterol through the insurance for 15 days and the directions for use fit that supply, then go for it.
 
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pharmacology888

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THANK YOU. You guys have been so helpful. I really appreciate it.

So in essence, if the direction states "2.5 mg every 4-8 hours as needed" then I could do 1 box as a 5 day supply?
What if it says "Use as Directed" and it was the pt's first fill (so you can't check in the computer for previous sigs)? What's a reasonable days supply?
 
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nnguyenc

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yeah...it always confused the crap out of me too

but for MDI = 20 days supply
nebulizer = 1 box for 7 days supply


regardless of directions...that's what i always do

i can careless what insurance says
i'll only change it if it says something like " dosage too high"
 

Old Timer

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Regardless of the directions. You should never bill nor dispense an Albuterol MDI with a days supply of less than 25 unless you have some documentation that the patient is maxed out on controller meds or has some other extenuating circumstances.
KEY POINTS: SAFETY OF INHALED SHORT-ACTING BETA 2 -AGONISTS


  • SABAs are the most effective medication for relieving acute bronchospasm
  • Increasing use of SABA treatment or using SABA >2 days a week for symptom relief (notprevention of EIB) generally indicates inadequate control of asthma and the need for initiating or intensifying anti-inflammatory therapy.
  • Regularly scheduled, daily, chronic use of SABA is not recommended
National Heart Lung and Blood Pressure Institute Guidelines
The frequency of SABA use can be clinically useful as a barometer of disease activity, because
increasing use of SABA has been associated with increased risk for death or near death in
patients who have asthma (Spitzer et al. 1992). Use of more than one SABA canister every
1–2 months
is also associated with an increased risk of an acute exacerbation that requires an ED visit or hospitalization (Crystal-Peters et al. 2002; Lieu et al. 1998; Schatz et al. 2005). Thus, the use of more than one SABA canister (e.g., albuterol, 200 puffs per canister), predominantly for quick-relief treatment during a 1-month period, most likely indicates overreliance on this drug and suggests inadequate control of asthma (Spitzer et al. 1992).
National Heart, Lung and Blood Pressure Institute

In plain ordinary English: No asthmatic patient should renew an Albuterol Inhaler in less than 25 days. In reality, every 25 days is a problem. You should be counseling the patient, reviewing their therapy and consulting with their physician.
 
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pharmacology888

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Regardless of the directions. You should never bill nor dispense an Albuterol MDI with a days supply of less than 25 unless you have some documentation that the patient is maxed out on controller meds or has some other extenuating circumstances.
National Heart Lung and Blood Pressure Institute Guidelines

In plain ordinary English: No asthmatic patient should renew an Albuterol Inhaler in less than 25 days. In reality, every 25 days is a problem. You should be counseling the patient, reviewing their therapy and consulting with their physician.
Interesting. I mean, clinically if a pt has syptoms for greater than 2 days a week or uses their rescue inhaler for greater than 2 days a wk, they are probably not well controlled and other measures should be taken to ascertain why their not well controlled (allergens, steroid dose ect). So just based on clinical judgement, you would put 25 days as days supply for albuterol inhaler? Then what about nebulizer (.083% 75ml)?
 

Old Timer

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Interesting. I mean, clinically if a pt has syptoms for greater than 2 days a week or uses their rescue inhaler for greater than 2 days a wk, they are probably not well controlled and other measures should be taken to ascertain why their not well controlled (allergens, steroid dose ect). So just based on clinical judgement, you would put 25 days as days supply for albuterol inhaler? Then what about nebulizer (.083% 75ml)?
I always put 25 days on an Albuterol inhaler. I'm more lenient with Nebulizer solutions, but the rules are about the same. If they are constantly using SABA's they are not in control and you need to intervene....

I have had two patient's in 2 different stores that were using 2 inhalers per month for more than six months and no controller meds. I stopped filling more than 1 per month and called the MD's in question to get them on some ICS. I don't want anything to happen to a patient when I can easily prevent it and I don't ever want to get sued and have some jerk off lawyer ask me why I dispensed out of the known standard of care.
 

Sparda29

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Hmm, around here we were told to assume that the patient is using it as per the directions, thus be lenient with the days supply.

For me, 1 box (25 vials) and use 1 vial every 6 hours as needed would mean a 6 day supply.
 

nnguyenc

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hey oldtimer,

if you see the demos for RxConnect, they used albuterol MDI as 20 day supply
you can view it on cvslearnet with on-hold prescriptions...

that's where i'm getting my info from
 

Old Timer

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hey oldtimer,

if you see the demos for RxConnect, they used albuterol MDI as 20 day supply
you can view it on cvslearnet with on-hold prescriptions...

that's where i'm getting my info from
Please tell me you are not basing clinical decisions on a powerpoint slide show of the new pharmacy software system.