71.林先生因氣喘發作至急診，到院前已自行使用兩種inhalers各一次。下列急診之處置，何者最不適當？
(A)IV bolus albuterol
(B)IV methylprednisolone
(C)oral prednisone
(D)inhaled ipratropium

查過藥物許可證，Albuterol在台灣沒有注射劑型

Albuterol (salbutamol)
IV: Infusion solution [Canadian product]: Do not inject undiluted. Reduce concentration by at least 50% before infusing. Administer as a continuous infusion via infusion pump.

→而且根本不能IV bolus --------------

急性氣喘處理

◆ 吸入beta-agonist: albuterol（nebulization或MDI with spacer）

◆ 氧氣

◆ Ipratropium bromide（nebulization或MDI with spacer）

◆ Systemic glucocorticoids（可IV、IM或口服）

◆ Magnesium sulfate（一小時支氣管擴張治療無效時使用）→下一題第72題的答案

參考整理自UpToDate

SABA (Short-Acting Beta-Agonists )

回覆最佳解 @Ching-Ju

在103-1-13題選項中沒有albuterol，意思是albuterol有其他非吸入式的方式。

https://yamol.tw/item-12.下列何種藥品僅以吸入方式給藥治療氣喘？++①cromolyn②terbut..-537483.htm

GINA在asthma exacerbation也沒有提到SABA injection的用法
UpToDate的sabutamol的用法則提到IV infusion須保留至不能好好吸入的人

Moderate to severe exacerbations (management in primary or acute care settings): Note: For severe exacerbations, albuterol is used in combination with an inhaled short-acting muscarinic antagonist, and nebulized treatments are generally preferred (Hess 2019).

IV continuous infusion [Canadian product]: Note: Reserve intravenous beta-agonists for those patients in whom inhaled therapy cannot be used reliably (BTS 2019).

• 支援最佳解目前台灣並沒有albuterol的注射劑型

• 根據GINA 2022 : 吸入劑型的SABA最常用；IV SABA不建議
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  Currently, inhaled albuterol is the usual bronchodilator in acute asthma management. Similar efficacy and safety have been reported from emergency department studies with formoterol,and in one study of budesonide-formoterol. More studies of ICS-formoterol in emergency department management are needed. Current evidence does not support the routine use of intravenous beta2-agonists in patients with severe asthma exacerbations.
• 根據GINA 2022: 急診處置如下表