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anticholinergic Flashcards

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1
Q

Anticholinergic AKA

A

Parasympatholytic

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2
Q

Anticholinergic Agents

A

Atropine
Atrovent
Spiriva

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3
Q

What do these drugs block?

A

(Ach) Cholinergic-induced bronchoconstriction

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4
Q

When are these drugs effective?

A

If bronchoconstriction is due to cholinergic activity

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5
Q

What disease are anticholinergic drugs approved for?

A

COPD ONLY

used a bronchodilator for maintenance treatment for copd including chronic bronchitis and emphysema.

May be used for severe asthma in addition to beta agonist- especially if patient does not respond well to beta agonist therapy.

BUT ONLY APPROVED FOR COPD!!!!

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6
Q

Specific anticholinergic agents

A

Atropine
Ipratropium bromide
Combination Ipratropium Bromide/Albuterol
Tiotropium bromide

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7
Q

How would you administer Atropine?

A

Injection

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8
Q

Why wouldn’t you use Atropine?

A

Because of the systemic side effects

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9
Q

What kind of membranes do Atropine cross over?

A

Lipid Membranes

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10
Q

When does the onset begin for Ipratropium Bromide begin?

A

in several minutes

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11
Q

When does Ipratropium bromide peak?

A

1-2 hours

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12
Q

When can B2 agonist peak?

A

20-30 minutes

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13
Q

In asthma patients how long will the Ipratropium Bromide’s duration last?

A

about the same length of time as the B2 agonist drugs.

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14
Q

In COPD patients how long will the Ipratropium Bromide’s duration last?

A

1-2 hours longer

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15
Q

What would you use for symptomatic relief of allergic/non-allergic perennial rhinitis AND the common cold?

A

Anticholinergic Nasal Spray

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16
Q

What kind of effect do you get when mixing Albuterol and Ipratropium Bromide?

A

Synergistic Effect

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17
Q

What are the trade names for Albuterol and Ipratropium Bromide mixed?

A

Combivent

Duo-Neb

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18
Q

What is the long acting anti-cholinergic?

A

Tiotropium Bromide

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19
Q

What is the Trade name for Tiotropium Bromide

A

Spiriva

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20
Q

How is Spiriva given?

A

DPI

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21
Q

When does Spiriva Peak?

A

1-3 hours (says the book)

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22
Q

Easily absorbed in the blood stream?

A

Tertiary

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23
Q

Poorly absorbed into the bloodstream

A

Quaternary

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24
Q

Why is Quaternary poorly absorbed into the bloodstream?

A

Low lipid solubility

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25
Crosses the Blood brain barrier?
Tertiary
26
CNS
Teritary
27
Does not cross into the Blood brain barrier?
Quaternary
28
What kind of compound is Quaternary?
Ipratropium Bromide Atrovent Spiriva
29
Effects of Tertiary (Atropine)
``` Bronchodilation Decreased Mucus Clearance Block Hypersecretion Altered CNS Heart rate (increases or decreases) dry mouth dysphagia dysphonia Urinary retention ```
30
Effects of Quarternary (Ipa)
Bronchodilation Dry mouth Blocks hypersecretion
31
(MOA) How does it enter the lung?
Vagus Nerve
32
(MOA) Where is it found
Epithelium Submucosal Glands Smooth Muscle Mast Cells
33
(MOA) Automapping on what sized airways?
Large to Midsized (3-8mm)
34
(MOA) Are there receptors in the smaller proximal airways or bronchioles?
NO!
35
(MOA) Basal level of bronchomotor tone is caused by what kind of activity?
Parasympathetic
36
(MOA) Metacholine stimulates what?
constriction
37
(MOA) the effects of anticholinergic agents depend upon the degree of tone present that can be?
Blocked
38
(MOA) In health subjects, there is minimal airway dilation with an anticholinergic agent because there is only what kind of tone being blocked
basal or resting
39
IF THERE IS NO PARASYMPATHETIC ACTIVITY what kind of effect will the drug have?
MINIMAL!!!!
40
Bronchoconstriction in COPD may be due in part by what kind of reflex innervation of airway smooth muscle.
Vagally Mediated Relex
41
What kind of irritants can cause the sensory C-fibers to respond
``` Aerosols cold air high flows cigarette smoke histamine ```
42
When C-fibers are activated they produce what kind of impulse to the CNS?
Afferent Nerve
43
When C-fibers are activated they produce an afferent impulse to the CNS that results in an ______ impulse to cause _______ of muscle?
Efferent; Constriction
44
When C-fibers are activated they produce an afferent impulse to the CNS that results in an efferent impulse to cause constriction of muscle, _____ and _______?
Mucus secretion; Cough
45
When C-fibers are activated they produce an afferent impulse to the CNS that results in an efferent impulse to cause constriction of muscle, mucus secretion and cough. What is this doing?
PROTECTING
46
These agents also ______ exercise induced asthma, psychogenic bronchoconstriction, and bronchoconstriction caused by beta blockade and cholinergic agents
Inhibit
47
These agents also inhibit ___________, psychogenic bronchoconstriction, and bronchoconstriction caused by beta blockade and cholinergic agents
exercise induced asthma
48
These agents also inhibit exercise induced asthma, ____________, and bronchoconstriction caused by beta blockade and cholinergic agents
psychogenic bronchoconstriction
49
These agents also inhibit exercise induced asthma, psychogenic bronchoconstriction, and ___________ caused by beta blockade and cholinergic agents
bronchoconstriction
50
These agents also inhibit exercise induced asthma, psychogenic bronchoconstriction, and bronchoconstriction caused by ________and ________
beta blockade and cholinergic agents
51
What else inhibits reflex bronchoconstriction by blocking irritant receptors?
Aerosolized Lidocaine
52
Changes in airway may also make cough mechanism more _____?
sensitive
53
Airways are hypersensitive to deep breaths that result in a cough or increase in
bronchomotor tone
54
At least a portion of the obstruction in COPD may be due to?
VAGALLY MEDIATED REFLEX BRONCHOCONSTRICITON
55
Stimuation by afferent ______, trigger reflex efferent vagal nerve activity and constriction
C-Fibers
56
Anticholinergic agents are ______ antagonists for acetylcholine at muscarinic receptors on airway smooth muscle and M1 receptors at the parasympathetic ganglia
competitive
57
Anticholinergic agents are competitive antagonists for ______ at muscarinic receptors on airway smooth muscle and M1 receptors at the parasympathetic ganglia
acetylcholine
58
Anticholinergic agents are competitive antagonists for acetylcholine at ______ receptors on airway smooth muscle and M1 receptors at the parasympathetic ganglia
muscarinic
59
Anticholinergic agents are competitive antagonists for acetylcholine at muscarinic receptors on ___________ and M1 receptors at the parasympathetic ganglia
airway smooth muscle
60
Anticholinergic agents are competitive antagonists for acetylcholine at muscarinic receptors on airway smooth muscle and ____ receptors at the parasympathetic ganglia
M1
61
Anticholinergic agents are competitive antagonists for acetylcholine at muscarinic receptors on airway smooth muscle and M1 receptors at the _____________?
parasympathetic ganglia
62
They block the action of ________ at the M3 receptor in the airway reversing bronchoconstriction due to cholinergic activity.
acetylcholine
63
They block the action of acetylcholine at the ____ receptor in the airway reversing bronchoconstriction due to cholinergic activity.
M3
64
They block the action of acetylcholine at the M3 receptor in the airway ________ bronchoconstriction due to cholinergic activity.
reversing
65
They block the action of acetylcholine at the M3 receptor in the airway reversing _______ due to cholinergic activity.
bronchoconstriction
66
They block the action of acetylcholine at the M3 receptor in the airway reversing bronchoconstriction due to ________
cholinergic activity
67
Atrovent blocks
m1, m2, and m3
68
Spiriva blocks
M1, M2, and M3
69
Spriva blocks more slowly from
M1 and M3
70
Spiriva last for how many hours
24 Hours, because it blocks M1 and M3 more slowly
71
Ipratropium Bromide trade name?
Atrovent
72
Ipratropium Bromide routes?
MDI | SVN
73
Dosages for MDI Atrovent
18ug/2puffs
74
Dosages for SVN Atrovent
0.5mg, 0.02%
75
Frequency of Ipratropium Bromide?
QID
76
Duration of Atrovent
4-6 hours
77
Tiotropium Bromide trade name?
Spiriva
78
Route for Spiriva?
DPI
79
Dosage for Spiriva
18ug/1 puff
80
Frequency for Spiriva
Once a day
81
Duration of Spriva
24 hours
82
Oxtropium bromide trade name?
Oxivent
83
Oxivent route?
MDI
84
Dosage for Oxivent
100ug/2 puff
85
Frequency for Oxivent
BID
86
Duration of Oxivent
8 hours
87
Common Side Effects of Atrovent MDI and SVN
Dry mouth | Cough
88
Occasional Side effects of MDI atrovent?
``` Nervousness Irritation Dizziness Headache Palpitation Rash ```
89
Occasional side effects of SVN atrovent
``` pharyngitis dyspnea flulike symptoms bronchitis upper respiratory infection nausea eye pain bronchoconstriction urinary retention ```
90
Use with caution in patients with?
prostatic hypertrophy urinary retention glaucoma
91
For what disease is proper use of MDI and SVN essential. Use of mouthpiece and reservoir?
Glaucoma
92
LEARN THE COMPARISON OF
Anticholinergic and Beta Agonist
93
(receptor types) Airway smooth muscle. Ipratropium and tiotropium block.
M3
94
(receptor types) ganglionic synapse. Enhance cholinergic nerve transmission. Ipratropium and Tiotropium block?
M1
95
(receptor types) auto-receptor, inhibition further release of acetycholine so that blocade can increase ach release and may offset the bronchodilating effect of ipratropium
M2
96
What percent strength is Ipratropium Bromide SVN?
0.02%. 2.5ml vial
97
parasympatholytic aka
antimuscaranic
98
What are C-fibers?
Nerves that respond to various stimuli
99
Sub mucosal gland
M3 receptor

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