CH.7 Anticholinergic (parasympatholytic) Bronchodilators

Question 1

Parasympatholytic (anticholinergics)

Answer 1

–increase in HR and BP
–Bronchodilation, drying of secretions
–Antagonists: anticholinergics block the effects of the parasympathetic system (bronchoconstriction in lungs and decreased HR)
–Anticholinergic bronchodilators are specifically parasympatholytic that is antimuscarinic agents, blocking the effect of acetylcholine (Ach) at the cholinergic (muscarinic) receptors on bronchial smooth muscle

Question 2

Clinical Indications for use

Answer 2

-indications for anticholinergic bronchodilator
–COPD maintenance
–may be used in some individuals with asthma (ipratropium and tiotropium)
-indication for combined anticholinergic and B-agonist bronchodilator
–COPD with airflow obstruction
–also used in cases of severe asthma not responsive to B-agonist therapy
-Indications for anticholinergic nasal spray
–allergic and nonallergic perennial rhinitis and the common cold

Question 3

Atropine Sulfate

Answer 3

–can be used as a bronchodilator, not aerosolized, given by IV
-Many side effects
–inhibits mucus production (dry mouth) and reduced mucociliary clearance (can cause thick retained airway secretions)
–blurred vision
–restlessness, irritability, drowsiness, and fatigue
–Increase heart rate: primarily used as a cardiac drug for low heart rate (below 60)
-easily absorbed in the bloodstream
–used to reverse Edrophonium (Tensilon Test) to keep HR from dropping
–not inhaled and RT can give to Pt

Question 4

Ipratropium Bromide (atrovent)

Answer 4

-Available as:
–MDI: 17mcg/puff, 2 puffs qid
–SVN: 0.02% solution (0.2mg/ml), TID or QID
–Nasal Spray: 0.03% solution, 21mcg/spray, 2 sprays per nostril, BID or TID
0.06% solution, 42mcg/spray, 2 spray per nostril, TID or QID
-Approved for the maintenance treatment of airflow obstruction in COPD
–Nasal Spray: rhinopathies and rhinorrhea, allergic and nonallergic perennial rhinitis and the common cold
-Derivative of atropine
-distribution is limited to lung when inhaled
Trade Name: Atrovent HFA
-Onset: 15-30 min
-Peak: 1-2hr
-Duration: 6 hrs

Question 5

Ipratropium and Albuterol

Answer 5

-available as:
–Dueneb (SVN): 0.5 mg ipratropium and 2.5 mg albuterol
–Combivent Respimat (soft mist inhaler): 20 mcg ipratropium and 100 mcg albuterol/puff, QID
-Combination therapy more effective in stable COPD than either agent alone
-Onset: 15 min
-Peak: 1-2 hrs
-Durations: 6 hrs
-A&A

Question 6

Glycopyrrolate Bromide

Answer 6

-available as:
–Seebri Neohaler DPI: 15. mcg/inhalation BID
–Lohala Magnair a liquid form utilizing a vibrating mesh nebulizer VMN: 25mcg/1mL, BID
–Derivative of atropine: fewer ocular or CNS effects
-usually administered parenterally to reverse neuromuscular blockade and nebulized for bronchodilation
-Approved by the FDA for treatment of COPD
-Onset 15-30min
-Peak: 1-2 hr
-Duration: 12hrs