Ipratropium

Question 1

Mechanism of action (nebulised Ipratropium)

Answer 1

1. Ipratropium is an anticholinergic (antagonises acetylcholine receptors) with antimuscarinic activity (inhibits the action of acetylcholine)
2. Anticholinergic medicines cause vagal inhibition resulting in bronchodilation. A beta-2 agonist (salbutamol) given in conjunction will maximise bronchodilation
3. Antimuscarinic medicines relax smooth muscle, decrease sweat and saliva secretion and dilate the pupil.

Question 2

Indications (nebulised Ipratropium)

Answer 2

1. Bronchospasm secondary to asthma or COPD
2. Prominent bronchospasm secondary to airway burns, smoke inhalation or chest infection

Question 3

Contraindications (nebulised Ipratropium)

Answer 3

Known severe allergy

Question 4

Cautions (nebulised Ipratropium)

Answer 4

None

Question 5

Pharmacokinetics (nebulised Ipratropium)

Answer 5

1.Inhaled ipratropium is absorbed through the lungs and some is swallowed.
2. Excretion is predominantly via urine
3. Significant kidney impairment prolongs clearance but this does not impact initial dosage.

Question 6

Common adverse effects (nebulised Ipratropium)

Answer 6

1. Tachycardia
2. Dry mouth
3. Blurred vision (usually only with repeated doses)

Question 7

Onset and duration of effects (nebulised ipratropium)

Answer 7

Onset 2-5 minutes
Duration approximately 6 hours

Question 8

Dosage (nebulised ipratropium)

Answer 8

0.5mg for adults and children

Administered once only in conjunction with salbutamol