Respiratory: Anticholinergics Flashcards
(151 cards)
1
Q
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Basic Understanding:
What are inhaled anticholinergics used primarily to treat?
A
COPD
2
Q
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Basic Understanding:
Other than COPD when are inhaled anticholinergics used?
A
- Asthma exacerbation
2. Intolerance to B2RAs
3
Q
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Basic Understanding:
What inhaled anticholinergics are used to treat asthma exacerbation or the patient who is intolerant to B2RAs?
A
- Ipratropium
2. Albuterol
4
Q
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Basic Understanding:
What type of substance is the anticholinergic Ipratropium bromide (Atrovent)?
A
Quaternary amine anticholinergic
5
Q
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Basic Understanding:
What is is the anticholinergic Ipratropium bromide structurally similar to?
A
Atropine
6
Q
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Basic Understanding:
What is Atropine?
A
Medication used to treat heart rhythm problems
7
Q
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Basic Understanding:
Is Ipratropium bromide used alone or in combination?
A
Alone or in combination
8
Q
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Basic Understanding:
When Ipratropium bromide is administered alone what is the brand name?
A
Atrovent
9
Q
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Basic Understanding:
When Ipratropium bromide is administered in combination what medication is it combined with?
A
Albuterol
Combivent
10
Q
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Basic Understanding:
When Ipratropium bromide is administered in combination with albuterol what is the brand name?
A
Combivent
11
Q
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Basic Understanding:
What is another common medication used to treat COPD?
A
Tiotropium bromide
12
Q
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Basic Understanding:
What is the Brand name for Tiotropium bromide?
A
Spiriva
13
Q
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Basic Understanding:
How is Tiotropium bromide administered?
A
It is inhaled
14
Q
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Examples:
Which Anticholinergics are on the quiz?
A
INN/Generic Names:
- ipratropium bromide
- tiotropium bromide
- ipratropium combined with albuterol
Brand/Trade Names:
- Atrovent
- Spiriva
- Combivent
15
Q
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacodynamics:
Is the action of each inhaled anticholinergic similar or different?
A
Similar
16
Q
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacodynamics:
What is the action of anticholinergics?
A
They block muscarinic cholinergic receptors
17
Q
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacodynamics:
How do anticholinergics block the muscarinic cholinergic receptors?
A
By inhibiting the action of acetylcholine
18
Q
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacodynamics:
What is an abbreviation for acetylcholine?
A
ACh
19
Q
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacodynamics:
What is ACh?
A
A neurotransmitter
20
Q
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacodynamics:
What does ACh do?
A
Sends messages to tell body to:
- Contract smooth muscles
- Dilates blood vessels
- Increases bodily secretions
- Slow HR
21
Q
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacodynamics:
What is the result of the cholinergic receptors being blocked by anticholinergics?
A
The formation of cGMP is decreased
22
Q
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacodynamics:
What is cGMP an abbreviation for?
A
Cyclic guanosine monophosphate
23
Q
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacodynamics:
What is the result of cGMP being decreased d/t cholinergic receptors being blocked by anticholinergics?
A
Decreased contractility of the smooth muscle
24
Q
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacodynamics:
Which smooth muscle’s contractility becomes decreased as a result of cGMP being decreased d/t cholinergic receptors being blocked by anticholinergics?
A
Lungs
25
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacodynamics:
What is a possible reason for the outcome of the smooth muscles of the lungs decreasing in contractility with use of anticholinergics?
Probably b/c of the actions of cGMP on intracellular calcium
26
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacodynamics:
What is the amount of bronchodilation by anticholinergics inhalation thought to reflect?
The level of parasympathetic tone
27
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacodynamics:
When ipratropium is inhaled where are the blocked receptors located?
Confined to:
1. Mouth
2. Airways
28
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacodynamics:
When Tiotropium is inhaled where are the blocked receptors located?
Lungs
29
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacodynamics:
What are the steps of the physiology of anticholinergic medications?
1. Inhibits the action of ACh which
2. Blocks muscarinic cholinergic receptors which leads
3. A decrease in the formation of cGMP which causes
4. Decreased contractility of smooth muscle leading to
5. Bronchodilation
30
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacokinetics: Absorption and Distribution:
Where is ipratropium absorbed?
1. Lungs
| 2. GI tract
31
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacokinetics: Absorption and Distribution:
Is ipratropium absorbed well or poorly?
Poorly
32
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacokinetics: Absorption and Distribution:
What percentage of a dose of ipratropium gets absorbed systemically?
1% to 2%
33
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacokinetics: Absorption and Distribution:
Does ipratropium penetrate the CNS (blood-brain barrier) well or poorly?
Poorly
34
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacokinetics: Absorption and Distribution:
Does ipratropium cross the placenta?
It is unknown
35
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacokinetics: Absorption and Distribution:
Is ipratropium excreted into breast milk?
Yes
36
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacokinetics: Absorption and Distribution:
How much ipratropium is excreted into breast milk?
Minimal amounts
37
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacokinetics: Absorption and Distribution:
How is tiotropium administered?
Inhaled or oral
38
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacokinetics: Absorption and Distribution:
What type of inhaler is used to administer tiotropium?
Dry powder inhaler
39
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacokinetics: Absorption and Distribution:
How much bioavailability does inhaled tiotropium have?
19.5%
40
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacokinetics: Absorption and Distribution:
What percentage of tiotropium is protein bound in human plasma?
72%
41
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacokinetics: Absorption and Distribution:
Where is oral tiotropium absorbed?
GI tract
42
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacokinetics: Absorption and Distribution:
Is tiotropium absorbed well or poorly?
Poorly
43
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacokinetics: Absorption and Distribution:
How much bioavailability does oral tiotropium have?
2% to 3%
44
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacokinetics: Absorption and Distribution:
Does tiotropium penetrate the CNS (blood-brain barrier) well or poorly?
Poorly
45
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacokinetics: Absorption and Distribution:
How much tiotropium is excreted into breast milk?
It is unknown
46
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacokinetics: Absorption and Distribution:
Does ipratropium cross the placenta?
It is unknown
47
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacokinetics: Absorption and Distribution:
What is known about the distribution of tiotropium in breast milk?
It is distributed in breast milk of rats but not studied in humans
48
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacokinetics: Metabolism and Excretion:
How is unabsorbed ipratropium excreted?
In feces
49
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacokinetics: Metabolism and Excretion:
In what form is unabsorbed ipratropium excreted?
Unchanged
50
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacokinetics: Metabolism and Excretion:
What percent of unabsorbed ipratropium is excreted in feces unchanged?
90%
51
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacokinetics: Metabolism and Excretion:
What happens to the ipratropium that is not excreted?
It is absorbed
52
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacokinetics: Metabolism and Excretion:
What happens to the portion of ipratropium that is absorbed?
It is partially metabolized
53
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacokinetics: Metabolism and Excretion:
By what mechanism of action is ipratropium metabolized?
Ester hydrolysis
54
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacokinetics: Metabolism and Excretion:
What is ester hydrolysis?
1. Reaction that breaks an ester bond with
2. A molecule of H2O or hydroxide ion to form
3. A carboxylic acid and an alcohol
55
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacokinetics: Metabolism and Excretion:
What is ipratropium metabolized into by the action of ester hydrolysis?
Inactive metabolites
56
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacokinetics: Metabolism and Excretion:
How is the absorbed ipratropium excreted?
In urine
57
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacokinetics: Metabolism and Excretion:
In what form is absorbed ipratropium excreted?
Unchanged
58
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacokinetics: Metabolism and Excretion:
What percent of absorbed ipratropium is excreted in urine unchanged?
50%
59
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacokinetics: Metabolism and Excretion:
How is absorbed tiotropium excreted?
In urine
60
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacokinetics: Metabolism and Excretion:
In what form is absorbed tiotropium excreted?
Unchanged
61
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics: Precautions and Contraindications:
In what patients is ipratropium contraindicated?
Hypersensitivity to:
1. atropine
2. atropine derivatives
3. bromide
62
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics: Precautions and Contraindications:
What is bromide?
1. Previously used as a sedative
| 2. Now used as a catalyst for the manufacturing of pharmaceuticals
63
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics: Precautions and Contraindications:
In what patients is tiotropium contraindicated?
Hypersensitivity to:
1. ipratropium
2. tiotropium
64
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics: Precautions and Contraindications:
Who should avoid use of inhaled anticholinergics?
Patients with:
1. Acute bronchospasm
2. Urinary retention
3. Bladder neck obstruction
4. BPH
65
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics: Precautions and Contraindications:
Why should patients with acute bronchospasm avoid the use of inhaled anticholinergics?
Its anticholinergic effects
66
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics: Precautions and Contraindications:
What is the exception in allowing the use of inhaled anticholinergics in bronchospasm patients?
When ipratropium is combined with albuterol in ER treatment of acute bronchospasm
67
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics: Precautions and Contraindications:
Why should patients with acute bronchospasm avoid the use of inhaled anticholinergics?
Its anticholinergic effects
68
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics: Precautions and Contraindications:
Which population has risks to take into consideration when taking inhaled anticholinergic therapy?
Older adults with BPH
69
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics: Precautions and Contraindications:
What are the older adults with BPH at risk for when taking inhaled anticholinergic therapy?
Acute urinary retention
70
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics: Precautions and Contraindications:
When are older adults with BPH at highest risk for developing acute urinary retention?
The beginning of therapy
71
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics: Precautions and Contraindications:
All three inhaled anticholinergic drugs may increase
___1____ in patients with ___2___.
1. Intraocular pressure
| 2. Closed-angle glaucoma
72
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics: Precautions and Contraindications:
What pregnancy category is ipratropium bromide?
Pregnancy Category B
73
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics: Precautions and Contraindications:
What pregnancy category is tiotropium bromide?
Pregnancy Category C
74
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics: Precautions and Contraindications:
Should inhaled anticholinergics be used in pregnancy?
Only if clearly indicated
75
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics: Precautions and Contraindications:
Why should inhaled anticholinergics be used in pregnancy only if clearly indicated?
Not well studied
76
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics: Precautions and Contraindications:
Why is it hypothesized that ipratropium is safe for use if needed during breastfeeding?
Because Atropine is considered safe during lactation
77
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics: Precautions and Contraindications:
Why is it hypothesized that ipratropium is safe for use if needed during breastfeeding because Atropine is considered safe during lactation?
Atropine is chemically related to ipratropium
78
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics: Precautions and Contraindications:
Have the safety and effectiveness of ipratropium been established in children under age 12?
No
79
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics: Precautions and Contraindications:
When may a provider use ipratropium to treat a young child?
In combination
1. adjunct to albuterol AND
2. acute exacerbation of asthma
80
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics: Precautions and Contraindications:
Tiotropium is approved only for which condition?
COPD
81
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics: Precautions and Contraindications:
Does COPD normally occur in children?
No
82
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics: Precautions and Contraindications:
Have safety and effectiveness of tiotropium been established in children?
No
83
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics: Adverse Drug Reactions:
What are common adverse effects of ipratropium?
1. Cough
2. Hoarseness
3. Throat irritation
4. Dysgeusia
5. Nausea
6. Vomiting
7. Dyspepsia
8. Xerostomia
9. Urinary retention
10. Dizziness
11. Drowsiness
12. Constipation
84
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics: Adverse Drug Reactions:
What is dysgeusia?
1. Perception of taste is altered
| 2. Everything seems sweet, sour, bitter, or metallic
85
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics: Adverse Drug Reactions:
What is dyspepsia?
Indigestion
86
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics: Adverse Drug Reactions:
What is xerostomia?
Dry mouth
87
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics: Adverse Drug Reactions:
What are common adverse effects of tiotropium?
1. Xerostomia
2. Mouth irritation
3. Pharyngitis
4. Nasal congestion
5. Sinusitis
6. Headache
7. Upper respiratory infections
8. Urinary retention
9. Dizziness
10. Drowsiness
11. Constipation
88
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics: Adverse Drug Reactions:
What are rare adverse effects of ipratropium and tiotropium?
Allergic and anaphylactoid reactions
89
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics: Adverse Drug Reactions:
What occurs with rare allergic and anaphylactoid reactions to ipratropium and tiotropium?
1. Urticaria
2. Maculopapular rash
3. Bronchospasm
4. Pruritus
5. Laryngospasm
6. Oropharyngeal edema
7. Angioedema: tongue, lips, and face
90
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics: Adverse Drug Reactions:
What is the most common adverse drug reaction reported with ipratropium?
Cough
91
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics: Adverse Drug Reactions:
What is thought to cause the adverse effects of nausea, vomiting, and dyspepsia with use of ipratropium?
The local anticholinergic effects it has on the GI tract
92
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics: Adverse Drug Reactions:
What percent of patients on ipratropium report the side effect of xerostomia?
2%
93
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics: Adverse Drug Reactions:
What is the most commonly reported adverse reaction to inhaled tiotropium?
Xerostomia
94
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics: Adverse Drug Reactions:
What percentage of patients taking inhaled tiotropium reported the adverse reaction of xerostomia?
16%
95
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics: Adverse Drug Reactions:
What percentage of patient taking inhaled anticholinergics reported anticholinergic effects including urinary retention, dizziness, drowsiness, and constipation?
< 2%
96
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics: Adverse Drug Reactions:
What percentage of patients taking ipratropium have a prostate disorder noted?
< 2%
97
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics: Adverse Drug Reactions:
What may the patient experience if ipratropium is accidentally sprayed in the eyes?
Temporary:
1. Eye irritation
2. Pain
3. Mydriasis
4. Blurred vision
5. Cycloplegia
6. Irritant conjunctivitis
7. Visual disturbances
98
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics: Adverse Drug Reactions:
What is Mydriasis?
Pupil dilation
99
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics: Adverse Drug Reactions:
What is Cycloplegia?
Paralysis of the ciliary muscle
100
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics: Drug Interactions:
What are the major drug reactions using ipratropium and tiotropium?
No major reactions
101
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics: Drug Interactions:
Why are there no major drug reactions using ipratropium and tiotropium?
They are minimally absorbed into the systemic circulation after inhalation
102
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics: Drug Interactions:
Which patients require special cautioning when considering use of ipratropium?
Patients who are concurrently using cromolyn sodium and ipratropium bromide via nebulizer
103
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics: Drug Interactions:
What should the practitioner caution patients concurrently using cromolyn sodium and ipratropium bromide via nebulizer to do?
Not to mix the two in the reservoir at the same time
104
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics: Drug Interactions:
Why should patients concurrently using cromolyn sodium and ipratropium bromide via nebulizer be cautioned not to mix the two?
Because a precipitate will form
105
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics: Rational Drug Selection:
What line bronchodilator is ipratropium in the treatment of asthma and COPD?
Second-line
106
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics: Rational Drug Selection:
What product would be an appropriate choice for the practitioner considering prescribing both ipratropium and albuterol?
Combivent
107
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics: Rational Drug Selection:
Why would a practitioner choose to use tiotropium for use of COPD rather than other options?
1. Cost
| 2. Ease of use
108
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics: Rational Drug Selection:
What is the cost of a month’s supply of Atrovent HFA MDI?
$237
109
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics: Rational Drug Selection:
What is the cost of a month’s supply of a generic ipratropium inhaler?
Generic ipratropium inhaler is no longer available
110
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics: Rational Drug Selection:
What is the cost of 150 unit-dose vials of Atrovent inhalation solution?
$200
111
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics: Rational Drug Selection:
What is the cost of 150 unit-dose vials of generic ipratropium inhalation solution?
$57
112
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics: Rational Drug Selection:
What is the cost of 30 vials of the combination product Combivent?
$307
113
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics: Rational Drug Selection:
What is the cost of 30 vials of the combination product for ipratropium and albuterol nebulizer solution?
$76.19
114
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics: Rational Drug Selection:
What is the cost of 30 vials of the generic combination product Duoneb (ipratropium and albuterol nebulizer solution)?
$13.97
115
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics: Rational Drug Selection:
What is significant regarding the prices of anticholinergic medications?
There is significant cost savings when buying ipratropium and albuterol combination products rather than the two products individually.
116
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics: Rational Drug Selection:
Although there is significant cost savings when buying ipratropium and albuterol combination products rather than the two products individually ______ can alter these prices to provide an opposite outcome.
Insurance (prescription drug coverage)
117
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics: Rational Drug Selection:
Is tiotropium available in only form or in many?
Only one
118
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics: Rational Drug Selection:
What form is tiotropium available in?
As a dry powder capsule
119
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics: Rational Drug Selection:
What must be used to administer tiotropium dry powder capsules?
HandiHaler
120
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics: Rational Drug Selection:
What is a HandiHaler?
Plastic device used to inhale medication
121
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics: Rational Drug Selection:
What is the cost of 1 month’s supply (30) of Tiotropium dry powder capsules?
$223.07
122
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics: Monitoring:
What lab monitoring should be done with patients taking inhaled anticholinergics?
No specific lab monitoring necessary
123
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics: Monitoring:
What should be monitored when taking inhaled anticholinergics?
The disease process
124
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics:
Patient Education:
What should a practitioner educated their patient on regarding frequency of use of their anticholinergics?
It should be used as prescribed
125
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics:
Patient Education:
What can occur if bronchodilators are overused?
Increased adverse effects
126
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics:
Patient Education:
What can occur if bronchodilators are used less than prescribed?
1. Increased bronchospasm
| 2. Decreased pulmonary function
127
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics:
Patient Education:
What should be taught to a patient about he administration of a medication via an MDI?
See cards on MDI administration in "Respiratory: General Information" deck
128
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics:
Patient Education:
If the patient is prescribed other inhalers, which inhaler would you advise the patient to use first?
Ipratropium
129
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics:
Patient Education:
If the patient is prescribed other inhalers and has used their ipratropium first what is their next action?
Wait 5 min before using other inhalers as directed
130
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics:
Patient Education:
What can be prescribed to assist with the delivery of inhaled medications?
See cards on the use of a spacer with inhaled medication administration in "Respiratory: General Information" deck
131
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics:
Patient Education:
Who provides education on the administration of ipratropium via nebulizer?
Manufacturer of the nebulizer
132
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics:
Patient Education:
Why should the manufacturers directions be followed?
Since directions can vary based on manufacturer of each nebulizer brand
133
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics:
Patient Education:
How often is ipratropium administered?
Every 6 to 8 hours
134
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics:
Patient Education:
When using a nebulizer; after how long can albuterol be mixed into an ipratropium solution that is already administered into the reservoir?
1 hr
135
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics:
Patient Education:
What should you advise a patient taking both Cromolyn and ipratropium concurrently of?
Do not combine the two
136
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics:
Patient Education:
What would occur is a patient taking both Cromolyn and ipratropium mixed the two medications?
It would create a precipitate
137
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics:
Patient Education:
What should be done when using a nebulizer for both Cromolyn and ipratropium concurrently?
Rinse the nebulizer medication cup well between use
138
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics:
Patient Education:
What action should occur directly after use of inhaled ipratropium or tiotropium?
Rinse their mouth with water
139
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics:
Patient Education:
Why is rinsing the mouth advised after use of inhaled ipratropium or tiotropium?
To minimize dry mouth
140
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics:
Patient Education:
What action should occur directly before the first time using a Combivent MDI?
Prime it
141
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics:
Patient Education:
How would you instruct a patient to prime their Combivent MDI before the first time using it?
"Test-spray” the MDI 3 times into the air
142
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics:
Patient Education:
In what situation other than using a Combivent MDI for the first would you instruct a patient to prime it?
If it has not been used in more than 24 hrs
143
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics:
Patient Education:
Other than using the HandiHaler device is there another method that Spiriva can be administered?
No
144
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics:
Patient Education:
Who provides directions on how to use the HandiHaler device?
Spiriva
145
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics:
Patient Education:
What do the directions provided by Spiriva on how t use the HandiHaler include?
1. Package insert
| 2. Step-by-step pictures and text
146
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics:
Patient Education:
What should the provider educate the patient about regarding common adverse reactions to either inhaled anticholinergic?
Cough may develop
147
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics:
Patient Education:
What should the provider educate the patient about regarding LESS common adverse reactions to either inhaled anticholinergic?
1. Throat irritation
2. Hoarseness
3. Dry mouth
148
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics:
Patient Education:
What can a provider instruct a patient to do to decrease the incidence of these adverse effects of inhaled anticholinergics?
1. Use spacer device
| 2. Rinse mouth after use
149
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics:
Patient Education:
If a patient does have adverse effects to inhaled anticholinergics what should they be instructed to do?
Notify their provider
150
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics:
Patient Education:
Which adverse effect of inhaled anticholinergics is particularly important to notify the provider of if noted?
Urinary retention
151
Types of Respiratory Drugs:
Bronchodilators: Anticholinergics:
Pharmacotherapeutics:
Patient Education:
What lifestyle management education should the provider instruct the patient using inhaled anticholinergics on?
1. Peak flowmeter
2. Avoid or quit smoking
3. Avoid environmental triggers for asthma
4. COPD patients should avoid exposure to viral respiratory infections
