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60 Cards in this Set
- Front
- Back
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An agent that blocks parasympathetic nervous fibers, which allow relaxation of smooth muscle in the airway |
Anticholinergic bronchodilator |
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Same as anticholinergic bronchodilator: an agent that blocks the effect of acetylcholine at the cholinergic site |
Antimuscarinic bronchodilator |
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An agent that produces the effect of acetylcholine |
Cholinergic |
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Same as cholinergic: an agent that produces the effect of acetylcholine or an agent that mimicks acetylcholine |
Muscarinic |
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Blocking parasympathetic nervous fibers |
Parasympatholytic |
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Producing effects similar to those of the parasympathetic nervous system
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Parasympathomimetic |
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Beta Adrenergic Adverse side effects |
1. Tremor 2. Cardiac effects 3. Tolerance to bronchodilator effect 4. Loss of bronchoprotection 5. CNS effects 6. Fall in PaO2 7. Metabolic disturbances 8. Propellant toxicity and paradoxical bronchospasm 9. sensitivity to additives |
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Parasympathomimetic = |
Muscarinic |
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Parasympatholytic = |
Antimuscarinic or Muscarinic Antagonist |
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Indication for Anticholinergic Bronchodilator |
Maintenance COPD -Chronic bronchitis -Emphysema |
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Indication for combined Anticholinergic & B-Agonist Bronchodilators |
1. Maintenance COPD with additional relief requirement for airflow obstruction 2. Commonly used in severe Asthma exacerbation |
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Indication for Anticholinergic Nasal spray |
Symptomatic relief of allergic/nonallergic perennial rhinitis |
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Specific Anticholinergic (parasympatholytic) agents |
1. Ipratropium bromide 2. Ipratropium bromide and albuterol 3. Tiotropium bromide |
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Drug name for Atrovent |
Ipratropium bromide |
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Atrovent HFA MDI Dosage |
17 μg/puff 2 puffs qid
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Atrovent SVN Dosage |
0.02% solution (0.2mg/ml), 500 μg tid, qid
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Atrovent Nasal spray Dosage |
21 μg: 42 μg: 2 sprays per nostrils 2 to 4 times daily (dosage varies)
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Atrovent (time course) Onset, Peak, Duration |
Onset: 15 min Peak: 1-2 hr Duration: 4-6 hr |
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Drug name for combivent |
Ipratropium bromide and albuterol |
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Combivent MDI Dosage |
ipratropium 18μg/puff and albuterol 90 μg/puff, 2 puff qid |
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Combivent (Time course) Onset, Peak, Duration |
Onset: 15 min Peak: 1-2 hr Duration: 4-6 hr |
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Spiriva Drug name |
Tiotropium bromide |
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Spiriva DuoNeb (SVN) Dosage |
Ipratropium 0.5 mg and albuterol 2.5 mg |
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Spiriva DPI Dosage |
18 μg/inhalation, 1 inhalation daily (one capsule) |
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Spiriva (Time Course) Onset, Peak, Duration |
Onset: 30 min Peak:1-3 hr Duration:24 hr |
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Aclidinium bromide |
Tudorza pressair (LAMA) |
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Glycopyrrolate bromide |
Lonhala magnair, seebri neohaler (LAMA) |
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Glycopyrrolate bromide and formoterol |
Bevespi Aerosphere (LAMA+ICS) |
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Glycopyrrolate bromide and Indacterol
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Ubitron Neohaler (LAMA+ ICS) |
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Tiotropium Bromide and olodaterol |
Striolto Respimat (LAMA+LABA) |
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Umeclidinium bromide |
Incruse Ellipta (LAMA) |
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Specific parasympatholytic (anticholinergic/Antimuscarinic) Agent -Not recommended for inhalation -Bronchodilator effect seen, side effects prominent |
Atropine Sulfate |
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Specific parasympatholytic (anticholinergic/Antimuscarinic) Agent -Available as MDI, SVN solution, and nasal spray -Quaternary ammonium derivative of atropine -Distribution is limited to lung when inhaled -Maintenance treatment of COPD -Quick Onset, peak effect 1-2 hr |
Ipratropium bromide |
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-synergistic effect in COPD -Combivent |
Ipratropium and albuterol |
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-Used parenterally to reverse neuromuscular blockade -Quaternary ammonium derivative |
Glycopyrrolate |
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-Longer acting (up to 24 hours) quaternary ammonium derivative of atropine |
Tiotropium bromide (Spiriva) |
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-Contains 2 long-acting bronchodilators in 1 inhaler -Combines an anticholinergic (umeclidinium) and a long-acting beta2 adrenergic agonist (LABA) medicine (vilanterol) |
Anoro Elipta |
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These anticholinergics are the only ones on the list approved for aerosolization by the FDA A. Glycopyrrolate B. Albuterol Sulfate C. Ipratropium bromide D. Atropine E. Aclidinium bromide F. Tiotropium |
A. Glycopyrrolate C. Ipratropium bromide D. Atropine E. Aclidinium bromide F. Tiotropium |
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Structure-activity relations Atropine and Scopolamine |
1. Tertiary ammonium compounds 2. Easily absorbed in bloodstream 3. Cross the blood -barrier> CNS |
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Structure-activity relations Quaternary forms (Atrovent) |
1. Poorly absorbed in the bloodstream or CNS 2. Better for inhalation, less systemic side effects |
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Tertiary ammonium Compound effects (Atropine) Respiratory, CNS, Eye, Cardiac, Gastrointestinal, Genitourinary |
1. Respiratory tract- inhibits mucocilliary clearance 2. CNS-irritability, Fatigue 3. Eyes- Iris contraction, pupil dilation, ciliary muscle paralysis 4. Cardiac- Slowing HR at LOW DOSE, increase of HR at HIGH DOSE 5. Gastrointestinal- dry mouth. decreased motility 6. Genitourinary- urinary retention |
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Quaternary ammonium compound effects
(Ipatropium, Tiotropium, Glycopyrolate) Respiratory, CNS, Eye, Cardiac, Gastrointestinal, Genitourinary |
1. Respiratory tract- bronchodilation
2. Central nervous system- none 3. Eyes- only if sprayed directly into eye 4. Cardiac- none 5. Gastrointestinal- dry mouth 6. Genitourinary- minimal to none - Side effects are localized to the site of drug exposure |
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Tertiary (Atropine) Side effects Respiratory, CNS, Eye, Cardiac, Gastrointestinal, Genitourinary |
1. Respiratory tract: Bronchodilation, decreased mucociliary clearance, blockage of hypersecretion 2. CNS: Altered CNS (dose related) 3. Eye: Mydriasis, cycloplegia, increased intraocular pressure 4. Cardiac: Slowing HR (small dose), Increasing HR (larger dose) 5.Gastrointestinal: Dry mouth, Dysphagia; slows motility 6. Genitourinary: Urinary retention |
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Quaternary (Ipratropium And Tiotropium) Side effects Respiratory, CNS, Eye, Cardiac, Gastrointestinal, Genitourinary |
1. Respiratory tract: Bronchodilation, Little to no change in mucocilliary clearance, blockage of nasal hypersecretions
2. CNS: No effect 3. Eye: Usually no effect 4. Cardiac: no effect 5.Gastrointestinal: Dry mouth 6. Genitourinary: Usually no effect |
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*Mode of action |
1. Parasympathetic innervation causes basal level bronchomotor tone 2. parasympatholytic bronchodilators block this tone. (can be abolished by Anticholinergic agents) -Competition for muscarinic receptor site block Ach action 3. Degree of bronchodilation depends on the amount of parasympathetic activity or tone present |
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-Decreased HR -Miosis (contraction of iris, eye) -Contraction (thickening) of lens eye -Salivation -Lacrimation -Urination -Defecation -Secretion of mucus -Bronchoconstriction |
Cholinergic effect (parasympathomimetic) |
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-Increased HR -Mydriasis (pupil dilation) -Cycloplegia (lens flattened) -Drying of upper airway -inhibition of tear formation -urinary retention -Antidiarrheal or constipation -Mucociliary slowing -Inhibition of constriction |
Anticholinergic Effect (parasympatholytic) |
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In the normal airway what can cause bronchomotor tone and how can it be stopped? |
Parasympathetic activity Can be stopped by anticholinergics |
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What intensifies the activity of normal airway bronchomotor tone? 2 Example |
Parasympathomimetics 1. Methacholine -Constriction 2. Cholinergic stimulation of muscarinic receptors- Contraction & release of mucus |
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In Anticholinergics, what "competitively blocks" Ach @ receptors & what does this help accomplish? |
Antimuscarinic -Block cholinergic induced bronchoconstriction |
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Definition -bronchoconstriction in COPD may be due to: Irritant aerosols, cold air, high flow rates, cigarette smoke, noxious fumes, histamine |
Vagally mediated reflex bronchoconstriction |
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Vagally mediated reflex bronchoconstriction mechanism |
1. Afferent impulse to CNS 2. Reflex cholinergic 3. Constriction of airway smooth muscle 4. Mucus and cough |
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What are the three muscarinic receptor subtypes? -Anticholinergics block these receptors |
-M1(Ach) and bronchoconstriction -M2 (bronchodilation) -M3 (smooth airway muscle) (cause bronchoconsrtiction) nasal gland secretion rhinitis |
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This anticholinergic is the only one on the list approved for aerosolization by the FDA: |
Ipratropium bromide |
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All anticholinergics agents used in respiratory therapy |
1. Ipratropium bromide (Atrovent) 2. Ipratropium bromide & albuterol 3. Aclidinium bromide 4. Aclidinium bromide & formoterol 5. Gylcopyrrolate bromide 6. Glycopyrrolate bromide & formoterol 7. Glycopyrrolate bromide & indacaterol 8. Revefenacin 9. Tiotropium bromide 10. Tiotropium bomide & olodaterol 11. Umeclidinium bromide 12. Umeclidinium bromide & vilanterol |
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Side effects with anticholinergic MDI and SVN
* ipratropium |
1. Dry mouth 2. Cough |
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Which type of anticholinergic agent are you most likely to observe systemic side effects?: Tertiary ammonium or quaternary ammonium compounds? |
Tertiary; these are less ionized and are better absorbed and distributed through body tissue |
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What precautions should you observe if administering ipratropium by SVN? |
protect the eyes from exposure to nebulized drug by using mouth piece instead.' -Avoids ocular effects of mydraisis |
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What is the usual recommended dose of ipratropium by MDI and by SVN? |
MDI: 34 mcg , 2 puff (each 17 mcg) SVN: 500mcg, (2.5 mL of a 0.02%) |
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Ipratropium bromde (atrovent) is a non selective antagonist of which of the following receptors? |
has select affinity for M1 and M3 receptors |
