Ipratropium asthma

Ipratropium Asthma and COPD (inhalational)—no CNS entry, no change in j mucus viscosity [... 

Ipratropium is the most commonly used anticholinergic for treating bronchoconstriction in asthma. It is available as an MDI and solution for nebulization. Ipratropium has an onset of action of approximately 30 minutes and a duration of action of 4 to 8 hours. Care should be taken not to spray the metered-dose inhaler into or allow the nebulized solution to get in the patient s eyes, as it can cause mydriasis and blurred vision. 

The addition of ipratropium bromide to inhaled p2-agonist therapy in acute severe asthma improves pulmonary function and decreases hospitalization rates in both adult and pediatric patients.31 The benefit of combining ipratropium and albuterol appears to be greatest in moderate to severe exacerbations, and the combination should be considered first-line therapy in severe exacerbations. 

The answer is c. (Hardman, pp 156-158.) A wide variety of clinical conditions are treated with antimuscarinic drugs. Dicyclomine hydrochloride and methscopolamine bromide are used to reduce Gl motility, although side effects—dryness of the mouth, loss of visual accommodation, and difficulty in urination—may limit their acceptance by patients. Cyclopentolate hydrochloride is used in ophthalmology for its mydriatic and cycloplegic properties during refraction of the eye. Trihexyphenidyl hydrochloride is one of the important antimuscarinic compounds used in the treatment of parkinsonism. For bronchodilation in patients with bronchial asthma and other bronchospastic diseases, ipratropium bromide is used by inhalation. Systemic adverse reactions are low because the actions are largely confined to the mouth and airways. 

Ipratropium bromide and tiotropium bromide are competitive inhibitors of muscarinic receptors they produce bronchodilation only in cholinergic-mediated bronchoconstriction. Anticholinergics are effective bronchodila-tors but are not as potent as /J2-agonists. They attenuate, but do not block, allergen- or exercise-induced asthma in a dose-dependent fashion. 

Inhaled ipratropium bromide is only indicated as adjunctive therapy in severe acute asthma not completely responsive to / -agonists alone because it does not improve outcomes in chronic asthma. Tiotropium bromide has not been studied in asthma. 

Ipratropium bromide is an antimuscarinic agent indicated in asthma and in chronic obstructive pulmonary disease but it is more effective in the latter. The drug is available only for inhalation because of the potential side-effects if given orally. 

Ipratropium is classified as an anticholinergic because it blocks acetylcholine release. It is indicated in asthma and chronic obstructive pulmonary disease and is available for inhalation. 

Prakash O, Kumar R, Rahman M, Gaur SN. (2006) The clinico-physiological effect of inhaled tiotropium bromide and inhaled ipratropium bromide in severe chronic obstructive pulmonary disease. Ind J Allergy Asthma Immunol 20 105-111 For further information http //www.rxlist.com/spiriva-drug.htm (accessed on 24.12.2010). 

Bronchodilation can be achieved by the use of ipratropium in conditions of increased airway resistance (chronic obstructive bronchitis, bronchial asthma). When administered by inhalation, this quaternary compound has Uttle effect on other organs because of its low rate of systemic absorption. 

Bronchodilators. Narrowing of bronchioles raises airway resistance, e.g in bronchial or bronchitic asthma Several substances that are employed as bronchodilators are described elsewhere in more detail P2-sympathomimetics (p. 84, given by pulmonary, parenteral, or oral route), the methylxanthine theophylline (p. 326, given parenterally or orally), as well as the parasympatholytic ipratropium (pp. 104, 107, given by inhalation). 

Atropine (1) Ipratropium bromide (25) Tropane alkaloid Asthma... 

Rodrigo G, Rodrigo C, Burschtin O, A meta-analysis of the effects of ipratropium bromide in adults with acute asthma. Am J Med 107 363-370, 1999. 

Ipratropium bromide (Atrovent) is a quaternary amine derivative that is used via inhalation in the treatment of chronic obstructive pulmonary disease and to a lesser extent, asthma. Ipratropium has a slower onset of action (1-2 hours for peak activity) than Pz-adrenoceptor agonists and thus may be more suitable for prophylactic use. Compared with p2-adrenoceptor agonists, ipratropium is generally at least as effective in chronic obstructive pulmonary disease but less effective in asthma. 

Ipratropium has greater effectiveness than P2-adreno-ceptor agonists in two settings in psychogenic asthma and in patients taking Pj-adrenoceptor antagonists. A fixed combination of ipratropium and albuterol (Combivent) is approved for use in chronic obstructive pulmonary disease. 

Anticholinergics, like atropine and its derivative ipratropium bromide block cholinergic pathways that cause airway constriction. They may provide added bronchodi-lator effect in patients who are receiving beta -adrenergic agents for asthma. 

Antimuscarinic Drugs Used in Asthma Ipratropium (generic, Atrovent)... 

Inhaled ipratropium [i pra TROE pee um], a quaternary derivative of atropine (see Figure 22.5, p. 220), is useful in treating asthma and chronic obstructive pulmonary disease in patients unable to take adrenergic agonists. Ipratropium is also used in the management of chronic obstructive pulmonary disease (see p. 222). Important characteristics of the muscarinic antagonists are summarized in Figure 5.6. 

A 22-year-old woman, Ms RJ, is admitted via casualty with sudden breathlessness and wheeze. She has had asthma for 10 years and her last hospital admission was a month ago. She is usually on salbutamol nebs, and at home uses them once or twice weekly, budesonide turbo 800 micrograms q.d.s., ipratropium nebs. Ms RJ was on 40 mg prednisolone daily since last hospital discharge but this was increased by GP a week ago for an upper respiratory tract infection. Recently Ms RJ has bought some painkillers from her local pharmacy. 

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