Ipratropium bronchodilation

IPRATROPIUM BRONCHODILATORS -SALBUTAMOL A few reports of acute angle closure glaucoma when nebulized ipratropium and salbutamol were coadministered Ipratropium dilates the pupil, which i drainage of aqueous humour, while salbutamol t production of aqueous humour Warn patients to prevent the solution to mist or enter the eye. Extreme caution in co-administering these bronchodilators by the nebulized route in patients with a history of acute closed-angle glaucoma... 

The two major types of bronchodilators are the sym-padiomimetics and die xantiiine derivatives. The anticholinergic drug ipratropium bromide (Atrovent) is used for bronchospasm associated witii COPD, chronic bronchitis, and emphysema. Ipratropium is included in die Summary Drug Table Bronchodilators. Chapter 25... 

Nebulized short-acting bronchodilator therapy (e.g., albuterol and ipratropium)... 

Tiotropium provides the most consistent improvements on the widest range of outcomes among all the bronchodilators. It has been shown to be superior to ipratropium and salmeterol in improving lung function and superior to ipratropium... 

Albuterol is the preferred bronchodilator for treatment of acute exacerbations because of its rapid onset of action. Ipratropium can be added to allow for lower doses of albuterol, thus reducing dose-dependent adverse effects such as tachycardia and tremor. Delivery can be through metered-dose inhaler (MDI) and spacer or nebulizer. The nebulizer route is preferred in patients with severe dyspnea and/or cough that would limit delivery of medication through an MDI with spacer. If response is inadequate, theophylline can be considered however, clinical evidence supporting its use is lacking. 

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. 

The time to reach maximum bronchodilation from aerosolized ipratropium is longer than from aerosolized short-acting / -agonists (30 to 60 minutes vs. 5 to 10 minutes). This is of little clinical consequence because some bronchodilation is seen within 30 seconds and 50% of maximum response occurs within 3 minutes. Ipratropium bromide has a duration of action of 4 to 8 hours tiotropium bromide has a duration of 24 hours. 

Ipratropium bromide has a slower onset of action than short-acting /J2-agonists (15 to 20 minutes vs. 5 minutes for albuterol). For this reason, it may be less suitable for as-needed use, but it is often prescribed in this manner. Ipratropium has a more prolonged bronchodilator effect than short-acting /l2-agonists. Its peak effect occurs in 1.5 to 2 hours and its duration is 4 to 6 hours. The recommended dose via MDI is two puffs four times a day with upward titration often to 24 puffs/day. It is also available as a solution for nebulization. The most frequent patient complaints are dry mouth, nausea, and, occasionally, metallic taste. Because it is poorly absorbed systemically, anticholinergic side effects are uncommon (e.g., blurred vision, urinary retention, nausea, and tachycardia). 

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). 

Pharmacology Ipratropium for oral inhalation is an anticholinergic (parasympatholytic) agent that appears to inhibit vagally mediated reflexes by antagonizing the action of acetylcholine. The bronchodilation following inhalation is primarily a local, site-specific effect, not a systemic one. 

Ipratropium has been used concomitantly with other drugs, including beta-adrenergic bronchodilators, sympathomimetic bronchodilators, methyixanthines, steroids, commonly used in the treatment of chronic obstructive pulmonary disease, without adverse drug reactions. 

Albuterol Ipratropium (Combivent, DuoNeb) [Bronchodilator/Adrenergic, Anticholinergic] Uses coPD ... 

Ipratropium Atrovent HFA, Atrovent Nasal) [Bronchodilator/ Anticholinergic] Uses Bronchospasm w/ COPD, rhinitis, rhinorrhea Action Synthetic anticholinergic similar to atropine antagonizes acetylcholine receptors, inhibits mucous gland secretions Dose Adults Peds >12 y. Nebuliza-tion 500 meg in 2.5-3.0 mL NS Peds. Nebulization 125-250 meg in 2.5-3.0 mL NS Caution [B, +/-] w/ inlial insulin Contra Allergy to soya lecitlrin/related foods Disp HFA met-dose inlial 18 meg/dose inlial soln 0.02% nasal spray 0.03,... 

The anticholinergic bronchodilators include ipratropium and tiotropium, which are muscarinic receptor blockers that are similar in structure and function to atropine. Although atropine is the prototypical muscarinic antagonist, its use in respiratory conditions is usually limited because it is readily absorbed into the systemic circulation and tends to produce many side effects even when administered by inhalation. Alternatively, ipratropium (Atrovent) is an anticholinergic agent that is poorly absorbed into the systemic circulation and can be administered by an aerosol inhaler.110 Thus, inhaled ipratropium is associated with substantially fewer systemic side effects. 

Tiotropium (Spiriva) was also developed as an anticholinergic bronchodilator that is similar to ipratropium, but with longer lasting effects.88 Tiotropium only needs to be inhaled once each day, whereas ipratropium is often inhaled 3 or 4 times each day.8,98 It appears that tiotropium may also be superior to ipratropium in improving pulmonary function and reducing the frequency and severity of exacerbations in people with COPD.41,51 Future studies will continue to clarify how tiotropium and other anticholinergics can be used to provide optimal treatment of COPD.7... 

Ipratropium is a QTA produced by N-alkylation (iso-propyl) of hyoscyamine (Fig. 1). When inhaled as aerosolized agent it is a short-acting (3-6 h) antimusca-rinic especially on MR subtypes Ml-3 present in the lung. Therefore, it is clinically used as bronchodilator, antiasthmatic and drug for chronic obstructive pulmonary disease (COPD) [31, 33], Ipratropium is part of the WHO list of essential medicines [41],... 

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