Short-acting anticholinergic

Short-Acting Anticholinergic Ipratropium Nebulization 1-30 minutes 1.5-2 hours 4-6 hours 500 meg every 6-8 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). 

The dose and frequency of bronchodilators are increased during acute exacerbations to provide symptomatic relief. Short-acting / -agonists are preferred because of their rapid onset of action. Anticholinergic agents may be added if symptoms persist despite increased doses of /T-agonisls. 

Huphenazine is a short acting agent. Eor the management of agitated and potentially violent patients its hydrochloride formulation is frequently used for parenteral administration. Fluphenazine decanoate is a widely used depot preparation. Although its principal pharmacological activities are similar to those of the other phenothiazines fluphenazine displays only weak sedative action and it shows little anticholinergic and hypotensive effect. 

Other SSRIs may be selected as an alternative to fluvoxamine in the event that fluvoxamine cannot be used. Sertraline is the first option because of efficacy for pediatric GAD (Rynn et ah, 2001) paroxetine is an option because of controlled treatment data for adolescent depression (Keller et ah, 2000) and OCD (see Chapter 39) and fluoxetine is an option because of controlled treatment data for pediatric depression (Em-slie et ah, 1997). Eorazepam is included as a short acting alternative to clonazepam. Nortriptyline, which is less anticholinergic and thus may be better tolerated, is included as an alternative to IMF... 

FIGURE 12—28. Icon for the cholinesterase inhibitor physostigmine. This agent is used intravenously as a short-acting cholinesterase inhibitor to reverse anticholinergic poisoning and is in testing in an oral sustained-release formulation for Alzheimer s disease. 

Long-acting inhaled bronchodilators (beta2-agonists or anticholinergics) should be used to control symptoms and improve exercise capacity in patients who continue to experience problems despite the use of short-acting dmgs. 

Tropicamide is an anticholinergic drug that tends to have a greater mydriatic than cycloplegic effect. It is a short-acting atropine-like derivative and has been regarded as an effective and safe mydriatic, used for pupillary dilatation by professionals, who are not always medical doctors. 

Prototypical agents Albuterol (short-acting Pj-agonist) ipratropium (anticholinergic)... 

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