Respiratory Pharmacology: Anticholinergics
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An agent that blocks parasympathetic nervous fibers is called a(n) ______.

anticholinergic

An agent that produces the effect of acetylcholine is called a(n) ______.

cholinergic

An agent that blocks parasympathetic nervous fibers, which allows relaxation of smooth muscle in the airway, is called a(n) ______.

anticholinergic bronchodilator

______ is the same as cholinergic, producing the effect of acetylcholine or an agent that mimics acetylcholine.

<p>Parasympathomimetic</p> Signup and view all the answers

The word ______ has the same meaning as anticholinergic: blocking the effect of acetylcholine at the cholinergic site.

<p>Anticholinesterase</p> Signup and view all the answers

A ______ agent produces effects similar to those of the parasympathetic nervous system.

<p>parasympathomimetic</p> Signup and view all the answers

List five anticholinergic bronchodilators that are indicated as a bronchodilator for maintenance and treatment in chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema (give generic and trade names).

<p>Aclidinium bromide and Tudorza Pressair (A), Tiotropium bromide and Spiriva (B), Ipratropium bromide and Atrovent (C), Glycopyrrolate bromide and Bevespi Aerosphere (D), Umeclidinium bromide and Incruse Ellipta (E)</p> Signup and view all the answers

A combination of an ______ with a ______ is indicated for use in patients needing regular treatment for COPD and who require additional bronchodilation for relief of airflow obstruction.

<p>anticholinergic; β-agonist</p> Signup and view all the answers

What two medications make up Combivent?

<p>Ipratropium bromide and albuterol (B)</p> Signup and view all the answers

The combination of umeclidinium bromide and vilanterol is called what?

<p>Anoro Ellipta</p> Signup and view all the answers

Utibron Neohaler is a combination of which two medications?

<p>Glycopyrrolate bromide and formoterol (D)</p> Signup and view all the answers

What is the indication for use of Stiolto Respimat? Stiolto Respimat is a combination of what two medications?

<p>COPD; tiotropium bromide and olodaterol (B)</p> Signup and view all the answers

The medication commonly used in severe asthma, especially bronchoconstriction that does not respond well to β-agonist therapy, is what?

<p>Ipratropium bromide</p> Signup and view all the answers

List the brand names for the following: a. Tiotropium bromide; b. Ipratropium bromide; c. Ipratropium bromide and albuterol (metered dose inhaler (MDI)); d. Ipratropium bromide and albuterol (small-volume nebulizer (SVN)); e. Aclidinium bromide; f. Umeclidinium bromide.

<p>a. Spiriva; b. Atrovent; c. DuoNeb; d. Combivent; e. Tudorza Pressair; f. Anoro Ellipta</p> Signup and view all the answers

Match the administration method to the correct drug. (Some may require more than one answer.)

<p>MDI = Atrovent, Combivent, DuoNeb, Spiriva, Incruse Ellipta, Tudorza Pressair Soft-mist inhaler = Combivent Respimat, Stiolto Respimat, Utibron Neohaler SVN = Combivent, DuoNeb Dry powder inhaler (DPI) = Spiriva, Incruse Ellipta, Tudorza Pressair, Anoro Ellipta</p> Signup and view all the answers

Ipratropium bromide is a derivative of ______.

<p>atropine</p> Signup and view all the answers

Atropine is a ______ and not fully ionized; it therefore is readily absorbed into the bloodstream, is distributed throughout the body, crosses the blood-brain barrier, and causes changes in the central nervous system (CNS).

<p>tertiary amine</p> Signup and view all the answers

Explain how the clinical effect for ipratropium differs from that for albuterol.

<p>Ipratropium bromide is a longer-acting bronchodilator that works by blocking the actions of acetylcholine but it does not have the same stimulatory effects on the lungs as albuterol.</p> Signup and view all the answers

Explain the receptor selectivity of tiotropium bromide. How does this explain once-a-day dosing?

<p>Tiotropium bromide is a long-acting anticholinergic that selectively blocks the muscarinic receptors in the lungs, specifically the M3 muscarinic receptor. This allows for once-a-day dosing because the tiotropium has a long duration of action.</p> Signup and view all the answers

Your patient has recently been prescribed umeclidinium bromide by his primary care physician and needs an explanation of how it works. What would you tell him?

<p>Umeclidinium bromide is long acting anticholinergic medication used to treat COPD. It works by blocking the action of acetylcholine in the lungs which causes relaxation of the airway muscles and improve airflow. This allows for an easier breathing experience.</p> Signup and view all the answers

What pharmacologic effects do ipratropium and tiotropium have on the respiratory and cardiac systems?

<p>Ipratropium and tiotropium are bronchodilators that work by blocking the action of acetylcholine in the lungs, which causes relaxation of airway muscles and improve airflow. They do not have any significant effects on the heart.</p> Signup and view all the answers

Your patient has just received an inappropriately high dose of atropine. Explain the pharmacologic effects you would expect to see during a physical assessment.

<p>A high dose of atropine, especially with an individual with underlying cardiovascular or pulmonary conditions, can cause life-threatening side effects. These can include: dry mouth, blurred vision, urinary difficulties, constipation, tachycardia, and even hallucinations.</p> Signup and view all the answers

Parasympathetic neurons from what cranial nerve enter the lung at the hila and travel along the airways?

<p>The vagus nerve (CN X).</p> Signup and view all the answers

Explain why the administration of an anticholinergic can cause significant bronchodilation.

<p>Anticholinergics work by blocking the action of acetylcholine in the lungs, which causes relaxation of airway muscles and improve airflow. This allows for an easier breathing experience.</p> Signup and view all the answers

Explain why methacholine is used in bronchial provocation testing.

<p>Methacholine is used in bronchial provocation testing to determine the sensitivity of the airways. It is a bronchoconstrictor, so it can be used to cause the airways to narrow so that clinicians can determine how severely the airways are narrowed.</p> Signup and view all the answers

The anticholinergic agents ipratropium and tiotropium are indicated for the treatment of [blank] in COPD.

<p>bronchospasm</p> Signup and view all the answers

Your patient is an 8-year-old female patient with persistent asthma not currently controlled with long-acting β-agonist and inhaled corticosteroid therapy. Which of the anticholinergics may help this patient?

<p>Ipratropium bromide.</p> Signup and view all the answers

When sensory C-fiber nerves are stimulated, what clinical manifestation may the patient present with?

<p>Bronchospasm.</p> Signup and view all the answers

List the two most common side effects seen with the anticholinergic aerosol ipratropium.

<p>Dry mouth and cough (A), Blurred vision and urinary retention (C)</p> Signup and view all the answers

The nebulized dose of ipratropium is more than 10 times greater than the MDI dose, which causes greater systemic effects.

<p>False (B)</p> Signup and view all the answers

Patients should use a holding chamber with MDI administration.

<p>True (A)</p> Signup and view all the answers

With nebulizer delivery, the patient must be instructed to keep the mouthpiece in the mouth, and a reservoir tube should be attached to the expiratory side of the T mouthpiece facing away from the patient.

<p>False (B)</p> Signup and view all the answers

Face mask delivery is recommended to deliver the maximal dose of the drug.

<p>False (B)</p> Signup and view all the answers

Complete the following table by comparing the general clinical effects of anticholinergic and β-adrenergic bronchodilators.

<p>Onset = Slower, but longer-acting Time to peak effect = About 30 minutes, but duration of action is long Duration = Longer, approximately 12 hours Fall in arterial partial pressure of oxygen (Pao2) = Less likely to cause a fall Site of action = Primarily smooth muscle in the airways, blocks acetylcholine</p> Signup and view all the answers

Where in the airway do anticholinergic bronchodilators seem to have their greatest effect?

<p>The central large airways.</p> Signup and view all the answers

The U.S. Food and Drug Administration (FDA) has given approval for ipratropium specifically for use in the treatment of [blank], and the drug can also be prescribed for the treatment of [blank].

<p>COPD; asthma (A)</p> Signup and view all the answers

Besides improving lung function in COPD and controlling symptoms, tiotropium may also be useful for controlling [blank] symptoms and deterioration of flow rates at nighttime.

<p>asthma</p> Signup and view all the answers

Anticholinergics may be useful in patients with acute severe episodes of asthma not responding to [blank].

<p>β-agonists</p> Signup and view all the answers

Anticholinergics act primarily on the [blank] airways; β agonists act primarily on the [blank] airways.

<p>peripheral; central</p> Signup and view all the answers

Because albuterol peaks sooner and terminates sooner, and ipratropium peaks slowly and lasts longer, they complement each other.

<p>True (A)</p> Signup and view all the answers

Combined [blank] and [blank] therapy may give additive bronchodilating results in COPD and in severe, acute asthma.

<p>anticholinergic β-agonist</p> Signup and view all the answers

An anticholinergic bronchodilator, because of its action on central large airways, should be given before a β agonist.

<p>False (B)</p> Signup and view all the answers

Long-term agents that help reduce the progression of COPD and improve lung function have been termed triple therapy. Name the three agents that fall into this category.

<p>a. Tiotropium bromide; b. Glycopyrrolate Bromide; c. Umeclidinium bromide.</p> Signup and view all the answers

Flashcards

Anticholinergic

An agent that blocks the parasympathetic nervous system.

Cholinergic

An agent that mimics the effect of acetylcholine.

Bronchodilator

An agent that relaxes smooth muscle in the airway.

Ipratropium bromide

An anticholinergic medication used for asthma and COPD.

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Tiotropium bromide

A long-acting anticholinergic bronchodilator.

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Combivent

Combination of ipratropium and albuterol.

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Aclidinium bromide

An anticholinergic medication indicated for COPD.

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Umeclidinium

An anticholinergic bronchodilator combined with vilanterol.

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Atropine

An anticholinergic compound that affects the CNS.

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Acetylcholine

A neurotransmitter that stimulates parasympathetic activity.

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Nebulizer

Device that turns liquid medication into mist for inhalation.

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MDI

Metered Dose Inhaler - delivers medication directly.

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Respimat

A soft-mist inhaler for slow medication delivery.

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Acute severe asthma

A sudden worsening of asthma symptoms.

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Glaucoma

A condition that can be aggravated by anticholinergic agents.

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Bronchoconstriction

Narrowing of the airways due to muscle tightening.

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Vagal reflex

Refers to involuntary responses from the vagus nerve.

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Beta-agonist

Agents that stimulate beta receptors causing bronchodilation.

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LAMA

Long-Acting Muscarinic Antagonist for COPD management.

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Combination therapy

Using multiple classes of medications together.

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Peak effect

The time when a drug's effect is strongest.

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Onset

The time it takes for a drug to start working.

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Duration

How long a drug's effects last.

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CNS effects

Changes in the central nervous system from anticholinergics.

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Side effects

Unwanted effects caused by medications.

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FDA approval

Formal authorization from the Food and Drug Administration.

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Relaxation of smooth muscle

The process by which bronchodilators reduce airway resistance.

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Peak flow meter

Device to measure airflow rate for asthma control.

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Respiratory effects

Impacts on breathing efficiency and airway function.

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Chronic bronchitis

A long-term inflammation of the bronchial tubes.

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Study Notes

Key Terms and Definitions

  • Parasympathetic nervous fiber blocker: An agent that blocks the parasympathetic nervous system fibers.
  • Acetylcholine producer: An agent that produces the effect of acetylcholine.
  • Bronchodilator: An agent that blocks parasympathetic nervous fibers, allowing airway smooth muscle relaxation.
  • Cholinergic: Is the same as cholinergic, producing the effect of acetylcholine or an agent that mimics acetylcholine.
  • Anticholinergic: Has the same meaning as anticholinergic: blocking the effect of acetylcholine at the cholinergic site.
  • Parasympathetic nervous system mimic: A type of agent that produces effects similar to those of the parasympathetic nervous system.

Clinical Indications for Use

  • Generic and trade name bronchodilators: Students should list five generic and trade names of anticholinergic bronchodilators indicated for maintenance and treatment of chronic obstructive pulmonary disease (COPD), including chronic bronchitis, and emphysema.

Specific Anticholinergic (Parasympatholytic) Agents

  • Students should list the brand names for the following medications: tiotropium bromide, ipratropium bromide, ipratropium bromide and albuterol (metered dose inhaler [MDI]), ipratropium bromide and albuterol (small-volume nebulizer [SVN]), aclidinium bromide, umeclidinium bromide.
  • Include the appropriate administration method to the correct drug.

Drug Dosage and Time Course

  • Students should complete the table for inhaled anticholinergic bronchodilator agents, including the drug, brand name, dosage, and time course (onset, peak, duration). Include examples such as Ipratropium bromide, Ipratropium bromide and albuterol, Aclidinium bromide, Glycopyrrolate bromide, Glycopyrrolate bromide and formoterol, Glycopyrrolate bromide and indacaterol, Tiotropium bromide, Tiotropium bromide and olodaterol, Umeclidinium bromide, Umeclidinium bromide and vilanterol for a comprehensive display.
  • Ipratropium bromide is a derivative of atropine.

Mode of Action

  • Parasympathetic neurons from the vagus nerve (cranial nerve X) enter the lung at the hila. These neurons release acetylcholine which contracts the bronchial smooth muscle.
  • Anticholinergic medications inhibit the parasympathetic nerve response, causing relaxation of the bronchial smooth muscle and resulting in bronchodilation.
  • Methacholine is used in bronchoprovocation testing to assess airway responsiveness. The medication is helpful to measure the amount of airway hyperresponsiveness and diagnose asthma.

Use in Chronic Obstructive Pulmonary Disease (COPD)

  • Ipratropium is FDA-approved for treatment of COPD
  • It is also prescribed in treatment of other conditions.

Use in Asthma

  • Anticholinergics may also be useful for controlling symptoms in asthma.
  • In COPD, the anticholinergic is typically given before a beta-agonist, though this could be reversed depending on individual circumstances and condition severity

Combination Therapy

  • Anticholinergic agents primarily affect the airways. Beta-agonists also affect airways. These medicines work synergistically.

Long-Term Agents

  • Long-term agents in triple therapy: Students should list three long-term agents that help reduce the progression of COPD and improve lung function.

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Ch. 7 Anticholinergic Worksheet

Description

This quiz focuses on key terms and clinical indications related to anticholinergic bronchodilators used for the treatment of COPD. Students will explore definitions, mechanisms, and various generic and trade names of these medications.

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