Ch. 7 Anticholinergic Worksheet

**[Ch. 7 Anticholinergic (Parasympatholytic) Bronchodilators Worksheet]** **[Key terms and definitions]** **Complete the following questions by writing the answer in the space provided.** 1. An agent that blocks parasympathetic nervous fibers is called \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_. 2. An age...

**[Ch. 7 Anticholinergic (Parasympatholytic) Bronchodilators Worksheet]** **[Key terms and definitions]** **Complete the following questions by writing the answer in the space provided.** 1. An agent that blocks parasympathetic nervous fibers is called \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_. 2. An agent that produces the effect of acetylcholine is called \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_. 3. An agent that blocks parasympathetic nervous fibers, which allow relaxation of smooth muscle in the airway, is called a(n) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_. 4. \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ is the same as cholinergic, producing the effect of acetylcholine or an agent that mimics acetylcholine. 5. The word \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ has the same meaning as anticholinergic: blocking the effect of acetylcholine at the cholinergic site. 6. A \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ agent produces effects similar to those of the parasympathetic nervous system. **[Clinical indications for use]** **Complete the following questions by writing the correct term in the blank provided.** 7. 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). Generic Trade a. \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ b. \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ c. \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ d. \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ e. \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 8. 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. 9. What two medications make up Combivent? a. \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ b. \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 10. The combination of umeclidinium and vilanterol is called \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_. 11. Utibron Neohaler is a combination of which two medications? 12. What is the indication for use of Stiolto Respimat? Stiolto Respimat is a combination of what two medications? 13. The medication commonly used in severe asthma, especially bronchoconstriction that does not respond well to β -agonist therapy, is \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_. **[Specific anticholinergic (parasympatholytic) agents]** **Complete the following questions by writing the correct term in the blank provided.** 14. 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: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ **Match the administration method to the correct drug. (Some may require more than one answer.)** 15. \_\_\_\_\_\_\_ MDI 16. \_\_\_\_\_\_\_ Soft-mist inhaler 17. \_\_\_\_\_\_\_ SVN 18. \_\_\_\_\_\_\_ Dry powder inhaler (DPI) a. Atrovent b. Combivent c. DuoNeb d. Spiriva e. Incruse Ellipta f. Tudorza Pressair g. Combivent Respimat h. Stiolto Respimat i. Utibron Neohaler j. Bevespi Aerosphere 19. Complete the following table for inhaled anticholinergic bronchodilator agents. **[Drug Brand Name Dosage Time Course (Onset, Peak, Duration)]** Ipratropium bromide Ipratropium bromide and albuterol Aclidinium bromide Glycopyrrolate bromide Glycopyrrolate bromide and formoterol Glycopyrrolate bromide and indacterol Tiotropium bromide Tiotropium bromide and Olodaterol Umeclidinium bromide Umeclidinium bromide and vilanterol 20. Ipratropium bromide is a derivative of \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_. 21. 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). 22. Explain how the clinical effect for ipratropium differs from that for albuterol. 23. Explain the receptor selectivity of tiotropium bromide. How does this explain once-a-day dosing? 24. 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? 25. What pharmacologic effects do ipratropium and tiotropium have on the respiratory and cardiac systems? Pharmacologic effects of anticholinergic (antimuscarinic) agents 26. Your patient has just received an inappropriately high dose of atropine. Explain the pharmacologic effects you would expect to see during a physical assessment. **[Mode of action]** 27. Parasympathetic neurons from what cranial nerve enter the lung at the hila and travel along the airways? 28. Explain why the administration of an anticholinergic can cause significant bronchodilation. Complete the following questions by writing the correct term in the blank provided. 29. Explain why methacholine is used in bronchial provocation testing. 30. The anticholinergic agents ipratropium and tiotropium are indicated for the treatment of \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ in COPD. 31. 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? **[Vagally Mediated Reflex Bronchospasm]** 32. When sensory C-fiber nerves are stimulated, what clinical manifestation may the patient present with? 33. List the two most common side effects seen with the anticholinergic aerosol ipratropium. a. \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ b. \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ **The following questions concern delivery of a quaternary ammonium antimuscarinic bronchodilator, such as ipratropium bromide. Identify each statement as either true or false.** 34. True or False: The nebulized dose of ipratropium is more than 10 times greater than the MDI dose, which causes greater systemic effects. 35. True or False: Patients should use a holding chamber with MDI administration. 36. True or False: 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. 37. True or False: Face mask delivery is recommended to deliver the maximal dose of the drug. **[Clinical application]** 38. Complete the following table by comparing the general clinical effects of anticholinergic and β-adrenergic bronchodilators. Anticholinergic β Agonist a. Onset b. Time to peak effect c. Duration d. Fall in arterial partial pressure of oxygen (Pao2) e. Site of action **[Use in Chronic Obstructive Pulmonary Disease]** 39. Where in the airway do anticholinergic bronchodilators seem to have their greatest effect? 40. The U.S. Food and Drug Administration (FDA) has given approval for ipratropium specifically for use in the treatment of \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_, and the drug can also be prescribed for the treatment of \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_. **[Use in Asthma]** 41. Besides improving lung function in COPD and controlling symptoms, tiotropium may also be useful for controlling \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ symptoms and deterioration of flow rates at nighttime. 42. Anticholinergics may be useful in patients with acute severe episodes of asthma not responding to \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_. **[Combination therapy: β-adrenergic plus anticholinergic agents]** 43. Anticholinergics act primarily on the \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ airways; β agonists act primarily on the \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ airways. 44. True or False: Because albuterol peaks sooner and terminates sooner, and ipratropium peaks slowly and lasts longer, they complement each other. 45. Combined \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ and \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ therapy may give additive bronchodilating results in COPD and in severe, acute asthma. 46. True or False: An anticholinergic bronchodilator, because of its action on central large airways, should be given before a β agonist. 47. 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. a. \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ b. \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ c. \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_