Anti muscarinics

Question 1

Name SAMA & LAMAs

Answer 1

SAMA:
Ipratropium

LAMA:
Tiotropium
Glyccopyrronium
Aclidinium

Question 2

SAMA & LAMA: MOA

dont need to know

Answer 2

Competitive Inhibitor of Acetylcholine (ACh) binding at the Muscarinic receptor.

this elicits an opposite effect of typical ACh binding : rest and digest such as: increased HR etc.

thus, inhibition =
- Reduced muscle tone in the airway.
- Reduced excretions in the airway.
= improved airflow

Question 3

SAMA & LAMA: Indications :)

Answer 3

1) COPD exacerbations (treatment and/or prevention):
- SAMA - an alternative to SABA in providing symptomatic relief for SOB during exacerbations.
- LAMA - long-term prevention of exacerbations
2) Asthma (treatment and/or prevention):
- SAMA - Added to SABA to help provide relief during acute exacerbations.
- LAMA - Added to ICS + LABA to help prevent exacerbations.

Question 4

SAMA & LAMA: Contraindications

Answer 4

NONE :)

Question 5

SAMA & LAMA: Warnings

Answer 5

use with caution in those with:

• Angle-closure glaucoma
• Arrhythmias
• Urinary retention

Question 6

Effect of SAMA / LAMA on the eyes

Answer 6

Increased intra-occular pressure :

hence avoid in those with close-angle glaucoma.

Question 7

SAMA & LAMA: side effects

Answer 7

1) Respiratory tract Irritation:
- Nasopharyngitis
- Sinusitis
- Cough

2) GI Irritation:
- Dry mouth (common)
- Constipation
- Urinary retention

Other effects:

• Blurred vision
• Headaches

Question 8

SAMA & LAMA: Monitoring

Answer 8

Review inhaler technique

Check Peak Flow in asthmatics

Question 9

SAMA & LAMA: Interactions

Answer 9

NONE :)