Anticholinergics (inhaled)

Question 1

Generic names of Anticholinergics (inhaled)

Answer 1

Short acting
Ipratropium
Long acting
Aclidinium
Glycopyrronium (inhaled)
Tiotropium
Umeclidinium

Question 2

Suffix
Anticholinergics (inhaled)

Answer 2

ium

Question 3

MOA
Anticholinergics (Inhaled)

Answer 3

Promote bronchodilation by inhibiting cholinergic bronchomotor tone. They block muscarinic actions of acetylcholine.

Question 4

Precautions
Anticolinergics (inhaled)

Answer 4

Cardiovascular disorders—anticholinergics may increase risk of cardiovascular adverse effects; patients with pre-existing cardiac conditions were often excluded from randomised, controlled trials.

Question 5

Adverse effects
Anticholinergics (inhaled)

Answer 5

dry mouth, throat irritation

Question 6

Anticholinergics (inhaled) aka …

Answer 6

antimuscarinics or muscarinic antagonists

Question 7

SAMAs VS LAMAs

Anticholinergics (inhaled) aka antimuscarinics

Answer 7

Short acting (SAMA)
Ipratropium is short acting; it is also known as a short-acting muscarinic antagonist (SAMA). It is an alternative to short-acting beta2 agonists (SABAs) in the initial management of symptoms such as breathlessness in mild COPD. In asthma, its use is mainly limited to treatment of severe acute attacks when SABA therapy is inadequate.

Long acting (LAMA)
Aclidinium, glycopyrronium, tiotropium and umeclidinium are long acting; they are also known as long-acting muscarinic antagonists (LAMAs).

All LAMAs are marketed for use in COPD

In asthma, tiotropium (Spiriva Respimat®) is marketed as an add-on inhaler to regular inhaled corticosteroid (ICS) with or without a long-acting beta2 agonist (LABA) for patients >6 years.

Question 8

Counselling
Anticholinergics (inhaled)

Answer 8

Ensure correct use of inhaler / use of spacer.

Question 9

Practice points
Anticholinergics (inhaled)

Answer 9

• stop ipratropium if treatment with a long-acting anticholinergic is required for COPD
• before diagnostic spirometry, withhold ipratropium for 12 hours and LAMAs for 36 hours

Question 10

Drug class and indication

Aclidinium

Answer 10

LAMA
COPD

Anticholinergic (inhaled)

Question 11

Drug class and indication

Aclidinium with formoterol

Answer 11

LAMA + LABA
COPD

long acting anticholinergic (inhaled) + long acting beta2 agonist

Question 12

Drug class and indication

Glycopyrronium (inhaled)

Answer 12

Anticholinergic (LAMA)
COPD

Question 13

Drug class and indication

Ipratropium

Answer 13

Anticholinergic (LAMA)
Symptom relief of asthma and COPD

Question 14

Drug class and indication

Tiotropium

Answer 14

Anticholinergic - inhaled (LAMA)
* COPD
* Maintenance treatment of moderate-to-severe asthma as adjunct to standard treatment including an inhaled corticosteroid (ICS)

Question 15

Drug class and indication

Tiotropium with olodaterol

Answer 15

Anticholinergic (inhaled) LAMA + Beta2 agonist (LABA)
COPD

Question 16

Drug class and indication

Umeclidinium

Answer 16

Anticholinergic (inhaled) LAMA
COPD

Question 17

Drug class and indication

Umeclidinium with vilanterol

Answer 17

Anticholinergic (inhaled) LAMA + beta2 agonist (LABA)
COPD