Antimuscarinic bronchodilators

Question 1

Antimuscarinic bronchodilators indications

Answer 1

COPD, SAMA used to relieve breathlessness, asthma as adjuvant in breathlessness. LAMA used to prevent breathlessness and exacerbations in COPD and added to high dose ICS in step 4 chronic asthma treatment

Question 2

Antimuscarinic bronchodilator MOA

Answer 2

Reduce smooth muscle tone in respiratory tract and reduce secretions from respiratory tract. (competitive inhibitor if acetylcholine)

Question 3

Antimuscarinic bronchodilator side effect

Answer 3

Dry mouth, little systemic effect

Question 4

Antimuscarinic bronchodilator examples

Answer 4

Ipratropium(SAMA) tiotropium, glycopyrronium

Question 5

Antimuscarinic bronchodilator dosing

Answer 5

SAMA ipratropium 40mcg preventative PRN but not worth using more than 4 times a day, 250-500mcg in 6hrly nebulisation in acute attack. LAMA OD.

Question 6

Nebulisation process

Answer 6

Nebulisation comes as a liquid, which is put into the chamber below a mask covering the mouth and nose of the patient. Oxygen is bubbled through the liquid, vaporising the medicine for the patient to inhale. In patients at risk of carbon dioxide retention, medical air is used in place of oxygen.