IAM

Question 1

How do inhaled
antimuscarinics work in asthma/COPD?

Answer 1

• Bronchodilation
• Bind to muscarinic receptors in smooth muscle, blocks the action of ACh

Question 2

2 types of inhaled antimuscarinics

Answer 2

SAMA
LAMA

Question 3

SAMA

Answer 3

short-acting muscarinic antagonist
* ipratropium
* Slower onset that SABA

Question 4

Ipratropium inhaler examples

Answer 4

• MDI: Atrovent, Inhalvent

Question 5

Ipratropium bromide - indication

Answer 5

• Ipratropium bromide by nebulisation can be added to other standard treatments in life-threatening asthma or if acute asthma fails to improve with standard therapy
• Ipratropium can be used as a nasal spray for rhinitis

Question 6

Duration of action of ipratropium bromide

Answer 6

• Effect occurs within 30-60 minutes of inhalation (this is slower than SABA)
• Last up to 6 hours
• Can be given TDS (Max QDS)

Question 7

What is the risk of nebulised ipratropium?

Answer 7

• Risk of acute-angle-closure-glaucoma (higher risk if given with nebulised salbutamol)
• STOP and seek medical attention - eye pain and changes in vision

Question 8

LAMA inhaler examples

Answer 8

1. Aclidinium bromide
2. Glycopyrronium bromide
3. Tiotropium
4. Umeclidinium

Question 9

Aclidinium bromide inhaler examples

Answer 9

• DPI: Ekilra
• With formoterol: Duaklir

Question 10

Glycopyrronium bromide inhaler examples

Answer 10

• DPI: Seebri Breezhaler
• With Indacaterol (LABA):
  Ultibro breezhaler

Question 11

Tiotropium inhaler examples

Answer 11

• DPI: Braltus, Spiriva
• MDI: Spiriva Respimat
• With Olodaterol: Spiolto
  respimat

Question 12

What is the CSM
warning about Braltus (Tiotropium)?

Answer 12

• MHRA have had reports of people choking on the capsules
• Patients should be advised to store capsules in the screw-top bottle provided and never in the inhaler
• Check inhaler is clear of capsules before inhaling

Question 13

Umeclidinium inhaler examples

Answer 13

• DPI: Incruse elipta

Question 14

How often are LAMAs inhaled?

Answer 14

• All ONCE daily (EXCEPT Aclidinium which is TWICE DAILY)
• LAMAs have a longer duration of action and therefore are inhaled less frequently during the day

Question 15

Which LAMA is the only one licensed for use in asthma?

Answer 15

Tiotropium (Spiriva Respimat)

Question 16

Common SE

Answer 16

AM SE - acts on parasympathetic pathways
- Constipation
- Dry mouth
- Increased ocular pressure (report halos or blurred vision)
- Urinary retention

Question 17

What drugs do inhaled antimuscarinics
interact with?

Answer 17

Other drugs which have antimuscarinic effects:
- tolterodine, oxybutinin, tamsulosin, solifenacin
- hyoscine
- TCAs