Ipratropium bromide

Question 1

Presentation

Answer 1

250mcg in 1ml nebule or polyamp

Question 2

Pharmacology

Answer 2

Anticholinergic bronchodilator.
Actions:
- allows bronchodilation by inhibiting cholinergic tone (i.e. blocks vagal reflexes which mediate bronchoconstriction)

Question 3

Metabolism

Answer 3

Excreted by the kidneys

Question 4

Primary emergency indications

Answer 4

1. severe respiratory distress associated with bronchospasm

2. exacerbation of COPD irrespective of severity

Question 5

Contraindications

Answer 5

1. known hypersensitivity to atropine or its derivatives

Question 6

Precautions

Answer 6

1. glaucoma

2. avoid contact with eyes

Question 7

Route of administration

Answer 7

Nebulised (in combination with salbutamol)

Question 8

Side effects

Answer 8

• headache
• nausea
• dry mouth
• skin rash
• tachycardia (rare)
• palpitations (rare)
• acute angle closure glaucoma secondary to direct eye contact (rare)

Question 9

Special notes

Answer 9

Isolated reports of ocular complications (dilated pupils, acute angle glaucoma, increased intraocular pressure, eye pain) asa result of direct eye contact. Nebuliser mask must be fitted properly.
Must be nebulised in conjunction with salbutamol and is to be administered as a single dose only.
Onset: 3-5mins
Peak: 1.5-2 hours
Duration: 6 hours