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Pharmacology Spring 2021 > Respiratory: Anticholinergics > Flashcards

Respiratory: Anticholinergics Flashcards

1
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Basic Understanding:

What are inhaled anticholinergics used primarily to treat?

A

COPD

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2
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Basic Understanding:

Other than COPD when are inhaled anticholinergics used?

A
  1. Asthma exacerbation

2. Intolerance to B2RAs

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3
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Basic Understanding:

What inhaled anticholinergics are used to treat asthma exacerbation or the patient who is intolerant to B2RAs?

A
  1. Ipratropium

2. Albuterol

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4
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Basic Understanding:

What type of substance is the anticholinergic Ipratropium bromide (Atrovent)?

A

Quaternary amine anticholinergic

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5
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Basic Understanding:

What is is the anticholinergic Ipratropium bromide structurally similar to?

A

Atropine

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6
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Basic Understanding:

What is Atropine?

A

Medication used to treat heart rhythm problems

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7
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Basic Understanding:

Is Ipratropium bromide used alone or in combination?

A

Alone or in combination

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8
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Basic Understanding:

When Ipratropium bromide is administered alone what is the brand name?

A

Atrovent

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9
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Basic Understanding:

When Ipratropium bromide is administered in combination what medication is it combined with?

A

Albuterol

Combivent

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10
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Basic Understanding:

When Ipratropium bromide is administered in combination with albuterol what is the brand name?

A

Combivent

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11
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Basic Understanding:

What is another common medication used to treat COPD?

A

Tiotropium bromide

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12
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Basic Understanding:

What is the Brand name for Tiotropium bromide?

A

Spiriva

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13
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Basic Understanding:

How is Tiotropium bromide administered?

A

It is inhaled

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14
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Examples:

Which Anticholinergics are on the quiz?

A

INN/Generic Names:

  1. ipratropium bromide
  2. tiotropium bromide
  3. ipratropium combined with albuterol

Brand/Trade Names:

  1. Atrovent
  2. Spiriva
  3. Combivent
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15
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacodynamics:

Is the action of each inhaled anticholinergic similar or different?

A

Similar

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16
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacodynamics:

What is the action of anticholinergics?

A

They block muscarinic cholinergic receptors

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17
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacodynamics:

How do anticholinergics block the muscarinic cholinergic receptors?

A

By inhibiting the action of acetylcholine

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18
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacodynamics:

What is an abbreviation for acetylcholine?

A

ACh

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19
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacodynamics:

What is ACh?

A

A neurotransmitter

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20
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacodynamics:

What does ACh do?

A

Sends messages to tell body to:

  1. Contract smooth muscles
  2. Dilates blood vessels
  3. Increases bodily secretions
  4. Slow HR
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21
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacodynamics:

What is the result of the cholinergic receptors being blocked by anticholinergics?

A

The formation of cGMP is decreased

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22
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacodynamics:

What is cGMP an abbreviation for?

A

Cyclic guanosine monophosphate

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23
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacodynamics:

What is the result of cGMP being decreased d/t cholinergic receptors being blocked by anticholinergics?

A

Decreased contractility of the smooth muscle

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24
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacodynamics:

Which smooth muscle’s contractility becomes decreased as a result of cGMP being decreased d/t cholinergic receptors being blocked by anticholinergics?

A

Lungs

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25
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacodynamics:

What is a possible reason for the outcome of the smooth muscles of the lungs decreasing in contractility with use of anticholinergics?

A

Probably b/c of the actions of cGMP on intracellular calcium

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26
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacodynamics:

What is the amount of bronchodilation by anticholinergics inhalation thought to reflect?

A

The level of parasympathetic tone

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27
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacodynamics:

When ipratropium is inhaled where are the blocked receptors located?

A

Confined to:

  1. Mouth
  2. Airways
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28
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacodynamics:

When Tiotropium is inhaled where are the blocked receptors located?

A

Lungs

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29
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacodynamics:

What are the steps of the physiology of anticholinergic medications?

A
  1. Inhibits the action of ACh which
  2. Blocks muscarinic cholinergic receptors which leads
  3. A decrease in the formation of cGMP which causes
  4. Decreased contractility of smooth muscle leading to
  5. Bronchodilation
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30
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacokinetics: Absorption and Distribution:

Where is ipratropium absorbed?

A
  1. Lungs

2. GI tract

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31
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacokinetics: Absorption and Distribution:

Is ipratropium absorbed well or poorly?

A

Poorly

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32
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacokinetics: Absorption and Distribution:

What percentage of a dose of ipratropium gets absorbed systemically?

A

1% to 2%

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33
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacokinetics: Absorption and Distribution:

Does ipratropium penetrate the CNS (blood-brain barrier) well or poorly?

A

Poorly

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34
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacokinetics: Absorption and Distribution:

Does ipratropium cross the placenta?

A

It is unknown

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35
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacokinetics: Absorption and Distribution:

Is ipratropium excreted into breast milk?

A

Yes

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36
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacokinetics: Absorption and Distribution:

How much ipratropium is excreted into breast milk?

A

Minimal amounts

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37
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacokinetics: Absorption and Distribution:

How is tiotropium administered?

A

Inhaled or oral

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38
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacokinetics: Absorption and Distribution:

What type of inhaler is used to administer tiotropium?

A

Dry powder inhaler

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39
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacokinetics: Absorption and Distribution:

How much bioavailability does inhaled tiotropium have?

A

19.5%

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40
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacokinetics: Absorption and Distribution:

What percentage of tiotropium is protein bound in human plasma?

A

72%

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41
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacokinetics: Absorption and Distribution:

Where is oral tiotropium absorbed?

A

GI tract

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42
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacokinetics: Absorption and Distribution:

Is tiotropium absorbed well or poorly?

A

Poorly

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43
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacokinetics: Absorption and Distribution:

How much bioavailability does oral tiotropium have?

A

2% to 3%

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44
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacokinetics: Absorption and Distribution:

Does tiotropium penetrate the CNS (blood-brain barrier) well or poorly?

A

Poorly

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45
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacokinetics: Absorption and Distribution:

How much tiotropium is excreted into breast milk?

A

It is unknown

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46
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacokinetics: Absorption and Distribution:

Does ipratropium cross the placenta?

A

It is unknown

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47
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacokinetics: Absorption and Distribution:

What is known about the distribution of tiotropium in breast milk?

A

It is distributed in breast milk of rats but not studied in humans

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48
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacokinetics: Metabolism and Excretion:

How is unabsorbed ipratropium excreted?

A

In feces

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49
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacokinetics: Metabolism and Excretion:

In what form is unabsorbed ipratropium excreted?

A

Unchanged

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50
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacokinetics: Metabolism and Excretion:

What percent of unabsorbed ipratropium is excreted in feces unchanged?

A

90%

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51
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacokinetics: Metabolism and Excretion:

What happens to the ipratropium that is not excreted?

A

It is absorbed

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52
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacokinetics: Metabolism and Excretion:

What happens to the portion of ipratropium that is absorbed?

A

It is partially metabolized

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53
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacokinetics: Metabolism and Excretion:

By what mechanism of action is ipratropium metabolized?

A

Ester hydrolysis

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54
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacokinetics: Metabolism and Excretion:

What is ester hydrolysis?

A
  1. Reaction that breaks an ester bond with
  2. A molecule of H2O or hydroxide ion to form
  3. A carboxylic acid and an alcohol
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55
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacokinetics: Metabolism and Excretion:

What is ipratropium metabolized into by the action of ester hydrolysis?

A

Inactive metabolites

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56
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacokinetics: Metabolism and Excretion:

How is the absorbed ipratropium excreted?

A

In urine

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57
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacokinetics: Metabolism and Excretion:

In what form is absorbed ipratropium excreted?

A

Unchanged

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58
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacokinetics: Metabolism and Excretion:

What percent of absorbed ipratropium is excreted in urine unchanged?

A

50%

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59
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacokinetics: Metabolism and Excretion:

How is absorbed tiotropium excreted?

A

In urine

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60
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacokinetics: Metabolism and Excretion:

In what form is absorbed tiotropium excreted?

A

Unchanged

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61
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics: Precautions and Contraindications:

In what patients is ipratropium contraindicated?

A

Hypersensitivity to:

  1. atropine
  2. atropine derivatives
  3. bromide
62
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics: Precautions and Contraindications:

What is bromide?

A
  1. Previously used as a sedative

2. Now used as a catalyst for the manufacturing of pharmaceuticals

63
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics: Precautions and Contraindications:

In what patients is tiotropium contraindicated?

A

Hypersensitivity to:

  1. ipratropium
  2. tiotropium
64
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics: Precautions and Contraindications:

Who should avoid use of inhaled anticholinergics?

A

Patients with:

  1. Acute bronchospasm
  2. Urinary retention
  3. Bladder neck obstruction
  4. BPH
65
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics: Precautions and Contraindications:

Why should patients with acute bronchospasm avoid the use of inhaled anticholinergics?

A

Its anticholinergic effects

66
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics: Precautions and Contraindications:

What is the exception in allowing the use of inhaled anticholinergics in bronchospasm patients?

A

When ipratropium is combined with albuterol in ER treatment of acute bronchospasm

67
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics: Precautions and Contraindications:

Why should patients with acute bronchospasm avoid the use of inhaled anticholinergics?

A

Its anticholinergic effects

68
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics: Precautions and Contraindications:

Which population has risks to take into consideration when taking inhaled anticholinergic therapy?

A

Older adults with BPH

69
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics: Precautions and Contraindications:

What are the older adults with BPH at risk for when taking inhaled anticholinergic therapy?

A

Acute urinary retention

70
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics: Precautions and Contraindications:

When are older adults with BPH at highest risk for developing acute urinary retention?

A

The beginning of therapy

71
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics: Precautions and Contraindications:

All three inhaled anticholinergic drugs may increase
___1____ in patients with ___2___.

A
  1. Intraocular pressure

2. Closed-angle glaucoma

72
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics: Precautions and Contraindications:

What pregnancy category is ipratropium bromide?

A

Pregnancy Category B

73
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics: Precautions and Contraindications:

What pregnancy category is tiotropium bromide?

A

Pregnancy Category C

74
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics: Precautions and Contraindications:

Should inhaled anticholinergics be used in pregnancy?

A

Only if clearly indicated

75
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics: Precautions and Contraindications:

Why should inhaled anticholinergics be used in pregnancy only if clearly indicated?

A

Not well studied

76
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics: Precautions and Contraindications:

Why is it hypothesized that ipratropium is safe for use if needed during breastfeeding?

A

Because Atropine is considered safe during lactation

77
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics: Precautions and Contraindications:

Why is it hypothesized that ipratropium is safe for use if needed during breastfeeding because Atropine is considered safe during lactation?

A

Atropine is chemically related to ipratropium

78
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics: Precautions and Contraindications:

Have the safety and effectiveness of ipratropium been established in children under age 12?

A

No

79
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics: Precautions and Contraindications:

When may a provider use ipratropium to treat a young child?

A

In combination

  1. adjunct to albuterol AND
  2. acute exacerbation of asthma
80
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics: Precautions and Contraindications:

Tiotropium is approved only for which condition?

A

COPD

81
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics: Precautions and Contraindications:

Does COPD normally occur in children?

A

No

82
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics: Precautions and Contraindications:

Have safety and effectiveness of tiotropium been established in children?

A

No

83
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics: Adverse Drug Reactions:

What are common adverse effects of ipratropium?

A
  1. Cough
  2. Hoarseness
  3. Throat irritation
  4. Dysgeusia
  5. Nausea
  6. Vomiting
  7. Dyspepsia
  8. Xerostomia
  9. Urinary retention
  10. Dizziness
  11. Drowsiness
  12. Constipation
84
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics: Adverse Drug Reactions:

What is dysgeusia?

A
  1. Perception of taste is altered

2. Everything seems sweet, sour, bitter, or metallic

85
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics: Adverse Drug Reactions:

What is dyspepsia?

A

Indigestion

86
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics: Adverse Drug Reactions:

What is xerostomia?

A

Dry mouth

87
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics: Adverse Drug Reactions:

What are common adverse effects of tiotropium?

A
  1. Xerostomia
  2. Mouth irritation
  3. Pharyngitis
  4. Nasal congestion
  5. Sinusitis
  6. Headache
  7. Upper respiratory infections
  8. Urinary retention
  9. Dizziness
  10. Drowsiness
  11. Constipation
88
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics: Adverse Drug Reactions:

What are rare adverse effects of ipratropium and tiotropium?

A

Allergic and anaphylactoid reactions

89
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics: Adverse Drug Reactions:

What occurs with rare allergic and anaphylactoid reactions to ipratropium and tiotropium?

A
  1. Urticaria
  2. Maculopapular rash
  3. Bronchospasm
  4. Pruritus
  5. Laryngospasm
  6. Oropharyngeal edema
  7. Angioedema: tongue, lips, and face
90
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics: Adverse Drug Reactions:

What is the most common adverse drug reaction reported with ipratropium?

A

Cough

91
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics: Adverse Drug Reactions:

What is thought to cause the adverse effects of nausea, vomiting, and dyspepsia with use of ipratropium?

A

The local anticholinergic effects it has on the GI tract

92
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics: Adverse Drug Reactions:

What percent of patients on ipratropium report the side effect of xerostomia?

A

2%

93
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics: Adverse Drug Reactions:

What is the most commonly reported adverse reaction to inhaled tiotropium?

A

Xerostomia

94
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics: Adverse Drug Reactions:

What percentage of patients taking inhaled tiotropium reported the adverse reaction of xerostomia?

A

16%

95
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics: Adverse Drug Reactions:

What percentage of patient taking inhaled anticholinergics reported anticholinergic effects including urinary retention, dizziness, drowsiness, and constipation?

A

< 2%

96
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics: Adverse Drug Reactions:

What percentage of patients taking ipratropium have a prostate disorder noted?

A

< 2%

97
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics: Adverse Drug Reactions:

What may the patient experience if ipratropium is accidentally sprayed in the eyes?

A

Temporary:

  1. Eye irritation
  2. Pain
  3. Mydriasis
  4. Blurred vision
  5. Cycloplegia
  6. Irritant conjunctivitis
  7. Visual disturbances
98
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics: Adverse Drug Reactions:

What is Mydriasis?

A

Pupil dilation

99
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics: Adverse Drug Reactions:

What is Cycloplegia?

A

Paralysis of the ciliary muscle

100
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics: Drug Interactions:

What are the major drug reactions using ipratropium and tiotropium?

A

No major reactions

101
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics: Drug Interactions:

Why are there no major drug reactions using ipratropium and tiotropium?

A

They are minimally absorbed into the systemic circulation after inhalation

102
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics: Drug Interactions:

Which patients require special cautioning when considering use of ipratropium?

A

Patients who are concurrently using cromolyn sodium and ipratropium bromide via nebulizer

103
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics: Drug Interactions:

What should the practitioner caution patients concurrently using cromolyn sodium and ipratropium bromide via nebulizer to do?

A

Not to mix the two in the reservoir at the same time

104
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics: Drug Interactions:

Why should patients concurrently using cromolyn sodium and ipratropium bromide via nebulizer be cautioned not to mix the two?

A

Because a precipitate will form

105
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics: Rational Drug Selection:

What line bronchodilator is ipratropium in the treatment of asthma and COPD?

A

Second-line

106
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics: Rational Drug Selection:

What product would be an appropriate choice for the practitioner considering prescribing both ipratropium and albuterol?

A

Combivent

107
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics: Rational Drug Selection:

Why would a practitioner choose to use tiotropium for use of COPD rather than other options?

A
  1. Cost

2. Ease of use

108
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics: Rational Drug Selection:

What is the cost of a month’s supply of Atrovent HFA MDI?

A

$237

109
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics: Rational Drug Selection:

What is the cost of a month’s supply of a generic ipratropium inhaler?

A

Generic ipratropium inhaler is no longer available

110
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics: Rational Drug Selection:

What is the cost of 150 unit-dose vials of Atrovent inhalation solution?

A

$200

111
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics: Rational Drug Selection:

What is the cost of 150 unit-dose vials of generic ipratropium inhalation solution?

A

$57

112
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics: Rational Drug Selection:

What is the cost of 30 vials of the combination product Combivent?

A

$307

113
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics: Rational Drug Selection:

What is the cost of 30 vials of the combination product for ipratropium and albuterol nebulizer solution?

A

$76.19

114
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics: Rational Drug Selection:
What is the cost of 30 vials of the generic combination product Duoneb (ipratropium and albuterol nebulizer solution)?

A

$13.97

115
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics: Rational Drug Selection:

What is significant regarding the prices of anticholinergic medications?

A

There is significant cost savings when buying ipratropium and albuterol combination products rather than the two products individually.

116
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics: Rational Drug Selection:

Although there is significant cost savings when buying ipratropium and albuterol combination products rather than the two products individually ______ can alter these prices to provide an opposite outcome.

A

Insurance (prescription drug coverage)

117
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics: Rational Drug Selection:

Is tiotropium available in only form or in many?

A

Only one

118
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics: Rational Drug Selection:

What form is tiotropium available in?

A

As a dry powder capsule

119
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics: Rational Drug Selection:

What must be used to administer tiotropium dry powder capsules?

A

HandiHaler

120
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics: Rational Drug Selection:

What is a HandiHaler?

A

Plastic device used to inhale medication

121
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics: Rational Drug Selection:

What is the cost of 1 month’s supply (30) of Tiotropium dry powder capsules?

A

$223.07

122
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics: Monitoring:

What lab monitoring should be done with patients taking inhaled anticholinergics?

A

No specific lab monitoring necessary

123
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics: Monitoring:

What should be monitored when taking inhaled anticholinergics?

A

The disease process

124
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics:
Patient Education:

What should a practitioner educated their patient on regarding frequency of use of their anticholinergics?

A

It should be used as prescribed

125
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics:
Patient Education:

What can occur if bronchodilators are overused?

A

Increased adverse effects

126
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics:
Patient Education:

What can occur if bronchodilators are used less than prescribed?

A
  1. Increased bronchospasm

2. Decreased pulmonary function

127
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics:
Patient Education:

What should be taught to a patient about he administration of a medication via an MDI?

A

See cards on MDI administration in “Respiratory: General Information” deck

128
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics:
Patient Education:

If the patient is prescribed other inhalers, which inhaler would you advise the patient to use first?

A

Ipratropium

129
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics:
Patient Education:

If the patient is prescribed other inhalers and has used their ipratropium first what is their next action?

A

Wait 5 min before using other inhalers as directed

130
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics:
Patient Education:

What can be prescribed to assist with the delivery of inhaled medications?

A

See cards on the use of a spacer with inhaled medication administration in “Respiratory: General Information” deck

131
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics:
Patient Education:

Who provides education on the administration of ipratropium via nebulizer?

A

Manufacturer of the nebulizer

132
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics:
Patient Education:

Why should the manufacturers directions be followed?

A

Since directions can vary based on manufacturer of each nebulizer brand

133
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics:
Patient Education:

How often is ipratropium administered?

A

Every 6 to 8 hours

134
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics:
Patient Education:

When using a nebulizer; after how long can albuterol be mixed into an ipratropium solution that is already administered into the reservoir?

A

1 hr

135
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics:
Patient Education:

What should you advise a patient taking both Cromolyn and ipratropium concurrently of?

A

Do not combine the two

136
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics:
Patient Education:

What would occur is a patient taking both Cromolyn and ipratropium mixed the two medications?

A

It would create a precipitate

137
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics:
Patient Education:

What should be done when using a nebulizer for both Cromolyn and ipratropium concurrently?

A

Rinse the nebulizer medication cup well between use

138
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics:
Patient Education:

What action should occur directly after use of inhaled ipratropium or tiotropium?

A

Rinse their mouth with water

139
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics:
Patient Education:

Why is rinsing the mouth advised after use of inhaled ipratropium or tiotropium?

A

To minimize dry mouth

140
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics:
Patient Education:

What action should occur directly before the first time using a Combivent MDI?

A

Prime it

141
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics:
Patient Education:

How would you instruct a patient to prime their Combivent MDI before the first time using it?

A

“Test-spray” the MDI 3 times into the air

142
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics:
Patient Education:

In what situation other than using a Combivent MDI for the first would you instruct a patient to prime it?

A

If it has not been used in more than 24 hrs

143
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics:
Patient Education:

Other than using the HandiHaler device is there another method that Spiriva can be administered?

A

No

144
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics:
Patient Education:

Who provides directions on how to use the HandiHaler device?

A

Spiriva

145
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics:
Patient Education:

What do the directions provided by Spiriva on how t use the HandiHaler include?

A
  1. Package insert

2. Step-by-step pictures and text

146
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics:
Patient Education:

What should the provider educate the patient about regarding common adverse reactions to either inhaled anticholinergic?

A

Cough may develop

147
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics:
Patient Education:

What should the provider educate the patient about regarding LESS common adverse reactions to either inhaled anticholinergic?

A
  1. Throat irritation
  2. Hoarseness
  3. Dry mouth
148
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics:
Patient Education:

What can a provider instruct a patient to do to decrease the incidence of these adverse effects of inhaled anticholinergics?

A
  1. Use spacer device

2. Rinse mouth after use

149
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics:
Patient Education:

If a patient does have adverse effects to inhaled anticholinergics what should they be instructed to do?

A

Notify their provider

150
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics:
Patient Education:

Which adverse effect of inhaled anticholinergics is particularly important to notify the provider of if noted?

A

Urinary retention

151
Q

Types of Respiratory Drugs:

Bronchodilators: Anticholinergics:

Pharmacotherapeutics:
Patient Education:

What lifestyle management education should the provider instruct the patient using inhaled anticholinergics on?

A
  1. Peak flowmeter
  2. Avoid or quit smoking
  3. Avoid environmental triggers for asthma
  4. COPD patients should avoid exposure to viral respiratory infections

Pharmacology Spring 2021 (22 decks)

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