Anticholinergics

Anticholinergics

Overview

• Inhaled Anticholinergics: Also known as muscarinic antagonists, used for managing airflow disorders, specifically in clients with Chronic Obstructive Pulmonary Disease (COPD).

• Purpose: Provide relief from bronchoconstriction and reduce secretions.

• Medication Selection: Aids in determining whether a fast relief (rescue inhalers) or long-term management approach is needed.

Prototype and Other Medications

• Short Acting Muscarinic Antagonists (SAMA): Ipratropium is the prototype example.

• Long Acting Muscarinic Antagonists (LAMA): Include umeclidinium, tiotropium, aclidinium, and revefenacin.

Expected Pharmacologic Action

• Mechanism of Action:

  • Anticholinergics act on the parasympathetic nervous system, which is responsible for bronchoconstriction via acetylcholine.

  • They inhibit acetylcholine at the muscarine receptors, resulting in bronchodilation.

Adverse Drug Reactions

• Common Reactions: Generally limited to local effects such as:

  • Dry Mouth

  • Pharyngeal Irritation

• Systemic Absorption Risks:

  • Potential for increased intraocular pressure in patients with narrow-angle glaucoma.

• Other Reactions:

  • Urinary Retention

  • Tachycardia

  • Headache

  • Dizziness

  • Blurred Vision

  • Epistaxis (nosebleeds)

  • Bronchospasms

  • Hypotension

Interventions

• Manage dry mouth side effects by:

  • Offering water to sip on.

  • Providing hard candy to alleviate discomfort.

• Schedule routine eye examinations for glaucoma testing, especially for clients not regularly monitored.

• Monitor urinary patterns for potential retention, particularly in older adults.

Administration

• Routes: Administer via inhaler or nebulizer.

• Recommendations:

  • Follow manufacturer’s instructions, including dosage limits and timing.

  • Maintain a 5-minute gap before administering any other inhaled medications.

  • Keep water handy to help with the unpleasant aftertaste.

Safety Alert

• Important Reminder: Inhaled anticholinergics are not intended for acute asthma exacerbations and are approved for use as bronchodilators specifically for COPD.

Client Instructions

• Discuss potential side effects and strategies for alleviating discomfort.

• Emphasize the importance of sipping water and sucking on hard candy to minimize dry mouth issues.

• Advise regular eye exams for glaucoma testing and to report any urinary elimination changes to their provider.

Contraindications and Precautions

• Take caution when administering ipratropium for clients with:

  • Glaucoma

  • Prostatic Hyperplasia

  • Bladder Neck Obstruction

  • Urinary Retention

• Monitor closely for exacerbation of these conditions.

Interactions

• When beta-adrenergic agonists are concurrently used, they enhance the bronchodilation effects of inhaled anticholinergics. Adjust dosages appropriately under provider's guidance.