5.11 Anticholinergics

Anticholinergics

Ipratropium is an example of a short-acting anticholinergic. Tiotropium is an example of a long-acting anticholinergic. Additional information regarding anticholinergics can be found in the “Autonomic Nervous System” chapter. (See Figure 5.11^[1] for an image of tiotropium.)

Mechanism of Action

Anticholinergics block the action of acetylcholine in bronchial smooth muscle, which reduces Broncho-constrictive substance release.

Indications for Use

Anticholinergics are used for maintenance therapy of bronchoconstriction associated with asthma, chronic bronchitis, and emphysema.

Adverse/Side Effects

Anticholinergics should be used with caution with the elderly and can cause cough, drying of the nasal mucosa, nervousness, nausea, GI upset, headaches, and dizziness.^[2]

Anticholinergic Drugs across the Life Span

Wheezing is an indication for using anticholinergic drugs but although we do see wheezing in infancy, using these drugs remains controversial.  Most wheezing in infancy is in response to viral infections.

Client Teaching & Education

Client should be instructed to use the inhaler as directed and be careful not to exceed dosage recommendations.  They should receive education regarding the onset of medication and differences in usage for short- and long-acting anticholinergics.  Clients with certain diseases should not use anticholinergics including Myasthenia gravis, hyperthyroidism, glaucoma, enlarged prostate, hypertension, urinary tract blockage, tachycardia and heart failure. Some long-acting anticholinergics may cause signs of angioedema and the healthcare provider should be notified if this occurs.^[3]

Now let’s take a closer look at the medication card for ipratropium and tiotropium in Table 5.11.^{[4],[5], [6],[7]}

Table 5.11 Ipratropium and Tiotropium Medication Card