{"id":230,"date":"2019-11-14T20:34:56","date_gmt":"2019-11-14T20:34:56","guid":{"rendered":"https:\/\/pressbooks.publishdot.com\/nursingpharmacology\/chapter\/5-11-anticholinergics\/"},"modified":"2021-12-07T11:11:24","modified_gmt":"2021-12-07T11:11:24","slug":"5-11-anticholinergics","status":"publish","type":"chapter","link":"https:\/\/pressbooks.publishdot.com\/nursingpharmacology\/chapter\/5-11-anticholinergics\/","title":{"raw":"5.11 Anticholinergics","rendered":"5.11 Anticholinergics"},"content":{"raw":"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 5.13[footnote]\"Spiriva HandiHaler\"-brand dry powder inhaler (open).png\" by RonEJ<\/a> at English Wikipedia<\/a> is licensed under CC0 1.0<\/a>[\/footnote]<\/sup> for an image of tiotropium.)\n\n[caption id=\"attachment_229\" align=\"aligncenter\" width=\"555\"]\"Photo Figure 5.13 Tiotropium, a long-acting anticholinergic[\/caption]\n\nMechanism of Action<\/strong>\n\nAnticholinergics block the action of acetylcholine in bronchial smooth muscle, which reduces bronchoconstrictive substance release.\n\nIndications for Use<\/strong>\n\nAnticholinergics are used for maintenance therapy of bronchoconstriction associated with asthma, chronic bronchitis, and emphysema.\n\nAdverse\/Side Effects<\/strong>\n\nAnticholinergics should be used with caution with the elderly and can cause cough, drying of the nasal mucosa, nervousness, nausea, GI upset, headaches, and dizziness.[footnote]Frandsen, G. & Pennington, S. (2018). Abrams\u2019 clinical drug: Rationales for nursing practice <\/em>(11th ed.). Wolters Kluwer.[\/footnote]<\/sup>\n\nPatient Teaching & Education<\/strong>\n\nPatients should be instructed to use the inhaler as directed and be careful not to exceed dosage recommendations.\u00a0 They should receive education regarding the onset of medication and differences in usage for short- and long-acting anticholinergics.\u00a0 Some long-acting anticholinergics may cause signs of angioedema and the healthcare provider should be notified if this occurs.[footnote]uCentral from Unbound Medicine. https:\/\/www.unboundmedicine.com\/ucentral<\/a>[\/footnote]<\/sup>\n\nNow let's take a closer look at the medication grid for ipratropium and tiotropium in Table 5.11.[footnote]This work is a derivative of\u00a0Pharmacology Notes: Nursing Implications for Clinical Practice<\/a>\u00a0by\u00a0Gloria Velarde<\/a>\u00a0licensed under\u00a0CC BY-NC-SA 4.0<\/a>.[\/footnote],[footnote]Frandsen, G. & Pennington, S. (2018).\u00a0Abrams\u2019 clinical drug: Rationales for nursing practice\u00a0<\/em>(11th ed.). Wolters Kluwer.[\/footnote], [footnote]This work is a derivative of\u00a0Daily Med<\/a>\u00a0by\u00a0U.S. National Library of Medicine<\/a>\u00a0in the public domain<\/a>. [\/footnote],[footnote]Adams, M., Holland, N., & Urban, C. (2020).\u00a0Pharmacology for nurses: A pathophysiologic approach\u00a0<\/em>(6th ed.). pp. 622-63 & 626. Pearson. [\/footnote]<\/span><\/sup>\n\nTable 5.11 Ipratropium and Tiotropium Medication Grid\n\n\n\n\n\n
\n
Class\/Subclass<\/strong><\/h5>\n<\/th>\n
\n
Prototype\/Generic<\/strong><\/h5>\n<\/th>\n
\n
Administration Considerations<\/strong><\/h5>\n<\/th>\n
\n
Therapeutic Effects<\/strong><\/h5>\n<\/th>\n
\n
Adverse\/Side Effects<\/strong><\/h5>\n<\/th>\n<\/tr>\n
Anticholinergics (short\u00a0 acting)<\/th>\nipratropium<\/a><\/td>\nLong-term management of pulmonary disease\n\nSlower onset of action<\/td>\nRapid bronchodilation<\/td>\nCough and drying of the nasal mucosa<\/td>\n<\/tr>\n
Anticholinergics (long acting)<\/th>\ntiotropium<\/a><\/td>\nLong-term management of pulmonary disease\n\nSlower onset of action<\/td>\nPrevention of bronchospasm and reduces exacerbations in COPD patients<\/td>\nCough and drying of the nasal mucosa<\/td>\n<\/tr>\n<\/tbody>\n<\/table>","rendered":"

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 5.13[1]<\/sup><\/a><\/sup> for an image of tiotropium.)<\/p>\n

\"Photo
Figure 5.13 Tiotropium, a long-acting anticholinergic<\/figcaption><\/figure>\n

Mechanism of Action<\/strong><\/p>\n

Anticholinergics block the action of acetylcholine in bronchial smooth muscle, which reduces bronchoconstrictive substance release.<\/p>\n

Indications for Use<\/strong><\/p>\n

Anticholinergics are used for maintenance therapy of bronchoconstriction associated with asthma, chronic bronchitis, and emphysema.<\/p>\n

Adverse\/Side Effects<\/strong><\/p>\n

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]<\/sup><\/a><\/sup><\/p>\n

Patient Teaching & Education<\/strong><\/p>\n

Patients should be instructed to use the inhaler as directed and be careful not to exceed dosage recommendations.\u00a0 They should receive education regarding the onset of medication and differences in usage for short- and long-acting anticholinergics.\u00a0 Some long-acting anticholinergics may cause signs of angioedema and the healthcare provider should be notified if this occurs.[3]<\/sup><\/a><\/sup><\/p>\n

Now let’s take a closer look at the medication grid for ipratropium and tiotropium in Table 5.11.[4]<\/sup><\/a>,[5]<\/sup><\/a>, [6]<\/sup><\/a>,[7]<\/sup><\/a><\/span><\/sup><\/p>\n

Table 5.11 Ipratropium and Tiotropium Medication Grid<\/p>\n\n\n\n\n\n
\n
Class\/Subclass<\/strong><\/h5>\n<\/th>\n
\n
Prototype\/Generic<\/strong><\/h5>\n<\/th>\n
\n
Administration Considerations<\/strong><\/h5>\n<\/th>\n
\n
Therapeutic Effects<\/strong><\/h5>\n<\/th>\n
\n
Adverse\/Side Effects<\/strong><\/h5>\n<\/th>\n<\/tr>\n
Anticholinergics (short\u00a0 acting)<\/th>\nipratropium<\/a><\/td>\nLong-term management of pulmonary disease<\/p>\n

Slower onset of action<\/td>\n

Rapid bronchodilation<\/td>\nCough and drying of the nasal mucosa<\/td>\n<\/tr>\n
Anticholinergics (long acting)<\/th>\ntiotropium<\/a><\/td>\nLong-term management of pulmonary disease<\/p>\n

Slower onset of action<\/td>\n

Prevention of bronchospasm and reduces exacerbations in COPD patients<\/td>\nCough and drying of the nasal mucosa<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
  1. \"Spiriva HandiHaler\"-brand dry powder inhaler (open).png\" by RonEJ<\/a> at English Wikipedia<\/a> is licensed under CC0 1.0<\/a> ↵<\/a><\/li>
  2. Frandsen, G. & Pennington, S. (2018). Abrams\u2019 clinical drug: Rationales for nursing practice <\/em>(11th ed.). Wolters Kluwer. ↵<\/a><\/li>
  3. uCentral from Unbound Medicine. https:\/\/www.unboundmedicine.com\/ucentral<\/a> ↵<\/a><\/li>
  4. This work is a derivative of\u00a0Pharmacology Notes: Nursing Implications for Clinical Practice<\/a>\u00a0by\u00a0Gloria Velarde<\/a>\u00a0licensed under\u00a0CC BY-NC-SA 4.0<\/a>. ↵<\/a><\/li>
  5. Frandsen, G. & Pennington, S. (2018).\u00a0Abrams\u2019 clinical drug: Rationales for nursing practice\u00a0<\/em>(11th ed.). Wolters Kluwer. ↵<\/a><\/li>
  6. This work is a derivative of\u00a0Daily Med<\/a>\u00a0by\u00a0U.S. National Library of Medicine<\/a>\u00a0in the public domain<\/a>. ↵<\/a><\/li>
  7. Adams, M., Holland, N., & Urban, C. (2020).\u00a0Pharmacology for nurses: A pathophysiologic approach\u00a0<\/em>(6th ed.). pp. 622-63 & 626. Pearson. ↵<\/a><\/li><\/ol><\/div>","protected":false},"author":2,"menu_order":11,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":"cc-by"},"chapter-type":[49],"contributor":[],"license":[53],"class_list":["post-230","chapter","type-chapter","status-publish","hentry","chapter-type-numberless","license-cc-by"],"part":195,"_links":{"self":[{"href":"https:\/\/pressbooks.publishdot.com\/nursingpharmacology\/wp-json\/pressbooks\/v2\/chapters\/230","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pressbooks.publishdot.com\/nursingpharmacology\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/pressbooks.publishdot.com\/nursingpharmacology\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/pressbooks.publishdot.com\/nursingpharmacology\/wp-json\/wp\/v2\/users\/2"}],"version-history":[{"count":1,"href":"https:\/\/pressbooks.publishdot.com\/nursingpharmacology\/wp-json\/pressbooks\/v2\/chapters\/230\/revisions"}],"predecessor-version":[{"id":231,"href":"https:\/\/pressbooks.publishdot.com\/nursingpharmacology\/wp-json\/pressbooks\/v2\/chapters\/230\/revisions\/231"}],"part":[{"href":"https:\/\/pressbooks.publishdot.com\/nursingpharmacology\/wp-json\/pressbooks\/v2\/parts\/195"}],"metadata":[{"href":"https:\/\/pressbooks.publishdot.com\/nursingpharmacology\/wp-json\/pressbooks\/v2\/chapters\/230\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.publishdot.com\/nursingpharmacology\/wp-json\/wp\/v2\/media?parent=230"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.publishdot.com\/nursingpharmacology\/wp-json\/pressbooks\/v2\/chapter-type?post=230"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.publishdot.com\/nursingpharmacology\/wp-json\/wp\/v2\/contributor?post=230"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.publishdot.com\/nursingpharmacology\/wp-json\/wp\/v2\/license?post=230"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}