5.11 Anticholinergics
Ipratropium is an example of a short-acting anticholinergic. Tiotropium is an example of a long-acting anticholinergic. (See Figure 5.14[1] for an image of the inhaler cartridge in which the tiotropium dose is inserted.)
Mechanism of Action: Anticholinergics block the action of acetylcholine in bronchial smooth muscle, which reduces bronchoconstrictive substance release.
Indications: Anticholinergics are used for maintenance therapy of bronchoconstriction associated with asthma, chronic bronchitis, and emphysema.
Nursing Considerations: Nurses must be aware that anticholinergic medications commonly cause dry mouth and may result in constipation or blurred vision.
Side Effects/Adverse 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]
Health Teaching & Health Promotion: Clients should be instructed to use the inhaler as directed and be careful not to exceed dosage recommendations. They should receive information regarding the onset of medication and differences in usage for short- and long-acting anticholinergics. Some long-acting anticholinergics may cause signs of angioedema, and the health care provider should be notified if this occurs.[3]
Now let’s take a closer look at the medication grid for ipratropium and tiotropium in Table 5.11.[4],[5],[6],[7]
Table 5.11 Ipratropium and Tiotropium Medication Grid
Class/Subclass |
Prototype/Generic |
Nursing Considerations |
Therapeutic Effects |
Side/Adverse Effects |
|---|---|---|---|---|
| Anticholinergics (short-acting) | ipratropium | Long-term management of pulmonary disease
Slower onset of action |
Bronchodilation | Cough and drying of the nasal mucosa |
| Anticholinergics (long-acting) | tiotropium | Long-term management of pulmonary disease
Slower onset of action |
Prevents bronchospasm and reduces exacerbations in COPD clients | Cough and drying of the nasal mucosa |
- “Spiriva HandiHaler-brand dry powder inhaler (open).png” by RonEJ at English Wikipedia is licensed under CC0 1.0 ↵
- Frandsen, G., & Pennington, S. (2018). Abrams’ clinical drug: Rationales for nursing practice (11th ed.). Wolters Kluwer. ↵
- uCentral from Unbound Medicine. https://www.unboundmedicine.com/ucentral ↵
- This work is a derivative of Pharmacology Notes: Nursing Implications for Clinical Practice by Gloria Velarde licensed under CC BY-NC-SA 4.0 ↵
- Frandsen, G., & Pennington, S. (2018). Abrams’ clinical drug: Rationales for nursing practice (11th ed.). Wolters Kluwer. ↵
- This work is a derivative of DailyMed by U.S. National Library of Medicine in the Public Domain. ↵
- Adams, M., Holland, N., & Urban, C. (2020). Pharmacology for nurses: A pathophysiologic approach (6th ed.). pp. 622-63. ↵