Respiratory Pharm: Anticholinergic Bronchodilators Pt 3

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By now, you are familiar and have a better understanding of the properties of cholinergic and anticholinergic medications. Just keep in mind, if you are giving an anticholinergic agent, you are basically increasing blood flow to the sympathetic nervous system – mainly the heart, lungs, and brain. Increased blood flow to these areas will result to proper and better functioning.

A Popular Drug

Ipratropium (Atrovent) is a popular anticholinergic bronchodilator that’s given inside the hospital to respiratory clients. Any drug that ends in “-pium” is an anticholinergic.

You have to remember that when giving anticholinergic medications, clients won’t be able to see clearly, spit, poop, and pee. This is one way to distinguish anticholinergic drugs from other respiratory medications.

Since the primary effect of anticholinergic drugs will be increased blood flow to the lungs, it will decrease wheezing, shortness of breath, and promote muscle relaxation.

Indications

Anticholinergic drugs are primarily indicated for chronic obstructive pulmonary disease (COPD) clients or those who have asthma and chronic bronchitis.

Side Effects

Since anticholinergic medications are turning on the sympathetic nervous system’s fight and flight response, it is thereby shutting down the rest and digest response. The rest and digest is the body’s parasympathetic nervous system (PNS) which primarily composes of the renal and digestive tract.

“Turning off” or “shutting down” of the PNS basically means that blood flow is decreased for the SNS to get sufficient amount of blood. The moment this happens, the body will experience the following side effects:

  • Inability to digest
  • Severe constipation
  • Upset stomach
  • Dry mucous membranes
  • Blurred vision
  • Heart palpitations

Food digestion is mainly affected when the PNS is “turned off,” as well as the ability to pee and poo (constipation) since blood flow is primarily flowing to the SNS. And since the primary concern is not digestive enzymes but the heart, lungs, and brain, there will be adverse effects concerning the digestion along with blurred vision.

Heart palpitations, on the other hand, happen because when the sympathetic nervous system is activated, increased perfusion occurs, causing increased heart rate.

Client Teaching

When giving anticholinergic medications, you have to advise your client to do the following:

  1. Drink a lot of water to help the body urinate since the client is not peeing enough. The client will also become dehydrated because the sympathetic nervous system is using up all that fluid; therefore, increased water intake is a priority.
  2. Good oral hygiene is essential because the gastrointestinal tract is affected leading to dry mouth, dry mucous membranes, and the client can also develop a cough due to this increased dryness.

Remember

Albuterol (Salbutamol) is not a rescue inhaler. Although it is used to treat breathing problems like asthma and COPD, Albuterol is only a rapid-acting inhaler. So, you have to remember this when dealing with questions regarding Albuterol.

On our next lecture, we will tackle methylxanthines like theophylline.

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