Ipratropium (Atrovent) question

[Linuss]

So, going through my Brady drug guide, studying for a quiz on Wednesday and looking at Atrovent. Contraindications are pretty simple, but had a question.

One of the only 2 contraindications is
"It should not be used as the primary treatment for acute episodes of bronchospasm"



Why? Yes, I know albuterol tends to be the go-to, and Duoneb when needed. Vent, or anyone, wanna regale me on the specifics? Did I miss something obvious?

[Sasha]

Atrovent is to be used with albuterol. It wont treat bronchospasm by itself, to my knowledge.

[rmellish]

Originally Posted by Sasha

Atrovent is to be used with albuterol. It wont treat bronchospasm by itself, to my knowledge.

I figure ipratropium would act as a muscarinic antagonist, but I'm not sure how quickly this effect occurs, or the degree of effect it would have.

[daedalus]

Probably because Albuterol is a adrenergic agonist that directly causes bronchodilation while Atrovent is an anticholinergic that will only prevent further parasympathetic activity.

[MSDeltaFlt]

Originally Posted by Linuss

So, going through my Brady drug guide, studying for a quiz on Wednesday and looking at Atrovent. Contraindications are pretty simple, but had a question.

One of the only 2 contraindications is
"It should not be used as the primary treatment for acute episodes of bronchospasm"



Why? Yes, I know albuterol tends to be the go-to, and Duoneb when needed. Vent, or anyone, wanna regale me on the specifics? Did I miss something obvious?

Albuterol kicks in faster than Atrovent. Atrovent lasts longer, but doesn't kick in as fast. You may use Duoneb when needed because it still has albuterol in it. Make sense?

[lafmedic1]

On a side note is ipatropium still peanut oil based ? I know we had peanut allergy listed as a contrindication .

[VentMedic]

Originally Posted by lafmedic1

On a side note is ipatropium still peanut oil based ? I know we had peanut allergy listed as a contrindication .

This has never been an issue for the liquid and that includes Duoneb or any of the Albuterol/Atrovent liquid combos by various manufacturers. There will also be a Xopenex/Atrovent combo in the future.

The Atrovent MDI when it was using a CFC proellant used a Lecithin base.

The HFA Atrovent MDI does not so the soy allergy is not an issue.

However, Combivent MDI has not be able to reformulate to HFA and are still CFC. The FDA has granted them a few more months to achieve this or risk being taken off the market completely.

Atrovent should not be used with patients who have narrow angle glaucoma. Some of the disorders and disease processes get overlooked in an H&P because they are considered to be unimportant. However, the meds used to treat something else can have serious effects or exacerbate something else.

Atrovent is primarily used for COPD such at that with emphysema. Since it has a different mechanism of action, asthmatics do not always need it unless they have a similar obstructive component as found in other forms of COPD. Thus, you may not find many asthmatics on Spiriva unless they are using GP as a physician who is just tossing samples of meds at them at random without any plan of care in mind. Also, if the patient is using Spiriva correctly, the Atrovent will have little effect.

Atrovent will be used by itself to treat some with COPD and if they are not bronchospastic. It may give them relief but not always immediately. They will usually take it as a scheduled med or PRN at the first signs of decompensation. However, they will usually also have a Albuterol inhaler nearby. For some, they become sensitive to the Albuterol as they develop more cardiac problems from advanced COPD.

Still, for rescue, the use of Albuterol or Xopenex is still recommended regardless of what other med is added or to follow.

[PapaBear434]

Originally Posted by daedalus

Probably because Albuterol is a adrenergic agonist that directly causes bronchodilation while Atrovent is an anticholinergic that will only prevent further parasympathetic activity.

Pretty much what I came in to say, as I just had that quiz myself.

[VentMedic]

Here is the clinical pharmacology of Albuterol and Atrovent taken form their websites. They are two different meds with different actions.

Again, Atrovent is primarily indicated for those with COPD such as emphysema and chronic bronchitis.

Atrovent is an anticholinergic (parasympatholytic) agent. It appears to inhibit vagally-mediated reflexes by antagonizing the action of acetylcholine, the transmitter agent released at the neuromuscular junctions in the lung. Anticholinergics prevent the increases in intracellular concentration of cyclic guanosine monophosphate (cyclic GMP) which are caused by interaction of acetylcholine with the muscarinic receptors on bronchial smooth muscle

Albuterol has a preferential effect on beta2-adrenergic receptors. Beta2-adrenergic receptors are the predominant receptors in bronchial smooth muscle, Activation of beta2-adrenergic receptors on airway smooth muscle leads to the activation of adenylcyclase and to an increase in the intracellular concentration of cyclic-3′,5′-adenosine monophosphate (cyclic AMP). This increase of cyclic AMP leads to the activation of protein kinase A, which inhibits the phosphorylation of myosin and lowers intracellular ionic calcium concentrations, resulting in relaxation. Albuterol relaxes the smooth muscles of all airways, from the trachea to the terminal bronchioles. Albuterol acts as a functional antagonist to relax the airway irrespective of the spasmogen involved, thus protecting against all bronchoconstrictor challenges. Increased cyclic AMP concentrations are also associated with the inhibition of release of mediators from mast cells in the airway.


We also have another drug, Intal, (Cromolyn sodium) which acts by inhibiting the release of mediators from mast cells.

Also, get familar with the new MDIs. Since they have reformulated to the HFA propellant, the names have changed and you may not see regular "Albuterol" inhaler. You will be seeing ProAir, Ventolin and Proventil.

There are also new names for the solutions with AccuNeb being one for Albuterol sulfate and it comes in different dosages.

Vospire ER is the albuterol sulfate tablets.

There names are for the U.S. as Canada and Mexico as well as the European countries have their own trade names and newer meds that are not available in the U.S. at this time as well as other approved routes in their country such as IV.




.

[ResTech]

The main reason for Atrovent is for the synergistic effect when administered together with Albuterol. Both albuterol and atrovent work by different mechanisms or pathways so when administered together you get a greater efficacy then if each med was administered alone.

Atrovent is a parasympatholytic which as you know works by blocking acetylcholine at the muscarinic receptors in the lungs to reduce bronchoconstriction. Atrovent has a greater onset of action time and its maximum effect is less than albuterol which is why I understand it not to be recommend for administration solely by itself. And factoring the synergistic effect with albuterol, it makes sense to administer atrovent together.

Its 1:30am and is all I can recall from class at the moment. zzzzzz zzzzz