Ipratropium (Atrovent) question

[18G]

But why withhold a medication that will help improve someones respiratory status especially when they are a priority patient and in a lot of distress?

As I have said, glaucoma is a relative contraindication. Atrovent is not going to make a patient go blind when used acutely.

 

[VentMedic]

But why withhold a medication that will help improve someones respiratory status especially when they are a priority patient and in a lot of distress?

Atrovent is not going to miraculously cure your patient.

Read its website or the package insert and understand its mechanisms.

If the patient is a known COPD patient, they will know if they can take Atrovent.

For someone who had never been diagnosed with lung disease and are having wheezing, the etiology may not even call for atrovent but you have it as a blanket order in your protocols because of limited respiratory knowledge.

If your patients are in that much distress the albuterol probably will be of little benefit either.

 

[VentMedic]

As I have said, glaucoma is a relative contraindication. Atrovent is not going to make a patient go blind when used acutely.

Says who?

I have seen this first hand.

 

[18G]

Atrovent is not going to miraculously cure your patient.
Never said that it would. Although does help in many cases and allows attacking the resp distress through two different pathways versus just one.

Read its website or the package insert and understand its mechanisms.
I already understand its mechanisms

If the patient is a known COPD patient, they will know if they can take Atrovent.

For someone who had never been diagnosed with lung disease and are having wheezing, the etiology may not even call for atrovent but you have it as a blanket order in your protocols because of limited respiratory knowledge.
I don't think its professional or safe to just assume someone has a "limited respiratory knowledge".

If your patients are in that much distress the albuterol probably will be of little benefit either.
Please don't take out of context what I was saying. I did not elude to a patient being so severely bronchoconstricted and hypoxic that they are unconscious.

Bottom line is always use your clinical judgment and be familiar with your medications.

 

[VentMedic]

Bottom line is always use your clinical judgment and be familiar with your medications.

Which is why I questioned you about why give atrovent if it may not even be indicated for your patient.

 

[Dutch-EMT]

Atrovent / ipratropiumbromide (parasympathicolyticum) takes 5 minutes to work at maximum effect.
The effect holds on forabout 6-8 hours.

Salbutamol (sympathicomimeticum) takes 1-2 minutes to work at maximum effect. It works shorter, about 5 hours.

We use in my hospital the combinations of both (known as combivent and ipramol or ipratropium/salbutamol).
We use it a lot and the most commonly side-effects are palpations and agitation, dry mouth, dry cough and sometimes headache.

 

[VentMedic]

Atrovent / ipratropiumbromide (parasympathicolyticum) takes 5 minutes to work at maximum effect.
The effect holds on forabout 6-8 hours.

Salbutamol (sympathicomimeticum) takes 1-2 minutes to work at maximum effect. It works shorter, about 5 hours.

We use in my hospital the combinations of both (known as combivent and ipramol or ipratropium/salbutamol).
We use it a lot and the most commonly side-effects are palpations and agitation, dry mouth, dry cough and sometimes headache.

But even in the European guidelines Atrovent is not recommended for any and all respiratory diseases.

Combivent is an MDI which I am surprised you are still using? Wasn't your area a little more strict with the CFC and HFA regulation so an extension was not so easy to get?

 

[coolidge]

Ipratropium
-anticholinergic
-is a bronchodilator
-has a slower onset of action than beta agonists
-competitive inhibitor of muscarinic cholinergic receptors
-anticholinergics are less potent bronchodilators than inhaled beta-2 agonists
-may provide additive effects to beta-2 agonist
-not used to block exercise-induced bronchospasm.
-associated with drying of the mouth and respiratory secretions
-it may increase wheezing

 

[Dutch-EMT]

The latest Dutch Ambulance protocols for Astma Bronchialis/COPD.

 

[redcrossemt]

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

I believe Intal to be a prophylactic/maintenance med. Am I right on that? Is it available as an aerosol for nebulizer? Is there any use in the pre-hospital or emergency department setting? What about ICU/medicine admissions?

 

[VentMedic]

I believe Intal to be a prophylactic/maintenance med. Am I right on that? Is it available as an aerosol for nebulizer? Is there any use in the pre-hospital or emergency department setting? What about ICU/medicine admissions?

No, it does not serve a purpose in prehospital since a diagnosis not have been made.

As RRTs we may start it in the ED under one pathway but not likely in an acute phase. It is a maintenance med.

You may see home patients on a Tilade (nedocromil sodium).

 

[redcrossemt]

No, it does not serve a purpose in prehospital since a diagnosis not have been made.

As RRTs we may start it in the ED under one pathway but not likely in an acute phase. It is a maintenance med.

You may see home patients on a Tilade (nedocromil sodium).

Cool stuff. Thanks. I used Intal for a long time when I was younger. It got me off steroids. It was a "miracle drug" for my allergy-induced asthma.

 

[NJFLGHTMDC]

Asthma Triade

If you recall there is actually three things that happen to your patients that present with Asthma.
It called the "Asthma Triade". 1)Bronchio-constriction, albuterol is the first treatment. Sometimes it is treated with a Magnesium drip, not a first line treatment. 2. Inflamation, treated by Sloumedrol. 3) Increased mucous production, of course thats what Atrovent treates.
Before we were approved to carry atrovent on the MICU here in NJ we would mix Atropine with albuterol, only Certain MD's would allow us to mix it with online medical control.
Hope this helps.

 

[VentMedic]

If you recall there is actually three things that happen to your patients that present with Asthma.
It called the "Asthma Triade". 1)Bronchio-constriction, albuterol is the first treatment. Sometimes it is treated with a Magnesium drip, not a first line treatment. 2. Inflamation, treated by Sloumedrol. 3) Increased mucous production, of course thats what Atrovent treates.
Before we were approved to carry atrovent on the MICU here in NJ we would mix Atropine with albuterol, only Certain MD's would allow us to mix it with online medical control.
Hope this helps.

The drying is a side effect of atrovent and not always desirable which is why we don't always give it to asthmatics. We may instead hydrate and treat the inflammation with a corticosterioid, either IV and/or inhaled, along with a bronchodilator such as albuterol. Asthmatics also don't always benefit from the mechanism of action as do those with other forms of COPD.

Atropine has definitely fallen off the map for over 15 years and if secretions are an issue for some with chronic processes, robinul (antimuscarinic) will be the drug of choice. I can't believe anyone would still use atropine. We only used it back in the 70s and 80s because it was the only anticholinergic available for nebulization. We also did not use it for the drying properties back then except for a few disease processes and asthma was not one of them. I would say your doctors are a little out of date (about 20 years or so) and probably should consult a couple of Pulmonologists to rewrite your protocols.