IPRATROPIUM BROMIDE

IPRATROPIUM BROMIDE
(i-pra-troe'pee-um)
Atrovent, Atrovent HFA
Classifications: anticholinergic; antimuscarinic; bronchodilator;
Therapeutic: bronchodilator

Pregnancy Category: B

Availability

0.02% solution for inhalation; 18 mcg inhaler; 0.03%, 0.06% nasal spray

Action

Results in bronchodilation by inhibiting acetylcholine at its receptor sites, thereby blocking cholinergic bronchomotor tone (bronchoconstriction); also abolishes vagally mediated reflex bronchospasm triggered by such nonspecific agents as cigarette smoke, inert dusts, cold air, and a range of inflammatory mediators (e.g., histamine).

Therapeutic Effect

Produces local, site-specific effects on the larger central airways including bronchodilation and prevention of bronchospasms.

Uses

Maintenance therapy in COPD including chronic bronchitis and emphysema; nasal spray for perennial rhinitis and symptomatic relief of rhinorrhea associated with the common cold.

Unlabeled Uses

Perennial nonallergic rhinitis.

Contraindications

Use as primary treatment for acute episodes; hypersensitivity to atropine, bromides, peanut oils, soy lecithin. Safe use in children ≤3 y (inhalation) or ≤5 y (intranasal) is not established.

Cautious Use

Pregnancy (category B), narrow-angle glaucoma; prostatic hypertrophy, bladder neck obstruction.

Route & Dosage

COPD
Adult: Inhalation 2 inhalations of MDI q.i.d. at no less than 4 h intervals (max: 12 inhalations in 24 h) Nebulizer 500 mcg (1 unit dose vial) q6–8h
Child (3–12 y): Inhalation 1–2 inhalations t.i.d. (max: 6/d) Nebulizer 125–250 mcg t.i.d.

Rhinitis
Adult (≥5 y): Intranasal 2 sprays of 0.03% each nostril b.i.d. or t.i.d.

Common Cold
Adult: Intranasal 2 sprays of 0.06% each nostril t.i.d. or q.i.d. up to 4 d

Administration

Intranasal/Inhalation/Nebulizer
  • Demonstrate aerosol use and check return demonstration.
  • Wait 3 min between inhalations if more than one inhalation per dose is ordered.
  • Avoid contact with eyes.

Adverse Effects (≥1%)

Special Senses: Blurred vision (especially if sprayed into eye), difficulty in accommodation, acute eye pain, worsening of narrow-angle glaucoma. GI: Bitter taste, dry oropharyngeal membranes. With higher doses: nausea, constipation. Respiratory: Cough, hoarseness, exacerbation of symptoms, drying of bronchial secretions, mucosal ulcers, epistaxis, nasal dryness. Skin: Rash, hives. Urogenital: Urinary retention. CNS: Headache.

Pharmacokinetics

Absorption: 10% of inhaled dose reaches lower airway; approximately 0.5% of dose is systemically absorbed. Peak: 1.5–2 h. Duration: 4–6 h. Elimination: 48% of dose excreted in feces; <5% excreted in urine. Half-Life: 1.5–2 h.

Nursing Implications

Assessment & Drug Effects

  • Monitor respiratory status; auscultate lungs before and after inhalation.
  • Report treatment failure (exacerbation of respiratory symptoms) to physician.

Patient & Family Education

  • Note: This medication is not an emergency agent because of its delayed onset and the time required to reach peak bronchodilation.
  • Review patient information sheet on proper use of nasal spray.
  • Allow 30–60 sec between puffs for optimum results. Do not let medication contact your eyes.
  • Wait 5 min between this and other inhaled medications. Check with physician about sequence of administration.
  • Take medication only as directed, noting some leniency in number of puffs within 24 h. Supervise child's administration until certain all of dose is being administered.
  • Rinse mouth after medication puffs to reduce bitter taste.
  • Discuss changes in normal urinary pattern with the physician (more common in older adults).
  • Call physician if you note changes in sputum color or amount, ankle edema, or significant weight gain.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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