Updated: 6/11/2019

Inhaled Muscarinic-Antagonists

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Topic
Snapshot
  • A 12-year-old boy is brought to the emergency department for difficulty breathing and wheezing. Per the mother, the patient has a history of asthma and has been stable with his rescue inhaler. However, he began coughing 3 days ago and his breathing has gotten progressively worse. A physical examination demonstrates subcostal retractions and diffuse wheezing throughout the lung fields. 
Overview
  • One of seven medications used for asthma aimed to reduce inflammation and obstruction 
    • corticosteroids 
    • β-agonists 
    • muscarinic antagonists 
    • methylxanthines 
    • cromolyn 
    • antileukotrienes 
    • omalizumab 
Inhaled Muscarinic Antagonists
  • Mechanism of action
    • competitive blockade of muscarinic receptors which allows for bronchodilation
      • examples
        • tiotropium and ipratropium
    • tiotropium is long-acting
  • Clinical use
    • asthma exacerbation
      • often used in combination with short-acting β-adrenergic agonist  
    • chronic obstructive pulmonary disease (COPD) 
  • Adverse effects
    • paradoxical bronchospasm
    • angle-closure glaucoma
    • bronchitis

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Average 3.0 of 4 Ratings

Questions (1)

(M2.PL.14.40) A 60-year-old man presents to the emergency department complaining of worsening exertional dyspnea over the last week. He denies chest pain and lightheadedness but reports persistent cough with white sputum. His past medical history includes hypertension and diabetes mellitus. He has a 50 pack-year history of smoking but denies any illicit drug use or alcohol consumption. His temperature is 101°F (38.3°C), blood pressure is 154/104 mmHg, pulse is 110/min, respirations are 26/min, and oxygen saturation is 88% on a non-rebreather mask. Physical exam is notable for an obese man in distress. The anteroposterior diameter of the patient's chest is increased, and he has decreased breath sounds bilaterally with diffuse expiratory wheezing. Which of the following is the best next step in management?

QID: 105857
1

Alpha-1 blocker

65%

(75/115)

2

Alpha-2 blocker

10%

(11/115)

3

Beta-2 blocker

5%

(6/115)

4

Glucocorticoid-analog

7%

(8/115)

5

Muscarinic blocker

12%

(14/115)

M 7 E

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