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Updated: Dec 29 2021

Inhaled Muscarinic-Antagonists

  • 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 7 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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