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Ipratropium bromide.

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VOL: 101, ISSUE: 14, PAGE NO: 27

Generic and proprietary names

- Ipratropium bromide, Atrovent, Ipratropium, Ipratropium steri-neb, Respontin, Rinatec.

- Also in combination bronchodilator preparations such as Combivent and Duovent.

Action

- Inhibits the interaction of acetylcholine at the bronchial smooth muscle receptor sites causing bronchodilation.

Classification

- Antimuscarinic.

- Synthetic quaternary ammonium compound.

Indications

- Reversible airways obstruction, particularly in patients who have COPD.

- Allergic and non-allergic rhinitis.

ContraIndications

- Hypersensitivity to previous administration.

Cautions

- Glaucoma.

- Prostatic hyperplasia.

- Pregnancy and breastfeeding.

- Bladder outflow obstruction.

Common side-effects

- Nausea.

- Constipation.

- Dry mouth.

- Headache.

- Nasal spray can cause nasal dryness and epistaxis.

Interactions

- Side-effects can be increased when used with any other antimuscarinic medication and with some antihistamines, antipsychotics, antidepressants and anti-arrhythmics. However, the reaction does not generally apply to inhalations. 

Administration

- Aerosol inhaler.

- Powder inhaler.

- Nebuliser solution.

- Nasal spray.

Nursing considerations

- Check inhaler technique.

- Ensure that patients are able to correctly use the delivery device for their medication and consider use of a space if appropriate.

- If administering by nebulisers use a mouthpiece rather than face mask.

- If administered by nebuliser the dilution of the solution should be adjusted according to equipment and length of administration.

- Paradoxical bronchospasm has occurred with nebulised solution, therefore first dose should be used under medical supervision.

- Caution should be taken not to confuse Atrovent with Alupent.

- Evaluate therapeutic response.

Patient teaching

- Advise patients not to exceed the prescribed dose.

- Rinse mouth after each use of the inhaler.

- Frequent drinks and the use of sugar-free gum can help with dry mouth.

- Seek medical attention if more than the usual dosage is required.

- Keep delivery devices clean and dry.

- Take a missed dose as soon as remembered unless it is almost time for the next dose. Do not take a double dose.

- Avoid getting in eyes.

Nurses should refer to manufacturer’s summary of product characteristics and to appropriate local guidelines

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