Atrovent


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Related to Atrovent: Atrovent HFA

ipratropium

(i-pra-troe-pee-um) ,

Atrovent

(trade name),

Atrovent HFA

(trade name)

Classification

Therapeutic: allergy cold cough remedies
Pharmacologic: anticholinergics
Pregnancy Category: B

Indications

Inhalation: Maintenance therapy of reversible airway obstruction due to COPD, including chronic bronchitis and emphysema. Intranasal: Rhinorrhea associated with allergic and nonallergic perennial rhinitis (0.03% solution) or the common cold (0.06% solution). Inhalation: Adjunctive management of bronchospasm caused by asthma.

Action

Inhalation: Inhibits cholinergic receptors in bronchial smooth muscle, resulting in decreased concentrations of cyclic guanosine monophosphate (cGMP). Decreased levels of cGMP produce local bronchodilation.
Intranasal: Local application inhibits secretions from glands lining the nasal mucosa.

Therapeutic effects

Inhalation: Bronchodilation without systemic anticholinergic effects.
Intranasal: Decreased rhinorrhea.

Pharmacokinetics

Absorption: Minimal systemic absorption (2% for inhalation solution; 20% for inhalation aerosol; <20% following nasal use).
Distribution: 15% of dose reaches lower airways after inhalation.
Metabolism and Excretion: Small amounts absorbed are metabolized by the liver.
Half-life: 2 hr.

Time/action profile (bronchodilation)

ROUTEONSETPEAKDURATION
Inhalation1–3 min1–2 hr4–6 hr
Intranasal15 minunknown 6–12 hr

Contraindications/Precautions

Contraindicated in: Hypersensitivity to ipratropium, atropine, belladonna alkaloids, or bromide;Avoid use during acute bronchospasm;Note: Atrovent HFA has replaced the discontinued Atrovent CFC (chlorofluorocarbon). Soy and CFC-allergic patients can now safely use the Atrovent HFA formulation. However, Combivent (ipratropium/albuterol combination) MDI does contain soya lecithin and is contraindicated in patients with a history of hypersensitivity to soy and peanuts.
Use Cautiously in: Patients with bladder neck obstruction, prostatic hyperplasia, glaucoma, or urinary retention; Geriatric: May be more sensitive to effects.

Adverse Reactions/Side Effects

Central nervous system

  • dizziness
  • headache
  • nervousness

Ear, Eye, Nose, Throat

  • blurred vision
  • sore throat
  • nasal only:
  • epistaxis
  • nasal dryness/irritation

Respiratory

  • bronchospasm
  • cough

Cardiovascular

  • hypotension
  • palpitations

Gastrointestinal

  • GI irritation
  • nausea

Dermatologic

  • rash

Miscellaneous

  • allergic reactions

Interactions

Drug-Drug interaction

↑ anticholinergic effects with other drugs having anticholinergic properties (antihistamines, phenothiazines, disopyramide ).

Route/Dosage

Inhalation (Adults and Children >12 yr) Metered-dose inhaler (nonacute)—2 inhalations 4 times daily (not to exceed 12 inhalations/24 hr or more frequently than q 4 hr). Acute exacerbations—4–8 puffs using a spacer device as needed. Via nebulization (nonacute)—500 mcg 3–4 times daily. Via nebulization (acute exacerbations)—500 mcg q 30 min for 3 doses then q 2–4 hr as needed.
Inhalation (Children 5–12 yr) Metered-dose inhaler (nonacute)—1–2 inhalations q 6 hr as needed (not to exceed 12 inhalations/24 hr). Acute exacerbations—4–8 puffs as needed Via nebulization (nonacute)—250–500 mcg 4 times daily given q 6 hr. Acute exacerbations—250 mcg q 20 min for 3 doses then q 2–4 hr as needed.
Inhalation (Infants) Nebulization—125–250 mcg 3 times a day.
Inhalation (Neonates) Nebulization—25 mcg/kg/dose 3 times a day.
Intranasal (Adults and Children > 6 yr) 0.03% solution—2 sprays in each nostril 2–3 times daily (21 mcg/spray).
Inhalation (Adults and Children > 5 yr) 0.06% solution—2 sprays in each nostril 3–4 times daily (42 mcg/spray).

Availability (generic available)

Aerosol inhaler (HFA) (chlorofluorocarbon-free): 17 mcg/spray in 12.9-g canister (200 inhalations)
Inhalation solution: 0.0125%, 0.02% in single-dose vials containing 500 mcg, 0.025%
Nasal spray: 0.03% solution—21 mcg/spray in 30-mL bottle (345 sprays/bottle), 0.06% solution—42 mcg/spray in 15-mL bottle (165 sprays)
In combination with: albuterol (Combivent, Duoneb). See combination drugs.

Nursing implications

Nursing assessment

  • Assess for allergy to atropine and belladonna alkaloids; patients with these allergies may also be sensitive to ipratropium. Atrovent HFA MDI does not contain CFC or soy and may be used safely in soy or CFC-allergic patients. However, Combivent MDI should be avoided in soy or peanut-allergic patients.
  • Inhalation: Assess respiratory status (rate, breath sounds, degree of dyspnea, pulse) before administration and at peak of medication. Consult health care professional about alternative medication if severe bronchospasm is present; onset of action is too slow for patients in acute distress. If paradoxical bronchospasm (wheezing) occurs, withhold medication and notify health care professional immediately.
  • Nasal Spray: Assess patient for rhinorrhea.

Potential Nursing Diagnoses

Ineffective airway clearance (Indications)
Activity intolerance (Indications)

Implementation

  • Inhalation: See for administration of inhalation medications.
    • When ipratropium is administered concurrently with other inhalation medications, administer adrenergic bronchodilators first, followed by ipratropium, then corticosteroids. Wait 5 min between medications.
    • Solution for nebulization can be diluted with preservative-free 0.9% NaCl. Diluted solution should be used within 24 hr at room temperature or 48 hr if refrigerated. Solution can be mixed with preservative-free albuterol, cromolyn, or metaproterenol if used within 1 hr of mixing.

Patient/Family Teaching

  • Instruct patient in proper use of inhaler, nebulizer, or nasal spray and to take medication as directed. Take missed doses as soon as remembered unless almost time for the next dose; space remaining doses evenly during day. Do not double doses.
    • Advise patient that rinsing mouth after using inhaler, good oral hygiene, and sugarless gum or candy may minimize dry mouth. Health care professional should be notified if stomatitis occurs or if dry mouth persists for more than 2 wk.
  • Inhalation: Caution patient not to exceed 12 doses within 24 hr. Patient should notify health care professional if symptoms do not improve within 30 min after administration of medication or if condition worsens.
    • Explain need for pulmonary function tests prior to and periodically during therapy to determine effectiveness of medication.
    • Caution patient to avoid spraying medication in eyes; may cause blurring of vision or irritation.
    • Advise patient to inform health care professional if cough, nervousness, headache, dizziness, nausea, or GI distress occurs.
  • Nasal Spray: Instruct patient in proper use of nasal spray. Clear nasal passages gently before administration. Do not inhale during administration, so medication remains in nasal passages. Prime pump initially with 7 actuations. If used regularly, no further priming is needed. If not used in 24 hr, prime with 2 actuations. If not used for >7 days, prime with 7 actuations.
    • Advise patient to contact health care professional if symptoms do not improve within 1–2 wk or if condition worsens.

Evaluation/Desired Outcomes

  • Decreased dyspnea.
    • Improved breath sounds.
  • Decrease in rhinorrhea from perennial rhinitis or the common cold.

Atrovent

(ăt′rə-vĕnt′)
A trademark for the drug ipratropium bromide.

Atrovent®

Ipratropium Br, see there.

Atrovent

A brand name for IPRATROPIUM BROMIDE in inhaler form or as a liquid for nebulization.
References in periodicals archive ?
Comment: In response to concerns about chlorofluorocarbons (CFCs) depleting the ozone layer, the new formulation of Atrovent contains the propellant hydrofluoroalkane (HFA).
Specifically, the States allege BIPI: (1) misrepresented that its antiplatelet drug, Aggrenox, was effective for many conditions, such as heart attacks and congestive heart failure, and that it was superior to Plavix without having evidence to substantiate that claim; (2) misrepresented that Micardis protected patients from early morning strokes and heart attacks and treated metabolic syndrome; (3) misrepresented that Combivent could be used as a first-line treatment for bronchospasms associated with chronic obstructive pulmonary disease (COPD); and (4) falsely stated that Atrovent and Combivent could be used at doses that exceeded the maximum dosage recommendation in the product labeling, and that they were essential for treatment of COPD.
Specifically, the States allege BIPI: (1) misrepresented that its antiplatelet drug, Aggrenox, was effective for many conditions below the neck, such as heart attacks and congestive heart failure, and that it was superior to Plavix without evidence to substantiate that claim; (2) misrepresented that Micardis protected patients from early morning strokes and heart attacks and treated metabolic syndrome; (3) misrepresented that Combivent could be used as a first-line treatment for bronchospasms associated with chronic obstructive pulmonary disease (COPD); and (4) falsely stated that Atrovent and Combivent could be used at doses that exceeded the maximum dosage recommendation in the product labeling and that they were essential for treatment of COPD.
Atrovent HFA was recently approved but won't be available until later this year.
Amoxicillin * Amoxil, Biomox, Polymox, Trimox, Wymox Cephalexin * Biocef, Keflex Celecoxib * Celebrex Diclofenac/Misoprostol * Arthrotec Ipratropium * Atrovent Labetalol * Trandate Methyldopa * Aldomet Naproxen * Aleve, Anaprox, Naprosyn Nitrofurantoin * Furadantin, Macrobid, Macrodantin Rofecoxib * Vioxx Tiotropium * Spiriva Tolmetin * Tolectin Triamcinalone * Aristocort, Atolone, Kenacort Sulfamethoxazole/Trimethoprim * Bactrim, Cotrim, Septra, Sulfatrim Sulfisoxazole * Gantrisin
Ulster Cesarewitch after Hogan was found trying to give Atrovent to the gelding through an inhaler.
Staffordshire's 350 CFRs were equipped with 13 life-saving drugs but an internal review concluded they were not qualified to use Atrovent, Diazepam Stesoloid, Entonox, GTN, Midazolam (Buccal), Pulmicort and Salbutamol.
Albuterol * Airet, Proventil, Ventolin, Volmax Ipratropium * Apo-Ipravent, Atrovent, Kendral-Ipratropium Racemic epinephrine * micoNephrine,Vaponefrin Ribavirin * Copegus, Rebetol, Virazole
Table 1: World Market for Inhaled Drug Delivery Systems (2004): Percentage Share Breakdown of Sales by Major Brands- Flovent, Serevent, Pulmicort, Atrovent, Ventolin, and Others (includes corresponding Graph/Chart) II-8 Industry Efforts II-8 Inefficient Use of Pulmonary Drug Delivery Systems II-9 MDIs II-9 Spacers II-9 Dry Powder Inhalers II-10 Issues Facing Various Inhalation Devices II-10 Jet Nebulizers II-10 MDIs II-10 DPIs II-10
Our medications have changed to Albuterol, Xopenex, and Atrovent (all in premixed unit doses).
Atrovent HFA is the latest inhalation aerosol approved by the Food and Drug Administration after reformulation without CFCs; others include fluticasone HFA (Flovent HFA Inhalation Aerosol, GlaxoSmithKline) and two formulations of albuterol sulfate HFA (Proventil HFA, 3M Pharmaceuticals; Ventolin HFA, GlaxoSmithKline).