Anticholinergic Respiratory Medications

Pharmacologic Class: Anticholinergic bronchodilators (muscarinic receptor antagonists) Learning Objectives: - Distinguish SAMA from LAMA by onset, duration, and indication - Identify unique adverse effects of anticholinergic inhalers - Apply nursing considerations for COPD patients on anticholinergic therapy - Educate patients on correct administration technique Drug Family Overview: | Feature | SAMA | LAMA | |---|---|---| | Agents | Ipratropium | Tiotropium, umeclidinium, aclidinium, glycopyrrolate | | Onset | 15–30 min | 30–60 min | | Duration | 4–6 hours | 24 hours | | Primary use | COPD rescue/additive; acute asthma exacerbation (add-on) | COPD daily maintenance | | Dosing | 3–4×/day or PRN | Once daily (most agents) | | Brand | Atrovent | Spiriva, Incruse Ellipta, Tudorza | Key Distinction — LABA vs LAMA in COPD: Both are bronchodilators for COPD maintenance. LAMAs (tiotropium) may be preferred as initial monotherapy. Combination LAMA+LABA (e.g., Anoro Ellipta = umeclidinium/vilanterol) provides additive bronchodilation. On the exam, writers often pair stable-sounding options with unstable data—notice the mismatch before you commit. If the stem names a license or role, reread that line; **scope...