Question

Problem #3

Ipratropium is a first line medication for treating COPD, but not for asthma. Long acting beta agonists (LABAs) such as salmeterol must be used in combination with a corticosteroid for treating asthma, but not for COPD. Atropine is not indicated for treating either condition, either as monotherapy or in combination with other drugs.

· What is the black box warning associated with salmeterol, and how does it preferentially relate to treating patients with asthma?

· How does the mechanism of action of ipratropium make it more suitable for patients with COPD?

· What is the key difference between ipratropium and atropine that makes ipratropium—but not atropine—suitable to administer to patients with asthma and COPD?

Answer 1

1) Long-acting beta-agonists (salmeterol and formoterol) received "black box" warnings because of reports of the occurrences of severe asthma exacerbations in some patients with asthma, with some associated death.Salmeterol is called a bronchodilator because it widens (dilates) your airways. It works by opening up the air passages in your lungs so that air can flow into your lungs more freely. This helps to ease symptoms such as coughing, wheezing and feeling breathless.
2) Ipratropium is an acetylcholine antagonist via blockade of muscarinic cholinergic receptors. Blocking cholinergic receptors decreases the production of cyclic guanosine monophosphate (cGMP). This decrease in the lung airways will lead to decreased contraction of the smooth muscles.Ipratropium is used to control and prevent symptoms (wheezing and shortness of breath) caused by ongoing lung disease (chronic obstructive pulmonary disease-COPD which includes bronchitis and emphysema). It works by relaxing the muscles around the airways so that they open up and you can breathe more easily.
3) Ipratropium is an acetylcholine antagonist via blockade of muscarinic cholinergic receptors. Blocking cholinergic receptors decreases the production of cyclic guanosine monophosphate (cGMP). This decrease in the lung airways will lead to decreased contraction of the smooth muscles.Ipratropium is used to control and prevent symptoms (wheezing and shortness of breath) caused by ongoing lung disease (chronic obstructive pulmonary disease-COPD which includes bronchitis and emphysema). It works by relaxing the muscles around the airways so that they open up and you can breathe more easily.Whereas, the atropine inhibits the muscarinic actions of acetylcholine on structures innervated by postganglionic cholinergic nerves, and on smooth muscles, which respond to endogenous acetylcholine but are not so innervated.