What is a commonly prescribed anticholinergic?
Tiotropium
What, in particular, is tiotropium used for?
it is a long-acting bronchodilator (LAMA) that is used in the management of COPD and asthma
it is used in the PREVENTION (not acute treatment) of exacerbations
How does tiotropium work?
- it is a muscarinic receptor antagonist (antimuscarinic agent) that binds to muscarinic receptors on smooth muscle cells and submucosal glands
- it prevents the actions of acetylcholine on smooth muscle cells
- this leads to a reduction in smooth muscle contraction and mucus secretion
- the overall effect is bronchodilation
What are the indications for use for tiotropium?
- it is used to PREVENT EXACERBATIONS in asthma and COPD
- it is used primarily as a maintenance treatment in COPD
- it is used as an add-on therapy in patients with moderate-to-severe asthma on medium to high dose inhaled corticosteroids
- it is NOT used for treatment of acute exacerbations in COPD or asthma
In what form is tiotropium usually administered?
it is commonly used in combination with olodaterol
this is a long-acting beta-agonist
this combination is known as Stiolto or Spioloto and is used to treat COPD
In what patients should caution be taken due to the anticholinergic effects of tiotropium?
- narrow-angle glaucoma
- prostatic hyperplasia
- bladder neck obstruction
What can occur immediately after taking tiotropium in some patients?
How should it be managed?
PARADOXICAL BRONCHOSPASM
this is the unexpected constriction of smooth muscle in the bronchial walls
it can occur immediately after inhalation with an increase in wheezing and shortness of breath
it should be treated immediately with a rapid-acting bronchodilator, such as salbutamol
In what group of patients should tiotropium be used with caution?
patients with cardiovascular issues, such as:
- myocardial infarction within the last 6 months
- unstable or life-threatening cardiac arrhythmia or cardiac arrhythmia requiring intervention or a change in drug therapy within the last year
- hospitalisation for heart failure within the last year
What are the common side effects of tiotropium bromide?
- dry mouth and/or throat irritation
- upper respiratory tract infection
- shortness of breath
What are rare side effects of tiotropium?
- urinary retention
- constipation
- acute angle closure glaucoma
- palpitations (particularly supraventricular tachycardia and atrial fibrillation)
- allergy (rash, angioedema, anaphylaxis)
What are the drug interactions associated with tiotropium?
there are currently no known drug interactions
Why is it important to keep good oral hygiene when taking tiotropium?
it can decrease oral secretions and lead to mouth dryness
in the long term, this can lead to tooth decay
What allergy may mean that some patients cannot take tiotropium in inhalation powder form?
some inhalation powders containing tiotropium cannot be taken in the patient is allergic to lactose, or any other sugars
