Ipratropium is an example of a short-acting anticholinergic. Tiotropium is an example of a long-acting anticholinergic. (See Figure 5.13^[1] for an image of tiotropium.)

Mechanism of Action: Anticholinergics block the action of acetylcholine in bronchial smooth muscle, which reduces bronchoconstrictive substance release.

Indications: Anticholinergics are used for maintenance therapy of bronchoconstriction associated with asthma, chronic bronchitis, and emphysema.

Nursing Considerations: Nurses must be aware that anticholinergic medications commonly cause dry mouth and may result in constipation or blurred vision.

Side Effects/Adverse Effects: Anticholinergics should be used with caution with the elderly and can cause cough, drying of the nasal mucosa, nervousness, nausea, GI upset, headaches, and dizziness.^[2]

Patient Teaching & Education: Patients should be instructed to use the inhaler as directed and be careful not to exceed dosage recommendations. They should receive education regarding the onset of medication and differences in usage for short- and long-acting anticholinergics. Some long-acting anticholinergics may cause signs of angioedema, and the health care provider should be notified if this occurs.^[3]

Now let’s take a closer look at the medication grid for ipratropium and tiotropium in Table 5.11.^{[4],[5],[6],[7]}

Table 5.11 Ipratropium and Tiotropium Medication Grid