Atrovent

ipratropium

Atrovent

Atrovent HFA

Indications

Action

Pharmacokinetics

Time/action profile (bronchodilation)

Contraindications/Precautions

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

Route/Dosage

Availability (generic available)

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

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.