Question

Mr. B is an 82 year old patient who comes to the dental hygiene clinic for removal of tobacco stain resulting from 50 years of smoking two packs a day. He quit smoking several years ago but is still short of breath when he has to climb stairs or walk any distance. His physician had been treating him for asthma with a short-acting albuterol metered-dose inhaler; however, Mr.B did not get any relief from his symptoms and was becoming increasingly tired and short winded. Upon recommendation from his daughter, a health professional, he went to see a pulmonologist, who diagnosed him as having COPD. His medication was changed to a long-acting B2-agonist salmeterol and a long-acting inhaled anticholinergic agent tiotropium bromide. He had almost immediate relief of his shortness of breath and reports that his energy level increased dramatically, which is important to him because he still works as the owner of a painting business. His other medications include clopidogrel, simvastatin, and hydrochlorothiazide. His BP is 140/90, heart rate is 94, and respiratory rate is 16 breaths per minute. His oral hygiene is fair, and he wears an upper denture. Upon removal of his denture, the hygienist notes that he appears to have a fungal infection on his plate. He also complains that he has had a bad taste in his mouth since starting these medications.

Which is the mechanism of action for the inhaled anticholinergic drugs such as ipratropium bromide and tiotropium bromide?
A. Antiinflammatory
B. Histamine antagonist
C. Acetylcholine antagonist
D. Mast cell degranulation inhibitor

Answer 1

Inhaled anticholinergic drugs like ipratropium bromide and tiotropium bromide work by antagonizing acetylcholine, which helps to ease breathing by reducing bronchoconstriction.

Step-by-step explanation:

The mechanism of action for inhaled anticholinergic drugs such as ipratropium bromide and tiotropium bromide is that they act as acetylcholine antagonists. These medications block the muscarinic acetylcholine receptors which inhibits the action of acetylcholine a neurotransmitter that can increase bronchoconstriction and mucus secretion. By blocking this action anticholinergic agents help to relax and open up the air passages in the lungs, thereby improving breathing in patients with COPD.

Mr. B's relief from symptoms upon starting treatment with a long-acting B2-agonist salmeterol and tiotropium bromide is consistent with this mechanism of action leading to improved airflow and reduction in shortness of breath.