So anticholinergic medications are bronchodilators
because there's muscarinic receptors
are activated or mediated by acetylcholine.
That's what makes them cholinergic receptors.
Yeah, I know you already knew that but
doesn't it feel good to know something?
Isn't that kind of fun, you're like
yeah, yeah I'm getting it because man,
nothing likeschool to make you fell like you
dont even remember how to dress yourself anymore
So enjoy it, celebrate anticholinergic bronchodilators,you
understand on a very clear level how those work
So, we talked about an inhaler, we've shown you a
picture there of just what a pocket inhaler looks like
sometimes we call that a metered-dose
inhaler or MDI if you're real fancy.
So metered dose inhaler just means this is gonna poof,
give me a measured dose and I'm going to inhale it.
So this is gonna make much more sense to
you because of all the work you've already done.
Muscarinic receptors in the airway
control airway and smooth muscle tone.
Check! you already knew that.
Anticholinergic bronchodilators open the airways because they
block or inhibit or antagonize cholinergic reflex, right?
of bronchoconstriction and they reduce the
vagal tone, that like vagal cholinergic tone.
That's a very fancy way of saying,
when I take an anticholinergic medication,
that smooth muscle is not going to constrict as much.
So this is the main reversible component in COPD.
If we can deal with that cholinergic
activity, that's gonna help that patient
with chronic obstructive pulmonary
disease (COPD) breathe easier.
Now anticholinergics can also reduce
the mucus hypersecretion which is bueno,
because nobody likes that goop in their lungs and having
to cough it up, it's kind of my least favourite part
when you're working with COPD patients
They always have an emesis
space in a little dish on their bedside
with Kleenex in it, and they cough into it which just kind
of grosses me out, but remember, nurses have therapeutic faces
so no matter how grossed out you are on the inside,
you have to appear professional on the outside
Sometimes that's not so easy
with emesis basins full of phlegm.
Now beta-2 bronchodilators.
Now we talked about muscarinic receptors
in the lungs, they're cholinergic type receptors.
Beta-2 receptors are in the lungs but
they're activated by different substances.
They are activated by norepinephrine and epinephrine
so beta-2 bronchodilators are activated in the bodies,
on the body by catecholamines - we
talked about norepinephrine and epinephrine.
So those are substances that
actually make your lungs broncodilate.
So if I take a metered dose inhaler or I
take an inhaled medication that is a beta-2,
it's gonna broncodilate, okay so a beta-2 medication
means,"Hey the job of beta-2 receptors to bronchodilate".
That's the opposite of a muscarinic receptor
which is like clamp down and squish out mucus.
A beta-2 receptor's job when it's activated
is to cause the lungs to bronchodilate.
So you could actually be on
both of those medications if necessary.
So anticholinergic medications
block the cholinergic receptors.
Beta-2 bronchodilators, these are agonists, they activate
the beta 2-receptors on your lungs to cause bronchodilation.
Okay now, inhaled steroids - these aren't rescue
If I'm having a significant asthma attack,
steroids are not your first choice, right?
Dont give me those, I need quick acting, short
acting beta-2 adrenergic agonist or something
rapid and fast that's gonna help me.
Inhaled steroids are important because
they'll help with that inflammation.
The inhaled steroids really need to be taken kind of in
a more regular basis, some patients take them every day.
Now cool part about inhaled because we know
steroids have a massive amount of side effects.
You're like moon face, facial hair, mood swings, buffalo hump,
it might cause extra volume on board and on and on and on.
it's hard on your skin, it's hard on your bones,
yeah it have a lot of like wicked side effects.
However that's most often seen with if
you take a steroid as a pill or steroid as IV.
if I inhale it, there's couple benefits there.
If I inhale the steroids, it goes immediately to the
site where want to reduce inflammation, that's fantastic.
Also, because it's not going systemic,
why? It's going directly to the lungs.
I have far less moon face, facial hair, mood swings,
buffalo hump, all that nastiness that comes with steroids.
So as much as possible, we like to handle
the respiratory problems with inhaled steroid.
As a patient progresses, if the inhaled steroids
don't work anymore, we might have to go to pill or IV.
Now you're gonna use the pill at home, IV
will be more in the hospital setting or at an ER.
So know that, if a respiratory patient, if inhaled
steroids are no longer strong enough to take care of it
and you have to advance the patient
to oral or IV, that is not a good sign.
Okay, we always want the patient to
be on inhaled steroids when possible.
If we have to progress the pill or IV, the patient is
not doing better, their disease is becoming more intense.
Hopefully it's just periodic, you can bump them up to
those methods, pill or IV for a short period of time.
and then go back to inhaled steroids.