Medication 7-472 - Ipratropium (Atrovent)

CMH EMS & MIH Protocols

Scope of Practice:

• Advanced Emergency Medical Technician
• Registered Nurse
• Paramedic
• Community Paramedic

Route(s):

• Neb,

Pharmacodynamics (class and mechanism of action):

• Acetylcholine antagonist via blockade of muscarinic cholinergic receptors. Blocking cholinergic receptors decreases the production of cyclic guanosine monophosphate (cGMP). This decrease in the lung airways will lead to decreased contraction of the smooth muscles. The actions of intranasal ipratropium mimic the action of atropine by inhibiting salivary and mucous glands secretions as well as dilating bronchial smooth muscle.
• Compared to atropine, orally inhaled ipratropium is a more potent antimuscarinic and bronchial dilator of smooth muscle. Intranasal ipratropium produces a local parasympathetic response, leading to decreased water secretions of mucosal glads of the nasal system alleviating symptoms of rhinorrhea.

Pharmacokinetics:

• Half-life: 2 hours.
• Onset time: 5-15 minutes.
• Peak action time: 1-2 hours.
• Duration of action: 3-6 hours.

• Peak	1	2	3	4	5	6	hours
  Duration	1	2	3	4	5	6	hours

Dosing:

• Refer to specific protocol(s) below for dose(s).

Indications:

• Not in current standing order protocols.

Contraindications:

• Hypersensitivity to Ipratropium, Albuterol, or Atropine.
• Allergy to soybeans or peanuts.
• Closed angle glaucoma.
• Bladder neck obstruction.
• Prostatic hypertrophy.

Pregnancy Risk Factor:

• Category B
• No risk in other studies: Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women, or animal studies have shown adverse effects, but adequate and well-controlled studies in pregnant women have failed to demonstrate a risk to the fetus in any trimester.

Potential Incompatibilities:

• NA.

Precautions and Adverse Effects:

• Blood pressure, pulse, and ECG should be monitored.
• Use caution in patients with known heart disease.
• May cause paradoxical acute bronchospasm.
• May cause palpitations, Anxiety, headache, dizziness, sweating, Tachycardia, cough, Nausea, and/or arrhythmias.

Antidote:

• Physostigmine (Antilirium).

Controlled Substance Information:

• Not a scheduled drug
• The DEA and FDA have not identified this drug with a schedule classification.
• DEA number: NA.
• Narcotic: No.
• Street names: NA.

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Polk, Hickory, Cedar, & St Clair County EMS Protocols is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.