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Ferrous Sulfate

Ferrous Sulfate

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Published by: Lelanie Japitana on Apr 18, 2012
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Ferrous sulfate Generic Name: Ferrous sulfate Trade Name: Classification: Iron Preparation Dose, Route, PO freq: BID

MECHANISM OF ACTION Elevates the serum iron concentration which then helps to form High or trapped in the reticuloendothelial cells for storage and eventual conversion to a usable form of iron. INDICATIONS • Prevention and treatment of iron deficiency anemias. • Dietary supplement for iron. CONTRAINDICATIONS • Hypersensitivity • Severe hypotension. ADVERSE EFFECT • Dizziness •N&V • Nasal Congestion • Dyspnea • Hypotension • CHF • MI • Muscle cramps • Flushing NURSING RESPONSIBILITIES • Advise patient to take medicine as prescribed. • Caution patient to make position changes slowly to minimize orhtostatic hypotension. • Instruct patient to avoid concurrent use of alcohol or OTC medicine without consulting the physician. • Advise patient to consult physician if irregular heartbeat, dyspnea, swelling of hands and feet and hypotension occurs. • Inform patient that angina attacks may occur 30 min. after administration due reflex tachycardia. • Encourage patient to comply with additional intervention for hypertension like proper diet, regular exercise, lifestyle changes and stress management.

Ferrous sulfate or FeSO4 is used to fortify foods and treat irondeficiency anemia. Common brand names are Ameciron, Appebon, Brisofer, Drexabion, Femina, Feosol, Ferglobin, Ferlin, Ferosal, Forlavit, Hemiron, Iberet, Sorbifer and Terraferron. Ferrous sulfate is classified as an Enzymatic mineral and Iron preparation. Indications for Ferrous Sulfate

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Vomiting Severe abdominal pain Diarrhea Dehydration Hyperventilation Pallor or cyanosis Cardiovascular collapse

Nursing Considerations for Clients Taking Ferrous Sulfate The prevention or treatment of iron deficiency anemia due to inadequate diet, malabsorption pregnancy, and blood loss. Routes and Dosage of Ferrous Sulfate Deficiency PO: ADULTS, ELDERLY: 2-3 mg/kg/day or 50-100mg elemental iron 2 time/day up to 100mg 4 time/day. CHILDREN: 3 mg/kg/day elemental iron in 1-3 divided doses. Prophylaxis PO: ADULTS, ELDERLY: 60-100 mg elemental iron/day. CHILDREN: 1-2 mg/kg/day elemental iron. Maximum: 15 mg elemental iron/day. Action of Ferrous Sulfate Ferrous Sulfate is an essential component in the formation of hemoglobin, myoglobin and enzymes. It is necessary for effective erythropoiesis and transport or utilization of oxygen. Side Effects and Adverse Reactions of Ferrous Sulfate Side Effects of Ferrous Sulfate

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Store all forms at room temperature. Give between meals with water but may give with meals if gastrointestinal discomfort occurs. Transient staining of mucous membranes and teeth will occur with liquid iron preparation. To avoid, place liquid on the back of the tongue with dropper or use straw. Avoid simultaneous administration of antacids or tetracycline. Do not crush sustained-release preparations. Eggs and milk inhibit absorption. Monitor serum iron, total iron-binding capacity, reticulocyte count, hemoglobin, and ferritin. Monitor daily pattern of bowel activity and stool consistency. Assess for clinical improvement, record of relief of symptoms (fatigue, irritability, pallor, paresthesia, and headache).

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Patient Teachings for Clients Taking Ferrous Sulfate

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Expect stools to darken in color. If gastrointestinal discomfort occurs, take after meals or with food. Do not take within 2 hours of antacids because it rpevents absorption.

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Mild, transient nausea Heartburn Anorexia Constipation Diarrhea Drug Category: Nutrional supplement. Contents: Powder: Per 100gm: Energy (kcal) 420, Protein 27gm, Carbohydrate 64.7gm, Fat 7gm. Amino Acids: Valine 3.27gm, leucine 4.06gm, iso-leucine 3.52gm, threonine 0.58gm, tryptophan 0.16gm, methionine 0.12gm, phenylalanine 0.32gm, alanine 1.31gm, arginine 1.39gm, histi-dine 0.47gm, proline AMINOLEBAN ORAL Otsuka

Adverse Reactions of Ferrous Sulfate

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Large doses may aggravate peptic ulcer, regional enteritis, and ulcerative colitis. Severe Iron Poisoning:

linezolid. salmeterol. Inc. during. PRECAUTIONS: Before using this product. benztropine. Recommended Dosage: For dosage information of prescription medicine.. magnesium 40. glaucoma.g. myopathy. Use usually 3 times daily by drinking or tube feeding. copper 282mcg.g.31 mg. trouble breathing.Laboratory and/or medical tests (e. Side Effect: Diarrhea. Do not start.30. SIDE EFFECTS: Headache. If you notice other effects not listed above. B6 0. It works in the airways by opening breathing passages and relaxing muscles. nervousness..This is not a complete list of possible side effects.g. INDICATIONS DuoNeb (ipratropium bromide and albuterol sulfate) is indicated for the treatment of bronchospasm associated with COPD in patients requiring more than one bronchodilator. use it daily. and promptly report worsening breathing problems (such as readings in the yellow/red range. due to enlarged prostate. Contraindication: Aldosteronism. fast/pounding heartbeat.71gm. soybeans. C 14.Seek immediate medical attention if any of these rare but very serious side effects occur: chest pain. If any of these effects persist or worsen. chronic obstructive pulmonary diseaseCOPD. iodine 19. Company: Otsuka (Philippines) Pharmaceutical. E 19. B2 0. for preventing the re-occurance of unconsciousness & hepatic en-cephalopathy in cirrhosis of liver. increased use of quick-relief inhalers). trihexyphenidyl). pollen. selegiline. "water pills"/diuretics (e.g. hypopotassemia. blood pressure. severe dizziness.g. SIDE EFFECTS Adverse reaction information concerning DuoNeb (ipratropium bromide and albuterol sulfate) was derived from the 12-week controlled clinical trial. It is used to treat or prevent wheezing and shortness of breath caused by ongoing breathing problems (e. Available Forms: Powder sachet 50 g. heart disease (e. irregular heartbeat.1. phosphorus 167. this medication should be used only when clearly needed. pramlintide.1mcg. please consult with your doctor. lysine 0. antispasmodic drugs (e. Combivent GENERIC NAME: IPRATROPIUM/ALBUTEROL (SALBUTAMOL) INHALATION (IP-ra-TROE-pee-um/al-BUE-ter-ol) (sal-BUE-tahmol) BRAND NAME(S): Combivent USES: This product is a combination of 2 medications: albuterol (also known as salbutamol) and ipratropium.In the US -Call your doctor for medical advice about side effects.. tricyclic antidepressants (e.Avoid allergens/irritants such as smoke.173mg.36gm. it may also cause temporary blurred vision. stop. before using this product.08gm. .g.inhalation. or runny nose may occur. possibly fatal drug interaction may occur. atropine. potassium 324mg. pseudoephedrine). If accidentally sprayed into your eyes. Indications: Nutrional supplement for patients with chronic liver impairment e. nausea. DRUG INTERACTIONS: Your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them.8mg.During pregnancy.35mg.. trouble sleeping.9mg.g. muscle cramps. Limit alcoholic beverages. vision changes. ephedrine. seek immediate medical attention. some beta blockers (such as propranolol). pet dander. diet aids) because they may contain ingredients that could increase your heart rate or blood pressure. zinc 10mg. high blood pressure. biotin SOmcg. phenelzine. tell your doctor or pharmacist if you are allergic to albuterol (salbutamol) or ipratropium.g.403 mg. coughing. formoterol).. ipratropium/albuterol (salbutamol) .Before using this product. furosemide.This document does not contain all possible interactions. tell your doctor or pharmacist promptly. tyro-sine 0.Rarely.17:991.84gm. trouble urinating. contact your doctor or pharmacist.g. urinary retention).86gm. nausea. asthma drugs (e. hydrochlorothiazide). isocarboxazid. itching/swelling (especially of the face/tongue/throat).9mg. ADVERSE EVENTS OCCURRING IN ≥ 1% OF ≥ 1 TREATMENT GROUP(S) AND WHERE THE COMBINATION TREATMENT SHOWED THE HIGHEST PERCENTAGE Additional adverse reactions reported in more than 1% of patients treated with DuoNeb (ipratropium bromide and albuterol sulfate) included constipation and voice alterations.. procarbazine. Ask your pharmacist about the safe use of these products.g.43gm. including: rash. or to peanuts. However. Therefore. Consult your doctor before breast-feeding. K Urncg. or if you have any other allergies. chloride 437..This drug may make you dizzy. Minerals: Sodium 94. and share the list with your doctor and pharmacist.Before having surgery. nortriptyline). B1 0. soy lecithin. seek immediate medical attention if you notice any symptoms of a serious allergic reaction.4mg. tell your doctor or pharmacist of all the products you use. tranylcypromine) within 2 weeks before.g. Vitamins: A 279.33 mcg.):450gm: 892. seizure. Consult your doctor for more details. carnitine 50mg.g. In some cases a serious. use machinery. pulmonary function tests.1mg.1mg. Dosage: Mix 50gms powder in 180ml warm water (about 50 degree Centigrade) to make 200ml which supplies 1 Kcal/ml energy. manganese 0.. low potassium blood level (hypokalemia). amitriptyline. or change the dosage of any medicine before checking with your doctor or pharmacist first. glutamic acid 1. overactive thyroid (hyperthyroidism). irregular heartbeat. potassium blood levels) may be performed periodically to monitor your progress or check for side effects.Avoid taking MAO inhibitors (e. dry mouth/throat. NOTES: Do not share this medication with others.Learn to use a peak flow meter.48mg. this medication has caused severe (rarely fatal). pantothenic acid 2.It is not known whether this drug passes into breast milk. dizziness.. D 2. Discuss the risks and benefits with your doctor. cough-and-cold products. coronary insufficiency). Many people using this medication do not have serious side effects. tell your doctor or pharmacist of all prescription and nonprescription/herbal products you may use. tell your doctor or dentist that you are using this medication. Controlling symptoms of breathing problems can decrease time lost from work or school. dicyclomine. or molds that may worsen breathing problems.. rasagiline.Tell your doctor immediately if any of these unlikely but serious side effects occur: eye pain.96gm. Keep a list of all your medications with you. serine 0.A very serious allergic reaction to this drug is rare. tell your doctor your medical history. If you have trouble breathing or experience sudden wheezing.6mcg. or other belladonna-type drugs. especially of: anticholinergic drugs (e. Nutritional support to patients with chronic liver disease especially those with hepatic encephalopathy.Ask your doctor or pharmacist whether you should have an annual flu shot.Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects.. B12 1mcg.63mg. Folic acid 0. urination problems (e. emphysema.No:Pack:Trade Prices:Retall Prices: Powder( . weakness.18mg. furazolidone. calcium 138mg.72mg. dust. or do any activity that requires alertness or clear vision until you are sure you can perform such activities safely. moclobemide. iron 2. PPD Drug Class: Dietary/ Dietary Supplements (registered as Food w/ FDA)/ Nutritional Formulas (registered as Food)/ Adult Formulas (registered as Food) Needs a Prescription: Yes (please see your doctor for proper supervision) Indications: Dietary supplement especially for patients with liver impairment. aspartic acid 0.5mg.. hyoscyamine).Before using this product. choline 10.Check the labels on all your medicines (e. especially of: diabetes. nicotinic acid 2. glycine 3. chronic bronchitis). and after treatment with this medication. sudden worsening of breathing problems/asthma (paradoxical bronchospasm). Do not drive. Regn. adrenaline-like drugs (e.g.

possibly through intracellular shunting. beta agonists have been reported to produce ECG changes. Albuterol sulfate was not mutagenic in the Ames test or a mutation test in yeast. including skin rash. bronchospasm. DuoNeb (ipratropium bromide and albuterol sulfate) . β-agonists may cause a decrease in serum potassium in some patients. elevated heart rate. back pain. albuterol sulfate showed no evidence of tumorigenicity at dietary doses up to 500 mg/kg (approximately 140 times the maximum recommended daily inhalation dose for adults on a mg/m² basis). Immediate Hypersensitivity Reactions Immediate hypersensitivity reactions to albuterol and/or ipratropium bromide may occur after the administration of DuoNeb (ipratropium bromide and albuterol sulfate) as demonstrated by rare cases of urticaria. Albuterol sulfate was not clastogenic in a human peripheral lymphocyte assay or in an AH1 strain mouse micronucleous assay. Patients should be instructed not to increase the dose or frequency of DuoNeb (ipratropium bromide and albuterol sulfate) without consulting their healthcare provider. they should contact their healthcare provider about use of DuoNeb. Effects Seen with Anticholinergic Drugs: Due to the presence of ipratropium bromide in DuoNeb (ipratropium bromide and albuterol sulfate) . wheezing. albuterol sulfate caused a significant dose-related increase in the incidence of benign leiomyomas of the mesovarium at and above dietary doses of 2 mg/kg (approximately equal to the maximum recommended daily inhalation dose for adults on a mg/m² basis). or precipitation or worsening of narrow-angle glaucoma may occur. oropharyngeal edema. Carcinogenesis. Use in Hepatic or Renal Disease: DuoNeb (ipratropium bromide and albuterol sulfate) has not been studied in patients with hepatic or renal insufficiency. Additionally. upper respiratory tract infection. there was a 0. See the illustrated Patient's Instruction for Use in the product package insert. Reproduction studies in rats demonstrated no evidence of impaired fertility at oral doses of albuterol sulfate up to 50 mg/kg (approximately 25 times the maximum recommended daily inhalation dose for adults on a mg/m² basis). if they occur. angioedema. However.In the clinical trial.3% incidence of possible allergictype reactions. DuoNeb (ipratropium bromide and albuterol sulfate) should be used with caution in patients with cardiovascular disorders. like other beta adrenergic agonists. or bladder-neck obstruction. Additional information derived from the published literature on the use of albuterol sulfate and ipratropium bromide singly or in combination includes precipitation or worsening of narrow-angle glaucoma. it should be used with caution in patients with narrow-angle glaucoma. and hypertension. blurred vision. In addition. drowsiness. a non-selective beta-adrenergic antagonist. or diabetes mellitus. Ipratropium bromide In 2-year studies in Sprague-Dawley rats and CD-1 mice. paradoxical bronchospasm. it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. 2. Although such effects are uncommon for DuoNeb (ipratropium bromide and albuterol sulfate) at recommended doses. ipratropium bromide showed no evidence of tumorigenicity at oral doses up to 6 mg/kg (approximately 15 times and 8 times the maximum recommended daily inhalation dose for adults in rats and mice respectively. Large doses of intravenous albuterol have been reported to aggravate pre-existing diabetes mellitus and ketoacidosis. should be used with caution in patients with cardiovascular disorders. particularly if a mask is used. Because these reactions are reported voluntarily from a population of uncertain size. paradoxical bronchospasm has been observed with both inhaled ipratropium bromide and albuterol products and can be life-threatening. such as flattening of the T-wave. and hypertension. aching. taste perversion. patients should be instructed to seek medical consultation. and in patients who are unusually responsive to sympathomimetic amines. cardiac arrhythmias. PRECAUTIONS General 1. Mutagenesis. sore throat. not requiring supplementation. Information for Patients The action of DuoNeb (ipratropium bromide and albuterol sulfate) should last up to 5 hours. and therefore proper nebulizer technique should be assured. prolongation of the QTc interval. Patients must avoid exposing their eyes to this product as temporary papillary dilation. exacerbation of COPD symptoms. DuoNeb (ipratropium bromide and albuterol sulfate) should not be used more frequently than recommended. In a 22-month study in Golden hamsters. Cardiovascular Effect DuoNeb (ipratropium bromide and albuterol sulfate) . like other sympathomimetic amines. and metabolic acidosis. If this occurs. rash. the drug may need to be discontinued. blurred vision. prostatic hypertrophy. In another study. sinusitis. cardiac arrhythmias. Do Not Exceed Recommended Dose Fatalities have been reported in association with excessive use of inhaled products containing sympathomimetic amines and with the home use of nebulizers. can produce a clinically significant cardiovascular effect in some patients as measured by pulse rate. If symptoms worsen. hyperthyroidism. this effect was blocked by the coadministration of propranolol. 3. pruritus. The clinical significance of these findings is unknown. DuoNeb (ipratropium bromide and albuterol sulfate) should be discontinued immediately and alternative therapy instituted. WARNINGS Paradoxical Bronchospasm In the clinical study of DuoNeb (ipratropium bromide and albuterol sulfate) . The decrease is usually transient. If a patient becomes pregnant or begins nursing while on DuoNeb (ipratropium bromide and albuterol sulfate) . palpitations. paradoxical bronchospasm was not observed. and anaphylaxis. flushing. blood pressure. in patients with convulsive disorders. and/or symptoms. especially coronary insufficiency. It should be used with caution in these patient populations. and ST segment depression. on a mg/m² basis). acute eye pain. In an 18-month study in CD-1 mice. Impairment of Fertility Albuterol sulfate In a 2-year study in Sprague-Dawley rats. . and urticaria. especially coronary insufficiency. Effects Seen with Sympathomimetic Drugs: As with all products containing sympathomimetic amines. eye pain. pruritus. Therefore. albuterol sulfate showed no evidence of tumorigenicity at dietary doses up to 50 mg/kg (approximately 20 times the maximum recommended daily inhalation dose for adults on a mg/m² basis).

Nursing Mothers It is not known whether the components of DuoNeb (ipratropium bromide and albuterol sulfate) are excreted in human milk. In vitro studies and in vivo pharmacologic studies have demonstrated that albuterol has a preferential effect on β2adrenergic receptors compared with isoproterenol. 62 percent were 65 and over.5 mg/kg (approximately equal to the maximum recommended daily inhalation dose for adults on a mg/m² basis). including cleft palate and limb defects. like other β-adrenergic agonist drugs. During worldwide marketing experience.5 mg/kg isoproterenol (positive control). Pregnancy Teratogenic Effects: Pregnancy Category C Albuterol sulfate Ipratropium bromide Pregnancy Category B. The cAMP thus formed mediates the cellular responses. A reproduction study in Stride rabbits revealed cranioschisis in 7 of 19 (37%) fetuses when albuterol was administered orally at a dose of 50 mg/kg (approximately 55 times the maximum recommended daily inhalation dose for adults on a mg/m² basis). Reproduction studies in rats and rabbits demonstrated no evidence of teratogenicity at inhalation doses up to 1.5 and 1. albuterol sulfate. The drug did not induce cleft palate formation when administered subcutaneously at a dose of 0. Pharmacokinetics Albuterol sulfate is longer acting than isoproterenol in most patients by any route of administration. taking into account the importance of the drug to the mother. in the form of bronchial smooth muscle relaxation. and other reported clinical experience has not identified differences in responses between the elderly and younger patients. respectively (approximately 4 and 10 times the maximum recommended daily inhalation dose for adults on a mg/m² basis). the enzyme that catalyzes the formation of cyclic-3'. Because of the potential for tumorigenicity shown for albuterol sulfate in some animals. CLINICAL PHARMACOLOGY DuoNeb (ipratropium bromide and albuterol sulfate) Inhalation Solution is a combination of the β2-adrenergic bronchodilator.5%) fetuses at 0.Ipratropium bromide was not mutagenic in the Ames test and mouse dominant lethal test. it is unlikely that ipratropium bromide would reach the infant to an important extent. and 125 mg/kg. Because of the potential of albuterol to interfere with uterine contractility.5'adenosine monophosphate (cAMP) from adenosine triphosphate (ATP). than isoproterenol at comparable doses while producing fewer cardiovascular effects. and 680 times the maximum recommended daily inhalation dose for adults on a mg/m² basis). ipratropium bromide. 100. however. Some of the mothers were taking multiple medications during their pregnancies. Ipratropium bromide was not clastogenic in a mouse micronucleous assay. . albuterol sulfate. Albuterol Sulfate Pregnancy Category C. Oral albuterol sulfate has been shown to delay preterm labor in some reports.25 mg/kg (less than the maximum recommended daily inhalation dose for adults on a mg/m² basis) and in 10 of 108 (9. Pediatric Use The safety and effectiveness of DuoNeb (ipratropium bromide and albuterol sulfate) in patients below 18 years of age have not been established.8 mg/kg. No overall differences in safety or effectiveness were observed between Mechanism of Action The prime action of β-adrenergic drugs is to stimulate adenyl cyclase. While it is recognized that β2-adrenergic receptors are the predominant receptors in bronchial smooth muscle. A study in CD-1 mice given albuterol sulfate subcutaneously showed cleft palate formation in 5 of 111 (4. Reproduction studies in CD-1 mice. and the anticholinergic bronchodilator. is not yet established. Albuterol sulfate has been shown to be teratogenic in mice.3%) fetuses at 2. Albuterol has been shown in most controlled clinical trials to have more effect on the respiratory tract. because it is not a substrate for the cellular uptake processes for catecholamine nor for the metabolism of catechol-O-methyl transferase. respectively (approximately 15. These effects were not seen with a dose of 50 mg/kg (approximately 140 times the maximum recommended daily inhalation dose for adults on a mg/m² basis). Labor and Delivery these subjects and younger subjects. Geriatric Use Of the total number of subjects in clinical studies of DuoNeb (ipratropium bromide and albuterol sulfate) . Cleft palate formation also occurred in 22 of 72 (30. A study in which pregnant rats were dosed with radiolabeled albuterol sulfate demonstrated that drug-related material is transferred from the maternal circulation to the fetus. a decision should be made whether to discontinue nursing or discontinue DuoNeb (ipratropium bromide and albuterol sulfate) .5%) fetuses from females treated subcutaneously with 2. or ipratropium bromide in pregnant women. Sprague-Dawley rats and New Zealand rabbits demonstrated no evidence of teratogenicity at oral doses up to 10. 270. or to atropine and its derivatives. DuoNeb (ipratropium bromide and albuterol sulfate) should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. CONTRAINDICATIONS DuoNeb (ipratropium bromide and albuterol sulfate) is contraindicated in patients with a history of hypersensitivity to any of its components. can produce a significant cardiovascular effect in some patients. Controlled clinical studies and other clinical experience have shown that inhaled albuterol. A reproduction study in rats demonstrated decreased conception and increased resorptions when ipratropium bromide was administered orally at a dose of 90 mg/kg (approximately 240 times the maximum recommended daily inhalation dose for adults on a mg/m² basis).025 mg/kg (less than the maximum recommended daily inhalation dose for adults on a mg/m² basis). especially when taken as a nebulized solution. but greater sensitivity of some older individuals cannot be ruled out. have been reported in the offspring of patients being treated with albuterol. The precise function of these receptors. Although lipid-insoluble quaternary bases pass into breast milk. There are no adequate and wellcontrolled studies of the use of DuoNeb (ipratropium bromide and albuterol sulfate) . a relationship between albuterol use and congenital anomalies has not been established. various congenital anomalies. Because no consistent pattern of defects can be discerned. while 19 percent were 75 and over. Instead the drug is conjugatively metabolized to albuterol 4'-O-sulfate. recent data indicated that 10% to 50% of the βreceptors in the human heart may be β2receptors. use of DuoNeb (ipratropium bromide and albuterol sulfate) during labor should be restricted to those patients in whom the benefits clearly outweigh the risks.

and. The pharmacokinetics of DuoNeb (ipratropium bromide and albuterol sulfate) Inhalation Solution or ipratropium bromide have not been studied in the elderly and in patients with hepatic or renal insufficiency (see PRECAUTIONS). Studies in laboratory animals (minipigs. a mean of 4% of the dose was excreted unchanged in the urine. . albuterol concentrations were found to be 100 times those found in whole brain. Ipratropium Bromide Mechanism of Action Ipratropium bromide is an anticholinergic (parasympatholytic) agent.Animal Pharmacology/Toxicology Intravenous studies in rats with albuterol sulfate have demonstrated that albuterol crosses the blood-brain barrier and reaches brain concentrations amounting to approximately 5% of plasma concentrations. The half-life of elimination is about 1. appears to inhibit vagally mediated reflexes by antagonizing the action of acetylcholine. In structures outside of the blood-brain barrier (pineal and pituitary glands). Ipratropium bromide is minimally (0% to 9% in vitro ) bound to plasma albumin and α1acid glycoproteins. The clinical significance of these findings is unknown. Pharmacokinetics The bronchodilation following inhalation of ipratropium is primarily a local. based on animal studies. It is partially metabolized to inactive ester hydrolysis products. Ipratropium bromide that reaches the systemic circulation is reportedly removed by the kidneys rapidly at a rate that exceeds the glomerular filtration rate. Following intravenous administration. rodents. Anticholinergics prevent the increases in intracellular concentration of cyclic guanosine monophosphate (cGMP). Much of an inhaled dose is swallowed as shown by fecal excretion studies.6 hours after intravenous administration. approximately one-half is excreted unchanged in the urine. the transmitter agent released from the vagus nerve. site-specific effect. not a systemic one. which blocks the muscarinic receptors of acetylcholine. and dogs) have demonstrated the occurrence of cardiac arrythmias and sudden death (with histological evidence of myocardial necrosis) when beta-agonists and methyl-xanthines are administered concurrently. Following nebulization of a 1-mg dose to healthy volunteers. resulting from the interaction of acetylcholine with the muscarinic receptors of bronchial smooth muscle.

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