Generic name of Drug: Ipratropium Bromide- Salbutamol Sulfate (Combivent) Pharmacologic action: Combivent Inhalation Solution is a combination of the

anticholinergic bronchodilator, ipratropium bromide, and the beta2-adrenergic bronchodilator, salbutamol sulfate. Ipratropium bromide is a quaternary ammonium derivative of atropine and is an anticholinergic drug which has bronchodilator properties. Salbutamol produces bronchodilation through stimulation of beta2-adrenergic receptors in bronchial smooth muscle, thereby causing relaxation of muscle fibres. This action is manifested by an increase in pulmonary function as demonstrated by spirometric measurements. Indications: For the management of bronchospasm in patients suffering from chronic obstructive pulmonary disease (COPD) who requires regular treatment with both ipratropium and salbutamol. Contraindications: Patients with cardiac tachyarrhythmias, hypertrophic obstructive cardiomyopathy and patients with a history of hypersensitivity to any of its components or to atropine or its derivatives. Adverse Effects of the Drug: fatigue, abdominal pain, hypertension, dyspepsia, tachycardia, sinusitis, dysuria, and urinary retention blurred vision, taste perversion, dry mouth, paradoxical bronchospasm, bronchitis, angina, arrhythmia, lightheadedness, drowsiness, insomnia, dizziness, vertigo, CNS stimulation, weakness, itching, rash, flushing, alopecia, hypotension, increased blood pressure, gastrointestinal distress, vomiting, diarrhea, edema, constipation and urinary difficulty Nursing Responsibilities/ Precautions: Assessment and Drug Effects: 1.monitor respiratory status; auscultate lungs before and after inhalation 2.report treatment failure (exacerbation of respiratory symptoms) to physician 3. Patient and Family Education: 1.do not allow the solution/ mist to enterthe eyes 2.consult a doctor immediately in the event of acute, rapidly worsening dyspnea. In addition, the patient should be warned to seek medical advice should a reduced response become apparent. 3.The concomitant use of Combivent with other sympathomimetic agents is not recommended since such combined use may lead to deleterious cardiovascular effects. 4.Eye pain or discomfort, blurred vision, visual halos or colored images in association with red eyes from conjunctival and corneal congestion may be signs of acute narrow-angle glaucoma. Should any combination of these symptoms develop, treatment with miotic drops should be initiated and specialist advice sought immediately. 5.allow 30-60 sec between puffs for optimum results. 6.wait 5 min between this and other inhaled medications. 7.rinse mouth after medication puffs to reduce bitter taste