3 - Long term meds for asthma/COPD Flashcards by Maggie Kl

What are the ICSs?

melomethasone
budesonide 
ciclesonide
flunisolide
fluticasone proprionate
fluictasone furoate
mometasone

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ICS dose types

https://quizlet.com/201444838/estimated-comparative-daily-dosages-for-inhaled-corticosteroids-flash-cards/

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short and long-acting meds flashcards

https://quizlet.com/201444892/asthma-and-copd-medications-flash-cards/?new

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meds by brand name

https://quizlet.com/201445677/asthma-and-copd-meds-by-brand-name-flash-cards/?new

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What are the DFs and approved ages for beclomethasone?

HFA 40 or 80 mcg/inh

> 4 yoa

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What are the approved age ranges for ICSs?

none of these besides bedesonide neb soln are avialble for <4 yoa (12 to 8 yoa)

ArmonAir and Arnuity Ellipta are not availble for <12 yoa

Pulmicort Flexhaler and Aerospan are for >=6 yoa

Flovent and Twisthaler for >=4 yoa

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What are the AEs of ICSs?

oral thrush
cough
dysphonia

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What are counseling tips for ICSs

rinse and spit!

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What are clinical pearls for ICSs?

most effective long-term control for asthma (improve QOL, incr lung fxn, reduct rsik of exac)

titrate to lowest effective dose

pulmicort Respules should use Jet Nebulizer and should nt be mixed with other neb meds

Aerospan has a built in spacer

High doses incr risk for systemic SEs

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What are the DFs and approved ages for budesonide (Pulmicort)?

Flexhaler: >6 yoa

Respules: 12mo-8yoa

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What are the DFs and ages for ciclesonide?

Alvesco HFA

> = 5 yo

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What are the DFs and age ranges for flunisolide?

Aerospan HFA

> = 6 yoa

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What are the DFs and age ranges for fluticasone propionate?

Flovent HFA or Diskus:
>=4 yo

ArmonAir Respiclick: adult

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What are the DFs and age for fluticasone furoate?

Arunity Ellipta

adult

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What ar ethe DFs and ages for mometasone?

Asmanex HFA: adult

or Twisthaler: >4

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What are the LABAs?

arformoeterol tartrate
formoterol
indacaterol
olodaterol
salmeterol

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What are AEs for LABAs?

tachycardia
HA
tremor
hypokalemia

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What are the boxed warning for LABAs?

shuld not be used as monotherapy for asthma d/t increased risk of asthma-related mortality

incr’d hospitalization in peds and adolescents

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What are clinical pearols for LABAs?

prolonged QT seen w intention overdoses

not for acute sx

may be helpful for EIB

formoterol and indacaterol capsules should not be taken orally

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What are important ped consierations for DPIs?

mos children <4 yo cannot provide suffiicnet resp flow for adequate lung delivery

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What are the DFs and ages for arformoeterol tartrate

Brovana neb soln

adult

**COPD only

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What are the DFs and ages for formoterol?

Foradil Aerolizer (capsules)

> =5

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What are DFs and ages for indacaterol?

Aracapta Neohaler (capsules)

COPD only**
adults

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What are the DFs and ages for olodaterol?

Striverdi Respimat

adult

**COPD only

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What are the DFs and ages for salmeterol?

Serevent Diskus >=5 yoa

What are the LAMAs?

aclinidium tiotropium umeclinidium

What are AEs of LAMAs?

``` dry mouth dizziness blurred vision URTIs paraodixcal bronchopasms ```

What are clinical spearls for LAMAs?

tiotropium has been approved for use in asthma as an add-o optin in step 4 or 5 (hx of exac despite ICs+ LABA use)

What are the ind for LAMAs?

COPD ONLY***** (except Spiriva Respimat)

What is the DF and age for aclinidium?

Tudorza Pressair (DPI) adult (COPD)

What is the DF and age for tiotropium?

Spiriva Handihaler (COPD ONLY) or Respimat adult

What is the Df and age for umeclidinium?

``` Incruse Ellipta (DPI) adult(COPD only) ```

What are DF and age for fluticasone/salmeterol?

Advair Diskus or HFA (MDI): no 0-4 AirDuo Respiclick (DPI): adult

What are the ICS/LABA combo products?

fluticasone/salmeterol budesonide/formoterol mometasone/formoeterol fluticasone/vilanterol

what are the DF and age for budesonide formoterol?

Symbicort HFA MDI: no 0-4

What are the DF and age for mometasone/formoeterol?

Dulera MDI | adult

What are the DF and age for fluticasone/vilanterol?

``` Breo Ellipta (DPI) adult ```

What are the clinical pearls for ICS/LABA combo?

guidlines recommend combo LABA w ICS in asthma, since LABA should not be used as monotherapy combo products devo'd to create convenient packaing and assist w patient adherence

What are the LABA/LAMA combo products?

olodaterol/tiotropium vilaneterol/umeclinidium indacaterol/glycopyrronium formoterol/glycopyrronium

What are the clinical pearsl for LABA/LAMA products?

COPD ONLY****** not ind for tx of acute deterioration adult only

What are the DF for LABA/LAMA products?

adult only (COPD only)

What is the DF of olodaterol/tiotropium?

Stiolto Respimat

What is the Df of vilanterol/umeclidinium?

Anoro Ellipta

What is the DF for indacaterol/glycopyrronium?

Ubitron Neohaler

What is the Df for formoterol/glycopyrronium?

Bevespi Aerosphere

What are the mast cell stabilizer?

cromolyn

What is the DF and age for cromolyn?

neb soln | all

What is AE of cromolyn?

``` high incidence of unpleasant taste in mouth rare cardiac arrhythmias coughing dyspnea sore throat N/V/D if systemic ```

What are clinical pearls for cromolyn?

less effective than low-dose ICS prevents incr in BHR seen in allergy season

What are the leukotriene modifiers?

montelukast zafirlukast zileuton

What is the Df of teh leukotriene modifiers?

tab | singulair also has granule packets

What are the age ranges for leukotriene modifiers?

singulair: all Accolate no 0-4 Zyflo adult only

What are AEs assoc'd w leukotirene modifiers?

neuropsychiatric events (agitation, anxiety, abnormal dreams, hallucination, dperession, suicidal thinking) Churg-Strauss syndrome incr'd hepatic transminzases (Zaiflulast and zileuton)

What are clinical perasl for leukotriene modifiers

less effective than low ICS and ICS/LABA in asthma | Have not be trialed in COPD

What are clinical pearls for Montelukast?

weak inhib of CYP2C8 and 2C0 major sub of CYP2C0 and3A4 not for acute relife of sx

What are clinicla pearsl for Zafirlukast?

take at least 1 hr before or 2 hr after meals | can incr INR

What are clinical pearsl for zileuton?

mod CYP1A2 inhib and minor CYP1A2, 2C9, 3A4 sub

What are the methylxanthine?

theophylline

What are the DFs of theophylline?

tab ER cap ER liquid

What r ethe age ranges of theophylline

all

What are AE of theophylline?

insomnia GI upset hyperactivity hypoTN

What are dose-related toxicities for theopylline?

``` tachycardia N/V HA Sz arryhtmias ```

What are CI for theophylline?

peptic ulcer dz arrhythmias Sz disorders

What are Dis for theophylline?

major sub of CYP 3A4, 1A2, 2E1 ``` incr concentration: ciemitidine, erythromycin clarithromycin ciprofloacin ticlopidine ``` ``` decr conc: phenobarbital phenytoin carmabazpein rifamin smoking ```

What are clincal pearls for theophylline?

serum conc 5-15 mcg/mL PDE III inhib likely cause for hypoTN, tachycardia and N

What are the anti-IGE meds?

omalizumab (Xolair)

What are the DF and age for omalizumab?

SC inj >=6 yo

What are AEs of omalizumab?

``` HA inj site rxns arthralgias thrombocytopenia pharyngitis sinusitis upper RTIs ```

What is the boxed warning of omalizumab?

anaphylaxis

What are clinical pearls for omalizumab?

do not admin more than 150 mg per inj site monitor for anaphylaxis FDA approval for mod to sev persis asthma in pts w positive skin test or reactivity to perentiial aeroallergen and sx that are inadequately controlled ICS

How is omalizumab dosed?

by body wt and pretreatment serum IgE conc

What are anti-IL5 meds?

mepolizumab (Nucala) | Reslizumab (Cinquair)

What are the age ranges and DFs for anti-IL5 meds?

adult (Cinquir >18 yo) SC inj

What are AE for Nucala?

HA inj site rxns arthralgias Herpes Zoster infx

What is a precaution (but not boxed warning for Nucala)

anaphylaxis

What is a clinical pearl for Nucala and Cinquair?

monitor for anaphylaxis before and after inj | ind for add-on maintenance tx of pts w severe asthma w an eosinophilic phenotype

what is a boxed warning for Cinquair?

anaphylaxis | maligancies

What are AEs for Cinquair?

inj site rxn myalgias incr creatinine phosphokinase

What are the PDE-4 inhibitors?

roflumilast (Daliresp)

What is the Df and age, ind for roflumilast?

tab adult COPD only

What are monitoring parameters for roflumilast?

liver fxn test, wt

what are DI for roflumilast?

CYP3A4 (major) CYP1A2 (minor)

What are CI for roflumilast?

Child-Pugh class B or C