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Pharmacotherapy 1 > 3 - Long term meds for asthma/COPD > Flashcards

3 - Long term meds for asthma/COPD Flashcards

1
Q

What are the ICSs?

A 
melomethasone
budesonide 
ciclesonide
flunisolide
fluticasone proprionate
fluictasone furoate
mometasone
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2
Q

ICS dose types

A

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

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3
Q

short and long-acting meds flashcards

A

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

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4
Q

meds by brand name

A

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

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5
Q

What are the DFs and approved ages for beclomethasone?

A

HFA 40 or 80 mcg/inh

> 4 yoa

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6
Q

What are the approved age ranges for ICSs?

A

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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7
Q

What are the AEs of ICSs?

A

oral thrush
cough
dysphonia

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8
Q

What are counseling tips for ICSs

A

rinse and spit!

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9
Q

What are clinical pearls for ICSs?

A

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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10
Q

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

A

Flexhaler: >6 yoa

Respules: 12mo-8yoa

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11
Q

What are the DFs and ages for ciclesonide?

A

Alvesco HFA

> = 5 yo

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12
Q

What are the DFs and age ranges for flunisolide?

A

Aerospan HFA

> = 6 yoa

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13
Q

What are the DFs and age ranges for fluticasone propionate?

A

Flovent HFA or Diskus:
>=4 yo

ArmonAir Respiclick: adult

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14
Q

What are the DFs and age for fluticasone furoate?

A

Arunity Ellipta

adult

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15
Q

What ar ethe DFs and ages for mometasone?

A

Asmanex HFA: adult

or Twisthaler: >4

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16
Q

What are the LABAs?

A 
arformoeterol tartrate
formoterol
indacaterol
olodaterol
salmeterol
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17
Q

What are AEs for LABAs?

A

tachycardia
HA
tremor
hypokalemia

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18
Q

What are the boxed warning for LABAs?

A

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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19
Q

What are clinical pearols for LABAs?

A

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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20
Q

What are important ped consierations for DPIs?

A

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

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21
Q

What are the DFs and ages for arformoeterol tartrate

A

Brovana neb soln

adult

**COPD only

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22
Q

What are the DFs and ages for formoterol?

A

Foradil Aerolizer (capsules)

> =5

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23
Q

What are DFs and ages for indacaterol?

A

Aracapta Neohaler (capsules)

COPD only**
adults

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24
Q

What are the DFs and ages for olodaterol?

A

Striverdi Respimat

adult

**COPD only

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25
Q

What are the DFs and ages for salmeterol?

A

Serevent Diskus

> =5 yoa

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26
Q

What are the LAMAs?

A

aclinidium
tiotropium
umeclinidium

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27
Q

What are AEs of LAMAs?

A 
dry mouth 
dizziness
blurred vision
URTIs 
paraodixcal bronchopasms
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28
Q

What are clinical spearls for LAMAs?

A

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)

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29
Q

What are the ind for LAMAs?

A

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

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30
Q

What is the DF and age for aclinidium?

A

Tudorza Pressair (DPI)

adult (COPD)

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31
Q

What is the DF and age for tiotropium?

A

Spiriva Handihaler (COPD ONLY) or Respimat

adult

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32
Q

What is the Df and age for umeclidinium?

A 
Incruse Ellipta (DPI)
adult(COPD only)
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33
Q

What are DF and age for fluticasone/salmeterol?

A

Advair Diskus or HFA (MDI):
no 0-4

AirDuo Respiclick (DPI): adult

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34
Q

What are the ICS/LABA combo products?

A

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

35
Q

what are the DF and age for budesonide formoterol?

A

Symbicort HFA MDI:

no 0-4

36
Q

What are the DF and age for mometasone/formoeterol?

A

Dulera MDI

adult

37
Q

What are the DF and age for fluticasone/vilanterol?

A 
Breo Ellipta (DPI)
adult
38
Q

What are the clinical pearls for ICS/LABA combo?

A

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

39
Q

What are the LABA/LAMA combo products?

A

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

40
Q

What are the clinical pearsl for LABA/LAMA products?

A

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

adult only

41
Q

What are the DF for LABA/LAMA products?

A

adult only (COPD only)

42
Q

What is the DF of olodaterol/tiotropium?

A

Stiolto Respimat

43
Q

What is the Df of vilanterol/umeclidinium?

A

Anoro Ellipta

44
Q

What is the DF for indacaterol/glycopyrronium?

A

Ubitron Neohaler

45
Q

What is the Df for formoterol/glycopyrronium?

A

Bevespi Aerosphere

46
Q

What are the mast cell stabilizer?

47
Q

What is the DF and age for cromolyn?

A

neb soln

all

48
Q

What is AE of cromolyn?

A 
high incidence of unpleasant taste in mouth 
rare cardiac arrhythmias
coughing
dyspnea
sore throat
N/V/D if systemic
49
Q

What are clinical pearls for cromolyn?

A

less effective than low-dose ICS

prevents incr in BHR seen in allergy season

50
Q

What are the leukotriene modifiers?

A

montelukast
zafirlukast
zileuton

51
Q

What is the Df of teh leukotriene modifiers?

A

tab

singulair also has granule packets

52
Q

What are the age ranges for leukotriene modifiers?

A

singulair: all
Accolate no 0-4
Zyflo adult only

53
Q

What are AEs assoc’d w leukotirene modifiers?

A

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

54
Q

What are clinical perasl for leukotriene modifiers

A

less effective than low ICS and ICS/LABA in asthma

Have not be trialed in COPD

55
Q

What are clinical pearls for Montelukast?

A

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

56
Q

What are clinicla pearsl for Zafirlukast?

A

take at least 1 hr before or 2 hr after meals

can incr INR

57
Q

What are clinical pearsl for zileuton?

A

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

58
Q

What are the methylxanthine?

A

theophylline

59
Q

What are the DFs of theophylline?

A

tab ER
cap ER
liquid

60
Q

What r ethe age ranges of theophylline

61
Q

What are AE of theophylline?

A

insomnia
GI upset
hyperactivity
hypoTN

62
Q

What are dose-related toxicities for theopylline?

A 
tachycardia
N/V
HA
Sz
arryhtmias
63
Q

What are CI for theophylline?

A

peptic ulcer dz
arrhythmias
Sz disorders

64
Q

What are Dis for theophylline?

A

major sub of CYP 3A4, 1A2, 2E1

incr concentration: ciemitidine, 
erythromycin
clarithromycin
ciprofloacin
ticlopidine
decr conc: phenobarbital
phenytoin
carmabazpein
rifamin
smoking
65
Q

What are clincal pearls for theophylline?

A

serum conc 5-15 mcg/mL

PDE III inhib likely cause for hypoTN, tachycardia and N

66
Q

What are the anti-IGE meds?

A

omalizumab (Xolair)

67
Q

What are the DF and age for omalizumab?

A

SC inj

> =6 yo

68
Q

What are AEs of omalizumab?

A 
HA
inj site rxns
arthralgias
thrombocytopenia
pharyngitis
sinusitis
upper RTIs
69
Q

What is the boxed warning of omalizumab?

A

anaphylaxis

70
Q

What are clinical pearls for omalizumab?

A

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

71
Q

How is omalizumab dosed?

A

by body wt and pretreatment serum IgE conc

72
Q

What are anti-IL5 meds?

A

mepolizumab (Nucala)

Reslizumab (Cinquair)

73
Q

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

A

adult
(Cinquir >18 yo)

SC inj

74
Q

What are AE for Nucala?

A

HA
inj site rxns
arthralgias
Herpes Zoster infx

75
Q

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

A

anaphylaxis

76
Q

What is a clinical pearl for Nucala and Cinquair?

A

monitor for anaphylaxis before and after inj

ind for add-on maintenance tx of pts w severe asthma w an eosinophilic phenotype

77
Q

what is a boxed warning for Cinquair?

A

anaphylaxis

maligancies

78
Q

What are AEs for Cinquair?

A

inj site rxn
myalgias
incr creatinine phosphokinase

79
Q

What are the PDE-4 inhibitors?

A

roflumilast (Daliresp)

80
Q

What is the Df and age, ind for roflumilast?

A

tab
adult
COPD only

81
Q

What are monitoring parameters for roflumilast?

A

liver fxn test, wt

82
Q

what are DI for roflumilast?

A

CYP3A4 (major) CYP1A2 (minor)

83
Q

What are CI for roflumilast?

A

Child-Pugh class B or C

Pharmacotherapy 1 (26 decks)

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