Asthma and COPD Controller Medications Flashcards
beclomethasone drug class
inhaled corticosteroids (ICS)
beclomethasone brand name
QVAR
beclomethasone dosage form
RediHaler (MDI)
beclomethasone age groups
> = 5 years old
budesonide drug class
inhaled corticosteroids (ICS)
budesonide brand names
Pulmicort and Pulmicort Respules
Pulmicort dosage form
flexhaler
Pulmicort Respules dosage form
nebulizer solution
Pulmicort age groups
> = 5 years old
Pulmicort Respules age groups
0-11 year olds
Pulmicort Respules counseling tip
should use jet nebulizer and not be mixed with other nebulizer medications
ciclesonide drug class
inhaled corticosteroids (ICS)
ciclesonide brand name
Alvesco
ciclesonide dosage form
HFA
ciclesonide age groups
> = 6 years old
fluticasone propionate drug class
inhaled corticosteroids (ICS)
fluticasone propionate brand names
Flovent and ArmonAir Digihaler
Flovent dosage forms
HFA and DPI
ArmonAir Digihaler dosage form
aerosol powder inhaler (DPI)
Flovent age groups
all
ArmonAir Digihaler age group
> = 12 years old
fluticasone furoate drug class
inhaled corticosteroids (ICS)
fluticasone furoate brand name
Arnuity Ellipta
fluticasone furoate dosage form
ellipta
fluticasone furoate age groups
> =5 years old
mometasone drug class
inhaled corticosteroids (ICS)
mometasone brand name
Asmanex
mometasone dosage forms
HFA and Twisthaler
mometasone age groups
> = 5 years old
inhaled corticosteroids adverse effects
-oral thrush (candidiasis)
-cough
-dysphonia
ICS counseling tips
-patients should rinse mouth and spit after use to prevent oral thrush
-most effective long-term control therapy for asthma (improves quality of life, increases lung function, and reduces risk of exacerbations)
-may increase risk of pneumonia in patients with COPD
-titrate to lowest effective dose
-high doses increase risk for systemic side effects
arformoterol tartrate drug class
long-acting beta agonist (LABA)
arformoterol tartrate brand name
Brovana
arformoterol tartrate dosage form
nebulizer solution
arformoterol tartrate age group
> =12 years old
arformoterol tartrate indication
COPD
formoterol drug class
long-acting beta agonist (LABA)
formoterol brand name
Perforomist
formoterol dosage form
nebulizer solution
formoterol age group
> =12 years old
formoterol indication
COPD only unless used in combination with ICS
indacaterol drug class
long-acting beta agonist (LABA)
indacaterol brand name
Arcapta Neohaler
indacaterol dosage form
neohaler
indacaterol age group
> = 12 years old
indacaterol indication
COPD
olodaterol drug class
long-acting beta agonist (LABA)
olodaterol brand name
Striverdi Respimat
olodaterol dosage form
respimat
olodaterol age group
> = 12 years old
olodaterol indication
COPD
salmeterol drug class
long-acting beta agonist (LABA)
salmeterol brand name
Serevent
salmeterol dosage form
diskus
salmeterol age groups
> = 4 years old
LABA adverse effects
-tachycardia
-headache
-tremor
-hypokalemia
LABA boxed warnings
-increased risk of asthma-related death for all monotherapy (LABA should not be used alone for asthma management)
-increasing hospitalizations in pediatric and adolescent patients
LABA counseling tips
-prolonged QT seen with intentional overdoses
-not for acute symptoms
-may be helpful for exercise-induced bronchospasm
-formoterol and indacaterol capsules should not be taken orally
LABA pediatric consideration
most children <4 years old cannot provide sufficient inspiratory flow for adequate lung delivery with a DPI
aclidinium drug class
long-acting antimuscarinic (LAMA)
aclidinium brand name
Turdorza Pressair
aclidinium dosage form
DPI
aclidinium age group
> = 12 years old
aclidinium indication
COPD
glycopyrrolate drug class
long-acting antimuscarinic (LAMA)
glycopyrrolate brand name
Seebri Neohaler
glycopyrrolate dosage forms
DPI and nebulization solution
glycopyrrolate age group
> =12 years old
glycopyrrolate indication
COPD
revefenacin drug class
long-acting antimuscarinic (LAMA)
revefenacin brand name
Yupelri
revefenacin dosage form
nebulization solution
revefenacin age group
> =12 years old
revefenacin indication
COPD
tiotropium drug class
long-acting antimuscarinic (LAMA)
tiotropium brand name
Spiriva
tiotropium dosage forms
HandiHaler and Respimat
Spiriva HandiHaler age group
> = 12 years old
Spiriva Respimat age groups
> = 6 years old
Spiriva HandiHaler indication
COPD
tiotropium counseling tip
approved for use in asthma as an add-on option for children >= 12 years old
umeclidinium drug class
long-acting antimuscarinic (LAMA)
umeclidinium brand name
Incruse Ellipta
umeclidinium dosage form
DPI
umeclidinium age group
> = 12 years old
umeclidinium indication
COPD
LAMA adverse effects
-dry mouth
-dizziness
-blurred vision
-upper respiratory infections
-paradoxical bronchospasms
fluticasone/salmeterol drug class
ICS/LABA combination
fluticasone/salmeterol brand names
Advair, AirDuo, and AirDuo Digihaler
Advair dosage forms
DPI and HFA MDI
Advair DPI age groups
> = 5 years old
Advair HFA MDI age group
> =12 years old
AirDuo and AirDuo Digihaler dosage form
Respiclick (DPI)
AirDuo and AirDuo Digihaler age group
> = 12 years old
budesonide/formoterol drug class
ICS/LABA combination
budesonide/formoterol brand name
Symbicort
budesonide/formoterol dosage form
HFA MDI
budesonide/formoterol age groups
> = 5 years old
mometasone/formoterol drug class
ICS/LABA combination
mometasone/formoterol brand name
Dulera
mometasone/formoterol dosage form
MDI
mometasone/formoterol age group
> = 12 years old
fluticasone/vilanterol drug class
ICS/LABA combination
fluticasone/vilanterol brand name
Breo Ellipta
fluticasone/vilanterol dosage form
DPI
fluticasone/vilanterol age group
> = 12 years old
ICS/LABA combination counseling tips
-recommend combination LABA with ICS in asthma because LABA should not be used as monotherapy
-combination products were developed to create convenient packaging and assist with patient adherence
olodaterol/tiotropium drug class
LABA/LAMA combination
olodaterol/tiotropium brand name
Stiolto Respimat
olodaterol/tiotropium dosage form
Respimat
olodaterol/tiotropium age group
> = 12 years old
olodaterol/tiotropium indication
COPD
vilanterol/umeclidinium drug class
LABA/LAMA combination
vilanterol/umeclidinium brand name
Anoro Ellipta
vilanterol/umeclidinium dosage form
Ellipta
vilanterol/umeclidinium age group
> = 12 years old
vilanterol/umeclidinium indication
COPD
indacaterol/glycopyrronium drug class
LABA/LAMA combination
indacaterol/glycopyrronium brand name
Utibron Neohaler
indacaterol/glycopyrronium dosage form
Neohaler
indacaterol/glycopyrronium age group
> = 12 years old
indacaterol/glycopyrronium indication
COPD
formoterol/glycopyrronium drug class
LABA/LAMA combination
formoterol/glycopyrronium brand name
Bevespi Aerosphere
formoterol/glycopyrronium dosage form
Aerosphere
formoterol/glycopyrronium age group
> = 12 years old
formoterol/glycopyrronium indication
COPD
formoterol/aclidinium drug class
LABA/LAMA combination
formoterol/aclidinium brand name
Duaklir Pressair
formoterol/aclidinium dosage form
DPI
formoterol/aclidinium age group
> = 12 years old
formoterol/aclidinium indication
COPD
LABA/LAMA combination counseling tip
not indicated for treatment of acute deteriorations
fluticasone/umeclidinium/vilanterol drug class
LABA/LAMA/ICS combination
fluticasone/umeclidinium/vilanterol brand name
Trelegy Ellipta
fluticasone/umeclidinium/vilanterol dosage form
Ellipta
fluticasone/umeclidinium/vilanterol age group
> =12 years old
budesonide/glycopyrrolate/formoterol fumarate drug class
LABA/LAMA/ICS combination
budesonide/glycopyrrolate/formoterol fumarate brand name
Breztri Aerosphere
budesonide/glycopyrrolate/formoterol fumarate dosage form
Aerosphere
budesonide/glycopyrrolate/formoterol fumarate age group
> = 12 years old
budesonide/glycopyrrolate/formoterol fumarate indication
COPD
cromolyn drug class
mast cell stabilizer
cromolyn brand name
Intal
cromolyn dosage form
nebulizer solution
cromolyn age groups
all
mast cell stabilizer adverse effects
-high incidence of unpleasant taste in mouth (>10%)
-rare cardiac arrhythmias
-coughing
-dyspnea
-sore throat
-nausea, vomiting, and diarrhea if absorbed systemically
mast cell stabilizer counseling tips
-less effective than low-dose ICS
-prevents increase in bronchial hyperreactivity seen in allergy season
montelukast drug class
leukotriene modifiers
montelukast brand name
Singulair
montelukast dosage forms
tablets, chewable tablets, and granule packets
montelukast age groups
> = 1 year old
montelukast counseling tips
-minor substrate of CYP2C8/9 and 3A4
-not for acute relief of symptoms
-boxed warning –> neuropsychiatric events
zafirlukast drug class
leukotriene modifiers
zafirlukast brand name
Accolate
zafirlukast dosage form
tablet
zafirlukast age groups
> = 5 years old
zafirlukast counseling tips
-take at least 1 hour before or 2 hours after meals
-can increase INR
-major substrate and minor inhibitor of CYP2C9
zileuton drug class
leukotriene modifiers
zileuton brand name
Zyflo CR
zileuton dosage forms
IR tablets and ER tablets
zileuton age group
> = 12 years old
zileuton counseling tips
-weak CYP1A2 inhibitor
-take with food
leukotriene modifier adverse effects
-neuropsychiatric events (agitation, anxiety, abnormal dreams, hallucinations, depression, suicidal thinking)
-Churg-Strauss syndrome (rare)
-increased hepatic transaminases (zafirlukast and zileuton)
leukotriene modifier counseling tips
-less effective than low-dose ICS and ICS/LABA in asthma
-have not been adequately trialed in COPD
theophylline drug class
methylxanthines
theophylline brand name
Theochron
theophylline dosage forms
ER 12 hour tablets, ER 24 hour tablets, ER 24 hour capsule, and liquid solution
theophylline indications
acute exacerbation and chronic management
methylxanthine adverse effects
-insomnia
-gastrointestinal upset
-hyperactivity
-hypotension
-tremor
methylxanthine dose-related toxicities
-tachycardia
-nausea
-vomiting
-headache
-seizures
-arrhythmias
methylxanthine contraindications
-peptic ulcer disease
-arrhythmias
-seizure disorders
methylxanthine drug interactions
-major substrate of CYP3A4, 1A2, and 2E1
-increases concentration –> cimetidine, erythromycin, clarithromycin, ciprofloxacin, ticlopidine
-decreases concentration –> phenobarbital, phenytoin, carbamazepine, rifampin, smoking
-PDE III inhibition is a likely cause for hypotension, tachycardia, and nausea
omalizumab drug class
anti-IgE
omalizumab brand name
Xolair
omalizumab dosage forms
prefilled syringe and vial
omalizumab age groups
> = 6 years old
anti-IgE adverse effects
-headache
-injection site reactions
-arthralgias
-thrombocytopenia
-pharyngitis
-sinusitis
-upper respiratory tract infections
anti-IgE boxed warning
anaphylaxis
anti-IgE counseling tips
-do not give more than 150 mg per injection site
-monitor for anaphylaxis before and after injection
-FDA approved for moderate to severe persistent asthma in patients with a positive skin test or reactivity to a perennial aeroallergen and symptoms that are inadequately controlled with ICS
mepolizumab drug class
anti-IL5
mepolizumab brand name
Nucala
mepolizumab dosage forms
auto-injector and vial
mepolizumab age groups
> = 6 years old
mepolizumab adverse effects
-headache
-injection site reactions
-arthralgias
-herpes zoster infection
mepolizumab counseling tips
-anaphylaxis (precaution)
-available as in-clinic or at-home injection
-monitor for anaphylaxis before and after injection
-indicated for add-on maintenance treatment of patients with severe asthma with an eosinophilic phenotype
reslizumab drug class
anti-IL5
reslizumab brand name
Clinqair
reslizumab dosage form
liquid solution
reslizumab age group
> = 18 years old
reslizumab adverse effects
-injection site reactions
-myalgias
-increased creatinine phosphokinase
reslizumab boxed warning
anaphylaxis and malignancies
reslizumab counseling tips
-monitor for anaphylaxis before and after injection
-indicated for add-on maintenance treatment of patients with severe asthma with an eosinophilic phenotype
benralizumab drug class
anti-IL5
benralizumab brand name
Fasenra
benralizumab dosage forms
auto-injector and pre-filled syringe
benralizumab age group
> = 12 years old
benralizumab adverse effects
-injection site reactions
-antibody development
-headache
-pharyngitis
-fever
benralizumab counseling tips
-anaphylaxis (precaution)
-available in pre-filled syringe for in-office or at-home administration
-indicated as an add-on maintenance treatment of severe asthma in adults and children >= 12 years of age with an eosinophilic phenotype
-acts on IL-5 receptors while others act on IL-5
dupilumab drug class
anti-IL4/IL13
dupilumab brand name
Dupixent
dupilumab dosage form
injection
dupilumab age group
> = 12 years old
dupilumab adverse effects
-injection site reactions
-antibody development
-arthralgias
-conjunctivitis
dupilumab counseling tips
-anaphylaxis (precaution)
-available in pre-filled syringe for in-office or at-home administration
-indicated as an add-on maintenance treatment in patients with moderate to severe asthma aged 12 years and older with an eosinophilic phenotype or with oral corticosteroid dependent asthma
roflumilast drug class
phosphodiaesterase-4 inhibitors
roflumilast brand name
Daliresp
roflumilast dosage form
tablet
roflumilast age group
> = 12 years old
roflumilast indication
COPD
roflumilast adverse effects
hemagglutinin
roflumilast monitoring
liver function test and weight
roflumilast drug interactions
CYP3A4 (major) and CYP1A2 (minor)
roflumilast contraindication
Child-Pugh class B or C