Asthma/COPD Flashcards
1
Q
Beclomethasone Brand Name
A
QVAR
2
Q
Beclomethasone Dosage Form
A
Redihaler (MDI)
3
Q
Beclomethasone Drug Class
A
Inhaled Corticosteroid (ICS)
4
Q
Budesonide Brand Name
A
Pulmicort
5
Q
Budesonide Dosage Form
A
Flexhaler or nebulizer
6
Q
Budesonide Drug Class
A
Inhaled Corticosteroid (ICS)
7
Q
Ciclesonide Brand Name
A
Alvesco
8
Q
Ciclesonide Dosage Form
A
HFA
9
Q
Ciclesonide Drug Class
A
Inhaled Corticosteroid (ICS)
10
Q
Fluticasone Propionate Brand Name
A
Flovent or ArmonAir Digihaler (only for Aerosol Powder Inhaler)
11
Q
Fluticasone Propionate Dosage Form
A
HFA, DPI, or Aerosol Powder Inhaler
12
Q
Fluticasone Propionate Drug Class
A
Inhaled Corticosteroid (ICS)
13
Q
Fluticasone Furoate Brand Name
A
Arnuity Ellipta
14
Q
Fluticasone Furoate Dosage Form
A
Ellipta
15
Q
Fluticasone Furoate Drug Class
A
Inhaled Corticosteroid (ICS)
16
Q
Mometasone Brand Names
A
Asmanex
17
Q
Mometasone Dosage Form
A
HFA and Twisthaler
18
Q
Mometasone Drug Class
A
Inhaled Corticosteroid (ICS)
19
Q
Arformoterol Tartrate Brand Name
A
Brovana
20
Q
Arformoterol Tartrate Dosage Form
A
Nebulizer solution
21
Q
Arformoterol Tartrate Drug Class
A
Long Acting Beta Agonist (LABA)
22
Q
Formoterol Brand Name
A
Perforomist
23
Q
Formoterol Dosage Form
A
Nebulizer Solution
24
Q
Formoterol Drug Class
A
Long Acting Beta Agonist (LABA)
25
Indacaterol Brand Name
Arcapta Neohaler
26
Indacaterol Dosage Form
Neohaler
27
Indacaterol Drug Class
Long Acting Beta Agonist (LABA)
28
Olodaterol Brand Name
Striverdi Respimat
29
Olodaterol Dosage Form
Respimat
30
Olodaterol Drug Class
Long Acting Beta Agonist (LABA)
31
Salmeterol Brand Name
Serevent
32
Salmeterol Dosage Form
Diskus
33
Salmeterol Drug Class
Long Acting Beta Agonist (LABA)
34
Aclidinium Brand Name
Turdorza Pressair
35
Aclidinium Dosage Form
DPI
36
Aclidinium Drug Class
Long-Acting Antimuscarinics (LAMA)
37
Glycopyrrolate Brand Name
Seebri Neohaler
38
Glycopyrrolate Dosage Form
DPI and Nebulization Solution
39
Glycopyrrolate Drug Class
Long-Acting Antimuscarinics (LAMA)
40
Revefenacin Brand Name
Yupelri
41
Revefenacin Dosage Form
Nebulization Solution
42
Revefenacin Drug Class
Long-Acting Antimuscarinics (LAMA)
43
Tiotropium Brand Name
Spiriva
44
Tiotropium Dosage Form
Handihaler and Respimat
45
Tiotropium Drug Class
Long-Acting Antimuscarinics (LAMA)
46
Umeclidinium Brand Name
Incruse Ellipta
47
Umeclidinium Dosage Form
DPI
48
Umeclidinium Drug Class
Long-Acting Antimuscarinics (LAMA)
49
Fluticasone/Salmeterol Brand Name
Advair/AirDuo and AirDuo Digihaler
50
Fluticasone/Salmeterol Dosage Form
Advair: DPI and HFA
Airduo: Respiclick (DPI)
51
Fluticasone/Salmeterol Drug Class
ICS/LABA Combination Products
52
Budesonide/Formoterol Brand Name
Symbicort
53
Budesonide/Formoterol Dosage Form
HFA MDI
54
Budesonide/Formoterol Drug Class
ICS/LABA Combination Products
55
Mometasone/Formoterol Brand Name
Dulera
56
Mometasone/Formoterol Dosage Form
MDI
57
Mometasone/Formoterol Drug Class
ICS/LABA Combination Products
58
Fluticasone/Vilanterol Brand Name
Breo Ellipta
59
Fluticasone/Vilanterol Dosage Form
DPI
60
Fluticasone/Vilanterol Drug Class
ICS/LABA Combination Products
61
Olodaterol/Tiotropium Brand Name
Stiolto Respimat
62
Olodaterol/Tiotropium Dosage Form
Respimat
63
Olodaterol/Tiotropium Drug Class
LABA/LAMA Combination Products
64
Vilanterol/Umeclidinium Brand Name
Anoro Ellipta
65
Vilanterol/Umeclidinium Dosage Form
Ellipta
66
Vilanterol/Umeclidinium Drug Class
LABA/LAMA Combination Products
67
Indacaterol/Glycopyrronium Brand Name
Utibron Neohaler
68
Indacaterol/Glycopyrronium Dosage Form
Neohaler
69
Indacaterol/Glycopyrronium Drug Class
LABA/LAMA Combination Products
70
Formoterol/Glycopyrronium Brand Name
Bevespi Aerosphere
71
Formoterol/Glycopyrronium Dosage Form
Aerosphere
72
Formoterol/Glycopyrronium Drug Class
LABA/LAMA Combination Products
73
Formoterol/Aclidinium Brand Name
Dukalir Pressair
74
Formoterol/Aclidinium Dosage Form
DPI
75
Formoterol/Aclidinium Drug Class
LABA/LAMA Combination Products
76
Fluticasone/Umeclidinium/Vilanterol Brand Name
Trelegy Ellipta
77
Fluticasone/Umeclidinium/Vilanterol Dosage Form
Ellipta
78
Fluticasone/Umeclidinium/Vilanterol Drug Class
LABA/LAMA/ICS Combination Products
79
Budesonide/Glycopyrrolate/Formoterol Fumarate Brand Name
Breztri Aerosphere
80
Budesonide/Glycopyrrolate/Formoterol Fumarate Dosage Form
Aerosphere
81
Budesonide/Glycopyrrolate/Formoterol Fumarate Drug Class
LABA/LAMA/ICS Combination Products
82
Cromolyn Brand Name
Intal
83
Cromolyn Dosage Form
Nebulizer Solution
84
Cromolyn Drug Class
Mast Cell Stabilizer
85
Montelukast Brand Name
Singulair
86
Montelukast Dosage Form
Tablets (chewable) and Granule Packets
87
Montelukast Drug Class
Leukotriene Modifiers
88
Zafirlukast Brand Name
Accolate
89
Zafirlukast Dosage Form
Tablets
90
Zafirlukast Drug Class
Leukotriene Modifiers
91
Zileuton Brand Name
Zyflo CR
92
Zileuton Dosage Form
IR Tablets and ER Tablets
93
Zileuton Drug Class
Leukotriene Modifiers
94
Theophylline Brand Name
Theochron
95
Theophylline Dosage Form
ER 12 Hour tablets, ER 24 Hour Tablets, ER 24 Hour Capsule, and Liquid
96
Theophylline Drug Class
Methylxanthines
97
Omalizumab Brand Name
Xolair
98
Omalizumab Dosage Form
Prefilled syringe and Vial
99
Omalizumab Drug Class
Anti-IgE
100
Mepolizumab Brand Name
Nucala
101
Mepolizumab Dosage Form
Auto-injector and Powder to be Reconstituted with Sterile Water
102
Mepolizumab Drug Class
Anti-IL5
103
Reslizumab Brand Name
Cinqair
104
Reslizumab Dosage Form
Solution for Dilution for Injection
105
Reslizumab Drug Class
Anti-IL5
106
Benralizumab Brand Name
Fasenra
107
Benralizumab Dosage Form
Auto-injector and Pre-filled Syringe
108
Benralizumab Drug Class
Anti-IL5
109
Dupilumab Brand Name
Dupixent
110
Dupilumab Dosage Form
Injection
111
Dupilumab Drug Class
Anti-IL4/IL13
112
Roflumilast Brand Name
Daliresp
113
Roflumilast Dosage Form
Tablets
114
Roflumilast Drug Class
Phosphodiaesterase-4 Inhibitors
115
Inhaled Corticosteroid (ICS) Action
Prevent and Control Inflammation
116
Inhaled Corticosteroid (ICS) Adverse Effects
Oral Thrush (Candidiasis), Cough, Dysphonia
117
Inhaled Corticosteroid (ICS) Counseling Tip
Counseling Tips: Patients should rinse their mouth and spit after use to prevent oral thrush
118
Inhaled Corticosteroid (ICS) Clinical Pearls
Inhaled corticosteroids (ICSs) are the most effective long-term control therapy for asthma (improve quality of life, increase lung function, and reduce the risk for exacerbations)
ICSs may increase the risk of pneumonia in patients with COPD
Titrate to the lowest effective dose- see low, medium, and high dose conversion table
Pulmicort Respules should use Jet Nebulizer and should not be mixed with other nebulizer medications
High doses can increase the risk for systemic side effects
See steroid potency chart for dosing
119
Long Acting Beta Agonist (LABA) Action
Increase in cAMP leads to bronchial smooth muscle relaxation and inhibits hypersensitivity mediators from mast cells (histamine and leukotrienes)
120
Long Acting Beta Agonist (LABA) Adverse Effects
Tachycardia, headache, tremor, hypokalemia
121
Long Acting Beta Agonist (LABA) Boxed Warnings
Increased risk of asthma related death for all monotherapy LABA use- should not be used alone for asthma treatment
Increasing hospitalizations in pediatric and adolescent patients
122
Long Acting Beta Agonist (LABA) Clinical Pearls
Prolonged QT seen with intentional overdoses
Not for acute symptoms
May be helpful for exercise induce bronchospasm
Formoterol and indacaterol capsules should not be taken orally
123
Long Acting Beta Agonist (LABA) Pediatric Considerations
Most children <4 years old cannot provide sufficient inspiratory flow for adequate lung delivery with a DPI
124
Long Acting Antimuscarinics (LAMA) Action
Blocks the bronchoconstrictor effects of acetylcholine on M3 and M2 receptors
125
Long Acting Antimuscarinics (LAMA) Adverse Effects
Dry mouth, dizziness, blurred vision, upper respiratory infections and paradoxical bronchospasms
126
Long Acting Antimuscarinics (LAMA) Clinical Pearls
Tiotropium has been approved for use in asthma as an add-on option for children 12 years and older
127
ICS/LABA Combination Clinical Pearls
Guidelines recommend combination LABA with ICS in asthma, as LABA should not be used as monotherapy
Combination products developed to create convenient packaging and assist with patient adherence
128
LABA/LAMA Combination Clinical Pearls
Not indicated for treatment of acute deteriorations
129
Mast Cell Stabilizer Adverse Effects
High incidence of unpleasant taste in mouth (>10%), rare cardiac arrhythmias, coughing, dyspnea, sore throat, N/V/D if absorbed systemically
130
Mast Cell Stabilizer Clinical Pearls
Less Effective than low-dose ICS
Prevents increase in bronchial hyperreactivity seen in allergy season
131
Leukotriene Modifier Action
Block the production of leukotrienes
132
Leukotriene Modifier Adverse Effects
Neuropsychiatric events (agitation, anxiety, abnormal dreams, hallucinations, depression, suicidal thinking), Churg-Strauss syndrome (rare), Increased hepatic transaminases (zafirlukast and zileuton)
133
Leukotriene Modifier Clinical Pearls
Less effective than low dose ICS and ICS/LABA in asthma
Have not been adequately trialed in COPD
134
Montelukast Clinical Pearls
Minor substrate of CYP2C8/9 and 3A4
Not for acute relief of symptoms
Boxed warning: neuropsychiatric events
135
Zafirlukast Clinical Pearls
Take at least 1 hour before or 2 hours after meals
Can increase INR
Major substrate, minor inhibitor of CYP2C9
136
Zileuton Clinical Pearls
Weak CYP1A2 inhibitor
Take with food
137
Methylxanthine Action
Bronchodilation through inhibition of PDE III and PDE IV
138
Methylxanthine Adverse Effects
Insomnia, gastrointestinal upset, hyperactivity, hypotension, tremor
Dose related toxicity: tachycardia, nausea, vomiting, headache, seizures, arrhythmias
CI: peptic ulcer disease, arrythmias, seizure disorders
139
Methylxanthine Clinical Pearls
DI: Major substrate of CYP3A4, 1A2, 2E1
Increased concentration caused by cimetidine, erythromycin, clarithromycin, ciprofloxacin, ticlopidine
Decreased Concentration caused by phenobarbital, phenytoin, carbamazepine, rifampin; smoking
PDE III inhibition likely cause for hypotension, tachycardia and nausea
140
Anti-IgE Action
Inhibit IgE binding to receptors on mast cells and basophils, inhibit mediator release and attenuation of early- and late-phase allergic response
141
Anti-IgE Adverse Effects
Headache, injection site reactions, arthralgias, thrombocytopenia, pharyngitis, sinusitis, upper respirator tract infections
142
Anti-IgE Clinical Pearls
Boxed warning: anaphylaxis
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
143
Anti-IL5 Action
Blocks binding of IL-5 to the alpha chain of the IL-5 receptor complex, which results in reduced production and survival of eosinophils
144
Mepolizumab Adverse Effects
Headache, injection site reactions, arthralgias, Herpes Zoster infection
145
Mepolizumab Clinical Pearls
Precaution: anaphylaxis
Available as an 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
146
Reslizumab Adverse Effects
Injection site reactions, myalgias, increased creatine phosphokinase
147
Reslizumab Clinical Pearls
Boxed warning: anaphylaxis, malignancies
Monitor for anaphylaxis before and after injection
Indicated for add-on maintenance treatment of patients with severe asthma with an eosinophilic phenotype
148
Benralizumab Adverse Effects
Injection site reactions, antibody development, headache, pharyngitis, fever
149
Benralizumab Clinical Pearls
Precaution: anaphylaxis
Available as an in-clinic or at-home injection
Indicated for add-on maintenance treatment of severe asthma in adults and children 12 years or older with an eosinophilic phenotype
Acts on IL-5 receptors while others act on IL-5
150
Anti-IL4/IL13 Action
Blocks binding of IL/4 to reduce eosinophil trafficking and IgE reactions while also blocking IL-13 to reduce mucus secretion and airway remodeling
151
Anti-IL4/IL13 Adverse Effects
Injection site reactions, antibody development, arthralgias, conjunctivitis
152
Anti-IL4/IL13 Clinical Pearls
Precaution: anaphylaxis
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
153
Phosphodiaesterase-4 Inhibitor Action
Inhibits PDE4 leading to an increase in cAMP
154
Phosphodiaesterase-4 Inhibitor Adverse Effects
HA, weight loss, diarrhea, nausea
155
Phosphodiaesterase-4 Inhibitor Clinical Pearls
Monitoring: liver function test, weight
DI: CYP3A4 (major), CYP1A2 (minor)
CI: Child-pugh class B or C
156
Albuterol HFA Brand Name
ProAir, Ventolin, Proventil, Proair Respiclick, and ProAir Digihaler
157
Albuterol HFA Dosage Form
Metered dose inhaler (MDI), aerosol powder inhaler, and nebulizer solution (not for HFA)
158
Albuterol HFA Drug Class
Short acting beta-2 agonists (SABA)
159
Levalbuterol HFA Brand Name
Xopenex
160
Levalbuterol Dosage Form
MDI and nebulizer solution (not for HFA)
161
Levalbuterol Drug Class
Short acting beta-2 agonists (SABA)
162
Ipratropium HFA Brand Name
Atrovent
163
Ipratropium Dosage Form
MDI and nebulizer solution
164
Ipratropium Drug Class
Short-acting anticholinergics (SAMA)
165
Ipratropium/Albuterol Brand Name
Combivent respimat (MDI) and DuoNeb (Nebulizer Solution)
166
Ipratropium/Albuterol Dosage Form
MDI and Nebulizer Solution
167
Ipratropium/Albuterol Drug Class
Short-acting anticholinergics (SAMA)
168
Methylprednisolone Dosage Form
Tablets
169
Methylprednisolone Drug Class
Systemic Corticosteroids
170
Prednisolone Dosage Form
Tablets and oral liquid
171
Prednisolone Drug Class
Systemic Corticosteroids
172
Prednisone Dosage Form
Tablets and oral liquids
173
Prednisone Drug Class
Systemic Corticosteroids
174
Dexamethasone Dosage Form
Oral liquid, tablets, and injection
175
Dexamethasone Drug Class
Systemic Corticosteroids
176
Methylprednisolone Acetate Dosage Form
Repository injection
177
Methylprednisolone Acetate Drug Class
Systemic Corticosteroids
178
Short Acting Beta-2 Agonist Action
Increases cAMP which antagonizes bronchoconstriction through smooth muscle relaxation (reverse obstruction and improve airflow)
179
Albuterol Adverse Effects
Tachycardia, tremor, hypokalemia, irritability
180
Albuterol Clinical Pearls
Chronic use (>2 times per day) indicates poor asthma control
May mix nebulizer solution with cromolyn solution, budesonide inhalant suspension, or ipratropium solution
In mild to moderate exacerbations, MDI plus valved holding chamber is as effective as nebulized therapy with appropriate administration technique and coaching by trained personnel
181
Levalbuterol Adverse Effects
Tachycardia, tremor, hypokalemia, irritability
182
Levalbuterol Clinical Pearls
Reserved for patients who do not respond to albuterol for quick relief
Nebulizer solution compatible with budesonide inhalant suspension
Levalbuterol administered in 1/2 the mg dose of albuterol provides comparable efficacy and safety
Has not been evaluated by continuous nebulization
183
Ipratropium Adverse Effects
Dry mouth, urinary retention, infection, sinusitis, bronchitis
184
Ipratropium Clinical Pearls
Used in combo with albuterol for asthma exacerbation treatment
May mix in same nebulizer with albuterol
Should not be used as first-line therapy; should be added to SABA therapy for severe exacerbations
DuoNeb: May be used for up to 3 hours in initial management of severe exacerbations
185
Short-Acting Anticholinergic Action
Completely inhibit cholinergic receptors in bronchial smooth muscle leads to a decrease in cGMP causing bronchodilation
186
Systemic Corticoids Action
Decrease in inflammation and an increase in response to beta-2 agonists
187
Systemic Corticoids Adverse Effects
Short term use - hyperglycemia, increased appetite, fluid retention, demargination of WBCs, psychiatric disturbances
188
Systemic Corticoids Clinical Pearls
CI: systemic fungal infections, administration of live vaccines if immunocompromised
DI: warfarin INR increase; decrease efficacy of inactivated vaccines
May be used with ICS if patient already taking ICS before hospitalization
May also be used for chronic therapy in both asthma (and COPD) only in severe stages
"Bursts" effective for establishing control when initiating therapy or during period of gradual deterioration
Injection may be used in place of "burst" if adherence is an issue or patient is vomiting
189
Epinephrine Comments
No proven advantage of systemic therapy over aerosol
Indicated in addition to standard therapy for acute asthma associated with anaphylaxis and/or angioedema
190
Terbutaline Comments
No proven advantage of systemic therapy over aerosol
191
Magnesium Sulfate Action
Smooth muscle relaxation through inhibition of calcium influx into smooth muscle cells
192
Magnesium Sulfate Comments
Adverse Effects: Flushing, hypotension, vasodilation
CI: Heart block; caution in renal dysfunction
Consider if patient remains in life threatening exacerbation after 1 hour of therapy
