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Therapeutics 1 > Asthma/COPD > Flashcards

Asthma/COPD Flashcards

1
Q

Beclomethasone Brand Name

A

QVAR

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2
Q

Beclomethasone Dosage Form

A

Redihaler (MDI)

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3
Q

Beclomethasone Drug Class

A

Inhaled Corticosteroid (ICS)

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4
Q

Budesonide Brand Name

A

Pulmicort

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5
Q

Budesonide Dosage Form

A

Flexhaler or nebulizer

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6
Q

Budesonide Drug Class

A

Inhaled Corticosteroid (ICS)

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7
Q

Ciclesonide Brand Name

A

Alvesco

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8
Q

Ciclesonide Dosage Form

A

HFA

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9
Q

Ciclesonide Drug Class

A

Inhaled Corticosteroid (ICS)

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10
Q

Fluticasone Propionate Brand Name

A

Flovent or ArmonAir Digihaler (only for Aerosol Powder Inhaler)

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11
Q

Fluticasone Propionate Dosage Form

A

HFA, DPI, or Aerosol Powder Inhaler

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12
Q

Fluticasone Propionate Drug Class

A

Inhaled Corticosteroid (ICS)

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13
Q

Fluticasone Furoate Brand Name

A

Arnuity Ellipta

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14
Q

Fluticasone Furoate Dosage Form

A

Ellipta

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15
Q

Fluticasone Furoate Drug Class

A

Inhaled Corticosteroid (ICS)

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16
Q

Mometasone Brand Names

A

Asmanex

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17
Q

Mometasone Dosage Form

A

HFA and Twisthaler

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18
Q

Mometasone Drug Class

A

Inhaled Corticosteroid (ICS)

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19
Q

Arformoterol Tartrate Brand Name

A

Brovana

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20
Q

Arformoterol Tartrate Dosage Form

A

Nebulizer solution

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21
Q

Arformoterol Tartrate Drug Class

A

Long Acting Beta Agonist (LABA)

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22
Q

Formoterol Brand Name

A

Perforomist

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23
Q

Formoterol Dosage Form

A

Nebulizer Solution

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24
Q

Formoterol Drug Class

A

Long Acting Beta Agonist (LABA)

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25
Q

Indacaterol Brand Name

A

Arcapta Neohaler

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26
Q

Indacaterol Dosage Form

A

Neohaler

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27
Q

Indacaterol Drug Class

A

Long Acting Beta Agonist (LABA)

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28
Q

Olodaterol Brand Name

A

Striverdi Respimat

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29
Q

Olodaterol Dosage Form

A

Respimat

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30
Q

Olodaterol Drug Class

A

Long Acting Beta Agonist (LABA)

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31
Q

Salmeterol Brand Name

A

Serevent

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32
Q

Salmeterol Dosage Form

A

Diskus

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33
Q

Salmeterol Drug Class

A

Long Acting Beta Agonist (LABA)

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34
Q

Aclidinium Brand Name

A

Turdorza Pressair

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35
Q

Aclidinium Dosage Form

A

DPI

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36
Q

Aclidinium Drug Class

A

Long-Acting Antimuscarinics (LAMA)

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37
Q

Glycopyrrolate Brand Name

A

Seebri Neohaler

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38
Q

Glycopyrrolate Dosage Form

A

DPI and Nebulization Solution

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39
Q

Glycopyrrolate Drug Class

A

Long-Acting Antimuscarinics (LAMA)

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40
Q

Revefenacin Brand Name

A

Yupelri

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41
Q

Revefenacin Dosage Form

A

Nebulization Solution

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42
Q

Revefenacin Drug Class

A

Long-Acting Antimuscarinics (LAMA)

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43
Q

Tiotropium Brand Name

A

Spiriva

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44
Q

Tiotropium Dosage Form

A

Handihaler and Respimat

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45
Q

Tiotropium Drug Class

A

Long-Acting Antimuscarinics (LAMA)

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46
Q

Umeclidinium Brand Name

A

Incruse Ellipta

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47
Q

Umeclidinium Dosage Form

A

DPI

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48
Q

Umeclidinium Drug Class

A

Long-Acting Antimuscarinics (LAMA)

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49
Q

Fluticasone/Salmeterol Brand Name

A

Advair/AirDuo and AirDuo Digihaler

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50
Q

Fluticasone/Salmeterol Dosage Form

A

Advair: DPI and HFA

Airduo: Respiclick (DPI)

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51
Q

Fluticasone/Salmeterol Drug Class

A

ICS/LABA Combination Products

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52
Q

Budesonide/Formoterol Brand Name

A

Symbicort

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53
Q

Budesonide/Formoterol Dosage Form

A

HFA MDI

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54
Q

Budesonide/Formoterol Drug Class

A

ICS/LABA Combination Products

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55
Q

Mometasone/Formoterol Brand Name

A

Dulera

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56
Q

Mometasone/Formoterol Dosage Form

A

MDI

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57
Q

Mometasone/Formoterol Drug Class

A

ICS/LABA Combination Products

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58
Q

Fluticasone/Vilanterol Brand Name

A

Breo Ellipta

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59
Q

Fluticasone/Vilanterol Dosage Form

A

DPI

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60
Q

Fluticasone/Vilanterol Drug Class

A

ICS/LABA Combination Products

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61
Q

Olodaterol/Tiotropium Brand Name

A

Stiolto Respimat

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62
Q

Olodaterol/Tiotropium Dosage Form

A

Respimat

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63
Q

Olodaterol/Tiotropium Drug Class

A

LABA/LAMA Combination Products

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64
Q

Vilanterol/Umeclidinium Brand Name

A

Anoro Ellipta

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65
Q

Vilanterol/Umeclidinium Dosage Form

A

Ellipta

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66
Q

Vilanterol/Umeclidinium Drug Class

A

LABA/LAMA Combination Products

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67
Q

Indacaterol/Glycopyrronium Brand Name

A

Utibron Neohaler

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68
Q

Indacaterol/Glycopyrronium Dosage Form

A

Neohaler

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69
Q

Indacaterol/Glycopyrronium Drug Class

A

LABA/LAMA Combination Products

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70
Q

Formoterol/Glycopyrronium Brand Name

A

Bevespi Aerosphere

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71
Q

Formoterol/Glycopyrronium Dosage Form

A

Aerosphere

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72
Q

Formoterol/Glycopyrronium Drug Class

A

LABA/LAMA Combination Products

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73
Q

Formoterol/Aclidinium Brand Name

A

Dukalir Pressair

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74
Q

Formoterol/Aclidinium Dosage Form

A

DPI

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75
Q

Formoterol/Aclidinium Drug Class

A

LABA/LAMA Combination Products

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76
Q

Fluticasone/Umeclidinium/Vilanterol Brand Name

A

Trelegy Ellipta

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77
Q

Fluticasone/Umeclidinium/Vilanterol Dosage Form

A

Ellipta

78
Q

Fluticasone/Umeclidinium/Vilanterol Drug Class

A

LABA/LAMA/ICS Combination Products

79
Q

Budesonide/Glycopyrrolate/Formoterol Fumarate Brand Name

A

Breztri Aerosphere

80
Q

Budesonide/Glycopyrrolate/Formoterol Fumarate Dosage Form

A

Aerosphere

81
Q

Budesonide/Glycopyrrolate/Formoterol Fumarate Drug Class

A

LABA/LAMA/ICS Combination Products

82
Q

Cromolyn Brand Name

A

Intal

83
Q

Cromolyn Dosage Form

A

Nebulizer Solution

84
Q

Cromolyn Drug Class

A

Mast Cell Stabilizer

85
Q

Montelukast Brand Name

A

Singulair

86
Q

Montelukast Dosage Form

A

Tablets (chewable) and Granule Packets

87
Q

Montelukast Drug Class

A

Leukotriene Modifiers

88
Q

Zafirlukast Brand Name

A

Accolate

89
Q

Zafirlukast Dosage Form

A

Tablets

90
Q

Zafirlukast Drug Class

A

Leukotriene Modifiers

91
Q

Zileuton Brand Name

A

Zyflo CR

92
Q

Zileuton Dosage Form

A

IR Tablets and ER Tablets

93
Q

Zileuton Drug Class

A

Leukotriene Modifiers

94
Q

Theophylline Brand Name

A

Theochron

95
Q

Theophylline Dosage Form

A

ER 12 Hour tablets, ER 24 Hour Tablets, ER 24 Hour Capsule, and Liquid

96
Q

Theophylline Drug Class

A

Methylxanthines

97
Q

Omalizumab Brand Name

A

Xolair

98
Q

Omalizumab Dosage Form

A

Prefilled syringe and Vial

99
Q

Omalizumab Drug Class

A

Anti-IgE

100
Q

Mepolizumab Brand Name

A

Nucala

101
Q

Mepolizumab Dosage Form

A

Auto-injector and Powder to be Reconstituted with Sterile Water

102
Q

Mepolizumab Drug Class

A

Anti-IL5

103
Q

Reslizumab Brand Name

A

Cinqair

104
Q

Reslizumab Dosage Form

A

Solution for Dilution for Injection

105
Q

Reslizumab Drug Class

A

Anti-IL5

106
Q

Benralizumab Brand Name

A

Fasenra

107
Q

Benralizumab Dosage Form

A

Auto-injector and Pre-filled Syringe

108
Q

Benralizumab Drug Class

A

Anti-IL5

109
Q

Dupilumab Brand Name

A

Dupixent

110
Q

Dupilumab Dosage Form

A

Injection

111
Q

Dupilumab Drug Class

A

Anti-IL4/IL13

112
Q

Roflumilast Brand Name

A

Daliresp

113
Q

Roflumilast Dosage Form

A

Tablets

114
Q

Roflumilast Drug Class

A

Phosphodiaesterase-4 Inhibitors

115
Q

Inhaled Corticosteroid (ICS) Action

A

Prevent and Control Inflammation

116
Q

Inhaled Corticosteroid (ICS) Adverse Effects

A

Oral Thrush (Candidiasis), Cough, Dysphonia

117
Q

Inhaled Corticosteroid (ICS) Counseling Tip

A

Counseling Tips: Patients should rinse their mouth and spit after use to prevent oral thrush

118
Q

Inhaled Corticosteroid (ICS) Clinical Pearls

A

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
Q

Long Acting Beta Agonist (LABA) Action

A

Increase in cAMP leads to bronchial smooth muscle relaxation and inhibits hypersensitivity mediators from mast cells (histamine and leukotrienes)

120
Q

Long Acting Beta Agonist (LABA) Adverse Effects

A

Tachycardia, headache, tremor, hypokalemia

121
Q

Long Acting Beta Agonist (LABA) Boxed Warnings

A

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
Q

Long Acting Beta Agonist (LABA) Clinical Pearls

A

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
Q

Long Acting Beta Agonist (LABA) Pediatric Considerations

A

Most children <4 years old cannot provide sufficient inspiratory flow for adequate lung delivery with a DPI

124
Q

Long Acting Antimuscarinics (LAMA) Action

A

Blocks the bronchoconstrictor effects of acetylcholine on M3 and M2 receptors

125
Q

Long Acting Antimuscarinics (LAMA) Adverse Effects

A

Dry mouth, dizziness, blurred vision, upper respiratory infections and paradoxical bronchospasms

126
Q

Long Acting Antimuscarinics (LAMA) Clinical Pearls

A

Tiotropium has been approved for use in asthma as an add-on option for children 12 years and older

127
Q

ICS/LABA Combination Clinical Pearls

A

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
Q

LABA/LAMA Combination Clinical Pearls

A

Not indicated for treatment of acute deteriorations

129
Q

Mast Cell Stabilizer Adverse Effects

A

High incidence of unpleasant taste in mouth (>10%), rare cardiac arrhythmias, coughing, dyspnea, sore throat, N/V/D if absorbed systemically

130
Q

Mast Cell Stabilizer Clinical Pearls

A

Less Effective than low-dose ICS

Prevents increase in bronchial hyperreactivity seen in allergy season

131
Q

Leukotriene Modifier Action

A

Block the production of leukotrienes

132
Q

Leukotriene Modifier Adverse Effects

A

Neuropsychiatric events (agitation, anxiety, abnormal dreams, hallucinations, depression, suicidal thinking), Churg-Strauss syndrome (rare), Increased hepatic transaminases (zafirlukast and zileuton)

133
Q

Leukotriene Modifier Clinical Pearls

A

Less effective than low dose ICS and ICS/LABA in asthma

Have not been adequately trialed in COPD

134
Q

Montelukast Clinical Pearls

A

Minor substrate of CYP2C8/9 and 3A4

Not for acute relief of symptoms

Boxed warning: neuropsychiatric events

135
Q

Zafirlukast Clinical Pearls

A

Take at least 1 hour before or 2 hours after meals

Can increase INR

Major substrate, minor inhibitor of CYP2C9

136
Q

Zileuton Clinical Pearls

A

Weak CYP1A2 inhibitor

Take with food

137
Q

Methylxanthine Action

A

Bronchodilation through inhibition of PDE III and PDE IV

138
Q

Methylxanthine Adverse Effects

A

Insomnia, gastrointestinal upset, hyperactivity, hypotension, tremor

Dose related toxicity: tachycardia, nausea, vomiting, headache, seizures, arrhythmias

CI: peptic ulcer disease, arrythmias, seizure disorders

139
Q

Methylxanthine Clinical Pearls

A

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
Q

Anti-IgE Action

A

Inhibit IgE binding to receptors on mast cells and basophils, inhibit mediator release and attenuation of early- and late-phase allergic response

141
Q

Anti-IgE Adverse Effects

A

Headache, injection site reactions, arthralgias, thrombocytopenia, pharyngitis, sinusitis, upper respirator tract infections

142
Q

Anti-IgE Clinical Pearls

A

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
Q

Anti-IL5 Action

A

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
Q

Mepolizumab Adverse Effects

A

Headache, injection site reactions, arthralgias, Herpes Zoster infection

145
Q

Mepolizumab Clinical Pearls

A

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
Q

Reslizumab Adverse Effects

A

Injection site reactions, myalgias, increased creatine phosphokinase

147
Q

Reslizumab Clinical Pearls

A

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
Q

Benralizumab Adverse Effects

A

Injection site reactions, antibody development, headache, pharyngitis, fever

149
Q

Benralizumab Clinical Pearls

A

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
Q

Anti-IL4/IL13 Action

A

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
Q

Anti-IL4/IL13 Adverse Effects

A

Injection site reactions, antibody development, arthralgias, conjunctivitis

152
Q

Anti-IL4/IL13 Clinical Pearls

A

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
Q

Phosphodiaesterase-4 Inhibitor Action

A

Inhibits PDE4 leading to an increase in cAMP

154
Q

Phosphodiaesterase-4 Inhibitor Adverse Effects

A

HA, weight loss, diarrhea, nausea

155
Q

Phosphodiaesterase-4 Inhibitor Clinical Pearls

A

Monitoring: liver function test, weight

DI: CYP3A4 (major), CYP1A2 (minor)

CI: Child-pugh class B or C

156
Q

Albuterol HFA Brand Name

A

ProAir, Ventolin, Proventil, Proair Respiclick, and ProAir Digihaler

157
Q

Albuterol HFA Dosage Form

A

Metered dose inhaler (MDI), aerosol powder inhaler, and nebulizer solution (not for HFA)

158
Q

Albuterol HFA Drug Class

A

Short acting beta-2 agonists (SABA)

159
Q

Levalbuterol HFA Brand Name

A

Xopenex

160
Q

Levalbuterol Dosage Form

A

MDI and nebulizer solution (not for HFA)

161
Q

Levalbuterol Drug Class

A

Short acting beta-2 agonists (SABA)

162
Q

Ipratropium HFA Brand Name

A

Atrovent

163
Q

Ipratropium Dosage Form

A

MDI and nebulizer solution

164
Q

Ipratropium Drug Class

A

Short-acting anticholinergics (SAMA)

165
Q

Ipratropium/Albuterol Brand Name

A

Combivent respimat (MDI) and DuoNeb (Nebulizer Solution)

166
Q

Ipratropium/Albuterol Dosage Form

A

MDI and Nebulizer Solution

167
Q

Ipratropium/Albuterol Drug Class

A

Short-acting anticholinergics (SAMA)

168
Q

Methylprednisolone Dosage Form

A

Tablets

169
Q

Methylprednisolone Drug Class

A

Systemic Corticosteroids

170
Q

Prednisolone Dosage Form

A

Tablets and oral liquid

171
Q

Prednisolone Drug Class

A

Systemic Corticosteroids

172
Q

Prednisone Dosage Form

A

Tablets and oral liquids

173
Q

Prednisone Drug Class

A

Systemic Corticosteroids

174
Q

Dexamethasone Dosage Form

A

Oral liquid, tablets, and injection

175
Q

Dexamethasone Drug Class

A

Systemic Corticosteroids

176
Q

Methylprednisolone Acetate Dosage Form

A

Repository injection

177
Q

Methylprednisolone Acetate Drug Class

A

Systemic Corticosteroids

178
Q

Short Acting Beta-2 Agonist Action

A

Increases cAMP which antagonizes bronchoconstriction through smooth muscle relaxation (reverse obstruction and improve airflow)

179
Q

Albuterol Adverse Effects

A

Tachycardia, tremor, hypokalemia, irritability

180
Q

Albuterol Clinical Pearls

A

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
Q

Levalbuterol Adverse Effects

A

Tachycardia, tremor, hypokalemia, irritability

182
Q

Levalbuterol Clinical Pearls

A

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
Q

Ipratropium Adverse Effects

A

Dry mouth, urinary retention, infection, sinusitis, bronchitis

184
Q

Ipratropium Clinical Pearls

A

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
Q

Short-Acting Anticholinergic Action

A

Completely inhibit cholinergic receptors in bronchial smooth muscle leads to a decrease in cGMP causing bronchodilation

186
Q

Systemic Corticoids Action

A

Decrease in inflammation and an increase in response to beta-2 agonists

187
Q

Systemic Corticoids Adverse Effects

A

Short term use - hyperglycemia, increased appetite, fluid retention, demargination of WBCs, psychiatric disturbances

188
Q

Systemic Corticoids Clinical Pearls

A

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
Q

Epinephrine Comments

A

No proven advantage of systemic therapy over aerosol

Indicated in addition to standard therapy for acute asthma associated with anaphylaxis and/or angioedema

190
Q

Terbutaline Comments

A

No proven advantage of systemic therapy over aerosol

191
Q

Magnesium Sulfate Action

A

Smooth muscle relaxation through inhibition of calcium influx into smooth muscle cells

192
Q

Magnesium Sulfate Comments

A

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

Therapeutics 1 (3 decks)

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