Asthma/COPD Flashcards
Which lung function test is a good predictor of morbidity and mortality in COPD?
FEV1 - the amount of air expelled in 1 second. If it is low, this implies slowing of expiratory flow.
What is a FEV1/FVC value that indicates COPD?
<0.7
What are the PEF readings scale?
Green zone - 80-100% of personal best
Yellow zone - 50-80%
Red zone <50%
What do you do if you blow in the red zone?
- Low dose ICS + formoterol (like symbicort) as a rescue inhaler
- Take oral steroids if available
- MUST go to ER
What do you do if you blow in the yellow zone?
- PRN low dose ICS + formoterol
- Alternative - Low dose ICS with SABA
If in green zone after one hour - continue with LABA/ICS for 7-10d
If in yellow zone after one hour - add short course of oral steroids
When would you utilize FeNO guided treatment>
In children and adolescents with allergic or eosinophillic asthma
It is an exhaled nitric oxide test
what is the GOLD grading scale?
GOLD 1 (mild) - FEV1 >80%
GOLD 2 (Moderate) - FEV1 50-80%
GOLD 3 (severe) - FEV1 30-50%
GOLD 4 (very severe) - FEV1<30%
Describe the GOLD classification based on symptoms and history and it’s treatments
Which asthma/COPD combination increases risk of pneumonia?
LABA + ICS
What three vaccines are recommended for COPD patients?
Pneumococcal
Influenza
Tdap
Albuterol
Brand
Formulation + counseling + ages
MDI - Ventolin, proventil, Proair | reprime after 2 weeks of not using | for >4y.o
DPI - proair respiclick | discard after 13 months , for >4y.o
Nebulization for >2y.o
Syrup for >2y.o
Tablets IR and ER
Levalbuterol
Brand
Formulations + Age
Dose
Counseling
Xopenex
MDI - >4y.o
Nebulizer solution >6y.o
2 inhalations Q4-6 hours
Shake before use, prime if not used for >3 days, use a spacer, breath in slowly and deeply
For the nebulized vials, once it’s out of the foil, it’s good for one week
Beclomethasone
Brand
Formulation
Dose
Counseling
Qvar Redihaler
Breath-acuated inhaler
4-11 y.o - 40 or 80mcg BID
>12 - 40-80mcg 1-4puffs BID
Open cap, inhale deeply, hold breath, rinse mouth
Budesonide
Brand
Formulation + age
Counseling
Why is this one unique?
DPI - Pulmicort - >6y.o , quick forceful breath
Respules for nebulization - >1 y.o
This is the only steroid that comes in nebulization form and the only one that can be used in a one-year-old
Mometasone
Brand
Formulation + age
Dose + counseling
Storage
Asmanex HFA , >12y.o , 400mcg BID
Asmanex twistihaler DPI-
4-11 y.o - 110mcg PM
>12 - 220mcg PM
Inhale deeply and forcefully
Discard after 45 days
Fluticasone
Brand
Formulation + age+ dose
Flovent HFA MDI - >4y.o - 44mcg 2 puffs BID
Flovent Diskus DPI - >4y.o 50-250mcg BID
Arnuity Ellipta DPI - >5y.o once daily
Ciclesonide
Brand
Formulation + age + dose
Counseling
PK
Alvesco
MDI , >12y.o , 80-320mcg BID
Don’t shake
Is a prodrug and is converted to active drug in lung
What are the 4 systemic steroids for acute asthma attacks?
Dose?
Oral prednisone - 40-60mg QD 3-10days
Dexamethasone - 0.3-0.6mg/kg PO QD x 1-2d
Medrol dose pack
Rayos = delayed release prednisone
Least to most potent steroids
Cute Hot Pretty Pharmacists Makes Triple Digits Booooom
Cortisone
Hydrocortisone
Prednisolone
Prednisone
Methylpredisone
Triamcinolone
Dexamethasone
Betamethasone
How do systemic steroids affect Na+ and K+?
Na+ Increases
K+ decreases
What are your two LABA’s?
Salmeterol
Formoterol
Salmeterol
Brand
Combo’s + age + dose
Serevent Diskus , >4y.o , 1puff BID
w/fluticasone - Advair diskus/HFA - Diskus is >4y.o and HFA >12y.o
100/50, 250/50, 500/50
w/fluticasone - Airduo Respiclick - >12y.o
55/14, 113/14, 232/14
If I have 100/50 advair, which component is which?
100 = fluticasone (larger number is always the steroid)
50 = salmeterol
Formoterol
Combo’s + brand + age+ dose
Symbicort = w/budesonide , >6y.o , BID
Dulera = w/mometasone, >12y.o BID
What are the three anti-leukotrienes + brand + MOA?
Montelukast - singular - receptor antagonist
Zafirlukast - Accolate - receptor antagonist
Zileuton - Zyflo - 5-lipoxygenase inhibitor
Montelukast
Dosage forms
Doses + age
Warnings
10mg tab and 4 & 5 mg chews
10mg HS >15 y.o
5mg HS >6-14y.o
4mg HS 2-5 y.o
4mg granules 6mo - 23months
Mood and behavioral changes
Zafirlukast
Brand
Dosage forms
Dose
Accolate
10 & 20mg tabs
> 12y.o - 20mg QD on empty stomach
5-11y.o - 10mg QD on empty stomach
Zileuton
Brand
Dosage form
Dose
Monitoring
Zyflo
600mg IR/ER
IR - 600mg QID
ER - 1200mg BID WITH FOOD
LFT’s
Omalizumab
Brand
MOA
Dose
Black box warning
Xolair
IgG1k mAb
75-375 SUBQ every 2-4 weeks
Anaphylaxis
IL-5R Antagonists
Generic and brand
Age
ROA
Reslizumba - cinqair - >18y.o - IV Q4 weeks
Mepolizumba - Nucala - >12y.o - SUBQ Q4weeks
Benralizumab - Fasenra - >12y.o - SUBQ every 4 weeks x 3 doses then Q8 weeks
Theophylline
Brand
MOA
Dose
Therapeutic level
ADE
Drug interactions
PO to IV conversion
Elixophyllin, Theo-24
PDEi
300-400mg/day - MAX 900mg/d
Children - 5-10mcg/ml
Adults - 5-15mcg/mL
Tremor, tachycardia, insomnia
Strong CYP1A2 substrate so inhibitors (fluvoxamine, ciprofloxacin) will increase [theophylline] and inducers (phenytoin, carbamazepine) will decrease [theophylline]
P.O Theophylline dose = IV amimophylline dose x 0.8
Cromolyn
MOA
Dosage form
Mast cell stabilizer
Nebulized solution - 20mg/2mL QID
Would you give ICS for COPD patient?
No, because it’s not an issue with inflammation like asthma is. COPD is more about damage.
Ipratropium
Brand
Combinations + dose
Formulation
ADE
Atrovent - MDI -2-3puffs QID
Combivent respimat is w/albuterol - QID - soft mist
Duoneb is w/albuterol but is a nebulizer QID PRN
Cough, dry mouth, blurry vision
What disease states are you concerned about when giving anticholinergics ?
BPH
Myasthenia gravis
Glaucoma
Tiotropium
Brand
Formulations + dose + age + counseling
Spiriva
Handihaler - 18mcg capsule - 1 capsule DAILY - cap SHOULD vibrate
Respimat - soft mist inhaler - >12y.o - 2 puffs QD
Umeclidinium
Brand
MOA
Dose
Incruse Elipta
Long acting anticholinergic dry powder (LAMA)
Daily
Aclidiunium
Brand
MOA
Dose
Discard
Tudorza pressair
Long acting anticholinergic (LAMA)
1 inhalation DPI BID
Discard after 45 days
Glycopyrrolate
Brand
Formulation
Dose
Seebri - DPI w/capsule - 1 capsule BID
Lonhala Magnair Nebulization - one vial BID
What are the 6 LABA’s + Brand + Dose?
Olodaterol - Striverdi Respimat - 2QD
Indacaterol - Arcapta neohaler - 1capsule QD
Formoterol nebulizer - BID
Arformoterol nebulizer - BID
Salmeterol - Serevent - 1 BID
Vilanterol + fluticasone - Breo - 1 QD
Vilanterol + Imeclidiunium - Anoro - 1 QD
What are the three LABA/ICS combinations + Brand + dose?
Formoterol + budesonide - symbicort = 2BID
Salmeterol + fluticasone - Advair - 1 BID
Vilaneerol + Fluticasone - Breo - 1 QD
Trelegy Elipta
Generic’s
Dose
Contraindication
Umeclidinium + Vilanterol + fluticasone furoate
1 puff QD
Hypersensitivity to milk
What are your 5 LABA/anticholinergic combinations + brand + dose
Olodaterol + tiotropium - Stiolto respimat - 2 QD
Indaceterol + glycopyrrolate - utibron neohaler - BID
Vilanterol + umeclidinium - Anora - 1 QD
Formoterol+ glycopyrrolate - Bevespi aerosphere MDI - 2 BID
Formoterol + aclidinium - Duaklir pressair - 1 BID
Roflumilast
Brand
Indication
MOA
Dose
ADE
Contraindication
Daliresp
COPD
PDE4 inhibitor
500mcg PO QD
Suicidality, weight loss
Moderate-severe liver impairment
Ensifentrine
Brand
MOA
Indication
Dose
ADE
Ohtuvayre
PDE3 and PDE4 inhibitor
Nebulized , 3mg BID
Mood changes, back pain, increased BP, UTI , diarrhea
Albuterol/budesonide
Brand
Formulation + dose
Indication
Airsupra
MDI - 2 puff PRN ; max 6 doses/day
PRN for treatment of prevention of brochoconstriction
Dupilumab
brand
MOA
Dose
Counseling
Dupixent
IL4R antagonist
> 12y.o ; 200 or 300mcg SUBQ every other week
Allow to come to room temp and do not shake
What is the difference between advair and wixela?
wixela is gray amd should be held vertically rather than horizontally
