ASTHMA/COPD *CONTROLLED* AE/CT

Question 1

ICS (Adverse Effects)

Answer 1

Oral Thrush (candidiasis), cough, dysphonia (difficulty speaking)

Question 2

ICS (Counseling Tips)

Answer 2

-rinse mouth and spit
-ICS are most effect long term therapy for asthma
-increase risk of pneumonia in COPD pts
-titrate to lowest effective dose
-Pulmicort Respules should use Jet nebulizer and should NOT be mixed with other nebulizer meds
-High doses increase risk for systemic side effects

Question 3

LABA (Adverse Effects)

Answer 3

Tachycardia, headache, tremor, hypokalemia

Question 4

LABA (Counseling Tips)

Answer 4

-BOXED WARNING for increased risk of asthma related death for all monotherapy LABA use (don’t use alone for asthma)
-BOXED WARNING for increasing hospitalizations in peds and adolescents pts
-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
-PEDS <4 can’t use DPI

Question 5

LAMA (Adverse Effects)

Answer 5

-Dry mouth
-Dizziness
-Blurred vision
-upper respiratory infections
-Paradoxical bronchospasms

Question 6

ICS/LABA (Counseling Tips)

Answer 6

-Guidelines recommend combo LABA with ICS in asthma (no LABA monotherapy)

Question 7

LABA/LAMA (Counseling Tips)

Answer 7

Not indicated for treatment of acute deteriotations

Question 8

Mast Cell Stabilizer (Adverse Effect)

Answer 8

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

Question 9

Mast Cell Stabilizer (Counseling Tips)

Answer 9

-Less effective than low-dose ICS
-Prevents increase in bronchial hyperreactivity seen in allergy season

Question 10

Leukotriene Modifiers (Adveres Effects)

Answer 10

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

Question 11

Leukotriene Modifiers (Counseling Tips)

Answer 11

-Less effective than low dose ICS and ICS/LABA in asthma
-Have not been trialed in COPD
-Montelukast: minor substrate of CYP2C8/9 and 3A4, NOT for acute relief of systems, BOXED WARNING: Neuropsychiatric events
-Zafirlukast: take at least 1 hour before or 2 hours after meals, can increase INR, major substrate, minor inhibitor of CYP2C9
-Zileuton: Weak CYP1A2 inhibitor, wf

Question 12

Metylxanthines (Adverse Effects)

Answer 12

-Insomnia
-GI upset
-Hyperactivity
-Hypotension
-Tremor

Question 13

Methylxanthines (Dose related toxicity)

Answer 13

-tachycardia
-nausea
-vomiting
-headache
-seizures
-arrhythmias

Question 14

Methylxanthines (Contraindications)

Answer 14

-Peptic ulcer disease
-arrhythmias
-seizure disorders

Question 15

Methylxanthines (Drug Interactions)

Answer 15

Major Substrate of CYP 3A4, 1A2, 2E1
- Increase concentration of: cimetidine, erythromycin, clarithromycin, ciprofloxacin, ticlopidine
-Decreases concentration of: Phenobarbital, phenytoin, carbamazepine, rifampin; smoking
-PDE III inhibition likely cause of hypotension, tachycardia and nausea

Question 16

Anti-IGE (Adverse Effects)

Answer 16

-headache
-injection site reactions
-arthralgias
-thrombocytopenia
-pharyngitis
-sinusitis
-upper respiratory tract infections

Question 17

Anti-IgE (Counseling TIps)

Answer 17

-BOXED WARNING: anaphylaxis
-Don’t give more than 150mg per inj site
-Monitor for anaphylaxis

Question 18

Mepolizumab Anti-IL5 (Adverse Effects)

Answer 18

-headache
-injection site rxns
-arthralgias
-herpes zoster infection

Question 19

Mepolizumab Anti-IL5 (counseling Tips)

Answer 19

Precaution: anaphylaxis
-in-clinic or at-home inj
-monitor for anaphylaxis

Question 20

Reslizumab Anti-IL5 (adverse effects)

Answer 20

-inj site rxns
-myalgias
-increased creatinine phosphokinase

Question 21

Reslizumab Anti-IL5 (counseling tips)

Answer 21

BOXED WARNING: anaphylaxis, malignancies
-monitor for anaphylaxis

Question 22

Benralizumab Anti-IL5 (adverse effects)

Answer 22

-inj site rxns
-antibody development
-headache
-pharyngitis
-fever

Question 23

Benralizumab Anti-IL5 (Counseling Tips)

Answer 23

PRECAUTION: anaphylaxis
-in-clinic or at-home inj
-indicated for severe asthma in >12 y/o
-acts on IL5 receptors while others act on IL5

Question 24

Dupilumab Anti-IL4/13 (Adverse Effects)

Answer 24

-inj site rxns
-antibody development
-arthralgias
-conjunctivitis

Question 25

Dupilumab Anti-IL4/13 (counseling tips)

Answer 25

-ANAPHYLAXIS
-available in pre-filled syringe for in-office or at-home admin
-indicated for moderate-to-severe asthma in >12 y/o

Question 26

Roflumilast phosphodiaesterase-4 inhibitor (Adverse effect)

Answer 26

-Headache
-weight loss
-diarrhea
-nausea

Question 27

Roflumilast phosphodiaesterase-4 inhibitor (Monitoring)

Answer 27

-liver function test
-weight

Question 28

Roflumilast phosphodiaesterase-4 inhibitor (Drug Interactions)

Answer 28

-CYP3A4 (major)
-CYP1A2 (minor)

Question 29

Roflumilast phosphodiaesterase-4 inhibitor (Contraindications)

Answer 29

Child-Pugh class B or C