ASTHMA/COPD *CONTROLLED* AE/CT Flashcards
ICS (Adverse Effects)
Oral Thrush (candidiasis), cough, dysphonia (difficulty speaking)
ICS (Counseling Tips)
-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
LABA (Adverse Effects)
Tachycardia, headache, tremor, hypokalemia
LABA (Counseling Tips)
-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
LAMA (Adverse Effects)
-Dry mouth
-Dizziness
-Blurred vision
-upper respiratory infections
-Paradoxical bronchospasms
ICS/LABA (Counseling Tips)
-Guidelines recommend combo LABA with ICS in asthma (no LABA monotherapy)
LABA/LAMA (Counseling Tips)
Not indicated for treatment of acute deteriotations
Mast Cell Stabilizer (Adverse Effect)
-High incidence of unpleasant taste in mouth (>10%)
-rare cardiac arrhythmias
-coughing
-dyspnea
-sore throat
-N/V/D if absorbed systemically
Mast Cell Stabilizer (Counseling Tips)
-Less effective than low-dose ICS
-Prevents increase in bronchial hyperreactivity seen in allergy season
Leukotriene Modifiers (Adveres Effects)
-Neuropsychiatric events (agitation, anxiety, abnormal dreams, hallucinations, depression, suicidal thinking)
-Churg-Strauss syndrome (rare)
-Increased hepatic transaminases
Leukotriene Modifiers (Counseling Tips)
-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
Metylxanthines (Adverse Effects)
-Insomnia
-GI upset
-Hyperactivity
-Hypotension
-Tremor
Methylxanthines (Dose related toxicity)
-tachycardia
-nausea
-vomiting
-headache
-seizures
-arrhythmias
Methylxanthines (Contraindications)
-Peptic ulcer disease
-arrhythmias
-seizure disorders
Methylxanthines (Drug Interactions)
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
Anti-IGE (Adverse Effects)
-headache
-injection site reactions
-arthralgias
-thrombocytopenia
-pharyngitis
-sinusitis
-upper respiratory tract infections
Anti-IgE (Counseling TIps)
-BOXED WARNING: anaphylaxis
-Don’t give more than 150mg per inj site
-Monitor for anaphylaxis
Mepolizumab Anti-IL5 (Adverse Effects)
-headache
-injection site rxns
-arthralgias
-herpes zoster infection
Mepolizumab Anti-IL5 (counseling Tips)
Precaution: anaphylaxis
-in-clinic or at-home inj
-monitor for anaphylaxis
Reslizumab Anti-IL5 (adverse effects)
-inj site rxns
-myalgias
-increased creatinine phosphokinase
Reslizumab Anti-IL5 (counseling tips)
BOXED WARNING: anaphylaxis, malignancies
-monitor for anaphylaxis
Benralizumab Anti-IL5 (adverse effects)
-inj site rxns
-antibody development
-headache
-pharyngitis
-fever
Benralizumab Anti-IL5 (Counseling Tips)
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
Dupilumab Anti-IL4/13 (Adverse Effects)
-inj site rxns
-antibody development
-arthralgias
-conjunctivitis
Dupilumab Anti-IL4/13 (counseling tips)
-ANAPHYLAXIS
-available in pre-filled syringe for in-office or at-home admin
-indicated for moderate-to-severe asthma in >12 y/o
Roflumilast phosphodiaesterase-4 inhibitor (Adverse effect)
-Headache
-weight loss
-diarrhea
-nausea
Roflumilast phosphodiaesterase-4 inhibitor (Monitoring)
-liver function test
-weight
Roflumilast phosphodiaesterase-4 inhibitor (Drug Interactions)
-CYP3A4 (major)
-CYP1A2 (minor)
Roflumilast phosphodiaesterase-4 inhibitor (Contraindications)
Child-Pugh class B or C