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MPJE + NAPLEX 2023 PREP > asthma copd inhalers > Flashcards

asthma copd inhalers Flashcards

1
Q

MDI counseling points

A

-need to prime (prime 4x b4 use)
-inhale slowly, deeply
-normally shake (UNLESS if solution then DONT shake)
-if need to shake, shake 10 to 15 times
-can use a spacer

solution MDI so don’t shake: alvesco, atrovent

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2
Q

respimat: soft, mist

A

DO NOT SHAKE

P-TOP

~prime it
~turn it
~open it
~press it

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3
Q

DPI counseling points

A

-inhale quickly and deeply (to pull into lungs)
-do NOT shake
-all are contraindicated in milk protein allergy
-store at room temp in a dry place
-do NOT exhale into the container
-single dose devices require placement of a capsule into the device immediately before each treatment (ex: indacaterol - arcapta neohaler, tiotropium - spiriva handihaler, indacaterol + glycopyrrolate - utibron)

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4
Q

asthma medication triggers

A

NSAIDs (including ASA) and beta blockers

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5
Q

albuterol dosage forms

A

-MDI
-DPI
-Nebulization
-Syrup
-Tablets (ER, IR)

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6
Q

albuterol: MDI examples

A

-ventolin HFA

-Proventil HFA

-ProAir HFA

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7
Q

albuterol: DPI examples

A

-ProAir RespiClick

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8
Q

levalbuterol (forms)

A

xopenex (R-isomer of albuterol)

xopenex HFA, MDI

xopenex nebulization

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9
Q

terbutaline (forms)

A

oral

injectable (SQ/IV)

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10
Q

beclomethasone (forms)

A

breath-actuated aerosol inhaler

QVAR redihaler, MDI

NO SPACER

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11
Q

budesonide (forms)

A

pulmicort flexhaler (DPI)

pulmicort respules (contains liquid for nebulizer)

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12
Q

mometasone (forms)

A

asmanex HFA, MDI

asmanex twisthaler DPI

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13
Q

fluticasone (forms)

A

flovent HFA (MDI)

flovent diskus (DPI)

arnuity ellipta (DPI)

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14
Q

ciclesonide (forms)

A

alvesco (MDI)

*prodrug requires hydrolyzation in the lung to form the active metabolite
*MDI BUT IS A SOLUTION –> DO NOT SHAKE

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15
Q

flunisolide (forms)

A

aerospan HFA (D/C’ed)

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16
Q

systemic steroids for acute tx of asthma
(along with a SABA)

A

-oral prednisone: 40 - 60mg QD x3 - 10 days

-dexamethasone: 16mg/d PO QD x1 - 2 days

-methylprednisolone (medrol dose pack): Taper 24 to 0 mg PO over 6 days. Start with 6, 5 –> 1mg (all tabs are 4 mg, total of 21 tabs)

-rayos (delayed release prednisone): QHS; coated to delay drug about 4 hr after the dose is taken

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17
Q

oral prednisolone formulations

A

-millipred: 10mg/5 mL, 5 mg tablet

-prelone: 5mg/5 mL, 15 mg/5 mL; contains 5% alcohol

-veripred 20: 20 mg/5 mL solution; REFRIGERATE

-generic: 15mg/5 mL

-orapred: 10, 15, 30 mg ODT

*administer with food or milk to decrease GI upset
*prednisone is a prodrug to prednisolone

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18
Q

salmeterol (forms)

A

[salmeterol is a CYP3A4 substrate]

-serverent diskus: 1 puff 30 to 60 minutes before exercise

-if includes fluticasone = Advair (Diskus / HFA)
*also approved for maintenance of COPD

-if includes fluticasone = AirDuo RespiClick (DPI)

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19
Q

formoterol (forms)

A

-formoterol + budesonide (Symbicort)

-formoterol + mometasone (Dulera)

*drug interactions:
-beta blockers may reduce efficacy
-theophylline, caffeine, thiazides, loop diuretics may increase
-beta-agonist-induced decreased K

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20
Q

montelukast (forms)

A

-singulair: tabs, chewable tabs, granules packet (if mixed, use within 15 minutes)
*indications: asthma, allergic rhinitis (seasonal or perennial), prevention of exercise-induced asthma (must be taken 2 hours before exercise)

10mg QHS: >/= 15 years old
5mg QHS: 6 - 14 years old
4mg QHS: 2 - 5 years old
4mg granules: 6 months - 23 months (QD)

*chewable tab has phenylalanine
*watch for mood and behavioral changes
*restlessness is a side effect

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21
Q

zafirlukast (forms)

A

-accolate: tabs
*indication: prophylaxis/chronic treatment of asthma

Dose:
-if >/= 12, 20 mg BID on an empty stomach (1 h ac or 2 h pc)
-if 5 - 11, 10 mg BID on an empty stomach

Drug interactions:
-major CYP2C9 substrate / inhibits 2C9
-theophylline may decrease accolate levels
-accolate increases warfarin levels: monitor INR

Caution:
-hepatotoxicity

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22
Q

zileuton (forms)

A

zyflo, zyflo CR (IR, ER tabs)

Indication: asthma for patients >/= 12

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23
Q

omalizumab

A

Xolair: subQ (IgG1k mAb)

Indications:
-allergic asthma: >/= 6 years
-chronic idiopathic urticaria (hives): >/= 12 years

*not used for the tx of acute asthma

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24
Q

reslizumab

meplizumab

benralizumab

(forms)

A

interleukin-5 receptor antagonists

reslizumab (cinqair): IV in NS (IV q4 weeks)

meplizumab (nucala): subQ (subQ q4 weeks)

benralizumab (fasenra): subQ (subQ q4 weeks), then q8 weeks thereafter

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25
Q

theophylline (forms)

A

elixophyllin: elixir

theo-24: ER caps, QHS

theochron ER-12H: ER tabs

-MOA: phosphodiesterase inhibitors
-MAX = 900mg/d
-DI: strong cyp1a2 substrate & minor 3a4 substrate
-also in IV

Therapeutic levels:
-Children: 5 - 10 mcg/ml
-Adults: 5 - 15 mcg/ml

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26
Q

theophylline - Aminophylline conversion

A

PO T = IV A x 0.8

27
Q

methylxanthines used in apnea of prematurity

A

-caffeine CITRATE: IV
-theophylline

28
Q

cromolyn (forms)

A

mast-cell stabilizer

Indications:
-asthma, maintenance
-prophylaxis of bronchospasm (allergen or exercise-induced)

Dosage form: nebulized solution 20mg/2 mL

29
Q

ipratropium (forms)

A

atrovent HFA (MDI) = solution (DO NOT SHAKE)

2-3 puffs QID

SE: dry mouth, cough, blurred vision

30
Q

albuterol + ipratropium (forms)

A

combivent respimat = DO NOT SHAKE

QID

NOT contraindicated with soybean or peanut allergy

Discard after 3 months after the cartridge is inserted

31
Q

albuterol + ipratropium solution

A

DuoNeb: Nebulizer solution

QID PRN

32
Q

tiotropium (forms)

A

advantage = QD

spiriva handihaler DPI

spiriva respimat SMI (soft mist inhaler)
*2 inhalations

33
Q

umeclidinium (forms)

A

incruse ellipta, dry powder

dose = QD

34
Q

aclidinium (forms)

A

tudorza pressair DPI

dose = BID

discard 45 days after opening

35
Q

glycopyrrolate (forms)

A

seebri DPI w/ capsule
*dose = 1 c BID

lonhala magnair nebulization solution
*dose = one vial inhaled BID

36
Q

olodaterol + tiotropium

A

stiolto respimat

2 QD

37
Q

indacaterol + glycopyrrolate

A

utibron neohaler

BID

38
Q

vilanterol + umeclidinium

A

anora ellipta

1 QD

39
Q

formoterol + glycopyrrolate (forms)

A

bevespi aerosphere MDI

2 BID

40
Q

formoterol + aclidinium

A

duaklir pressair

1 BID

41
Q

formoterol + budesonide (forms)

A

symbicort MDI

2 BID

42
Q

salmeterol + fluticasone

A

advair diskus

1 BID

43
Q

vilanterol + fluticasone (forms)

A

breo ellipta DPI (ONLY FOR COPD)

1 QD

contraindicated in milk protein allergy

44
Q

trelegy ellipta

A

umeclidinium + vilanterol + fluticasone

FDA approved for both asthma and COPD

Dose = Single puff QD

Contraindication = hypersensitivity to milk proteins

45
Q

roflumilast

A

daliresp

indication = COPD maintenance

moa = phosphodiesterase 4 (PDE4) inhibitor

not indicated for acute attack

form = 250, 500 mcg tablet

SE = psych, suicidality, weight LOSS, decreased appetite

DI = major cyp3a4 substrate

CI = moderate-severe liver impairment

THIS IS LAST LINE THERAPY

46
Q

most effective tx for nasal symptoms is a

A

CORTICOSTEROID NASAL SPRAY

47
Q

beclomethasone (forms): AR

A

beconase (in asthma = QVAR)

48
Q

flunisolide (forms): AR

A

…not listed

49
Q

mometasone (forms): AR

A

nasonex

OTC

50
Q

ciclesonide (forms): AR

A

omnaris

zetonna

51
Q

triamcinolone (forms): AR

A

nasacort allergy 24 hr

OTC

52
Q

budesonide (forms): AR

A

rhinocort

OTC

53
Q

fluticasone furoate (forms): AR

A

flonase sensimist

OTC

53
Q

antihistamines

azelastine (forms): AR

54
Q

antihistamines

olopatadine (forms): AR

55
Q

antihistamine/steroid

azelastine/fluticasone (forms): AR

56
Q

antihistamine/steroid

olopatadine/mometasone (forms): AR

57
Q

mast cell stabilizer

cromolyn (forms): AR

A

nasalcrom

OTC

58
Q

anticholinergic

ipratropium: AR

A

…none listed

59
Q

dupilumab

A

dupixent

MOA: interleukin-4 receptor antagonist

Indication: add on for moderate-to-severe asthma, atopic dermatitis

Dose: >/= 12 yrs; 200 or 300 mg SQ once every other week

Counseling:
*allow solution to reach room temperature
*DO NOT SHAKE
*DONT USE IF DISCOLORED OR CONTAINS PARTICULATE MATTER
*PREFILLED SYRINGE DOES NOT CONTAIN A PRESERVATIVE; discard unused portion

60
Q

fluticasone + salmeterol

[new generic formulation for advair diskus]

A

Wixela Inhub

*THIS IS GRAY, NOT PURPLE LIKE THE DISKUS
*PTS HOLD THIS VERTICALLY INSTEAD OF HORIZONTALLY

61
Q

aclidinium + formoterol (forms)

A

duaklir pressair DPI

indication: COPD

dose: one inhalation BID

62
Q

budesonide/glycopyrrolate/formoterol

A

breztri aerosphere MDI

indication: COPD

dose: oral inhalation; 2 inhalations BID [this is the MAX]

63
Q

intravenous Mg Sulfate

A

off-label for severe or life-threatening exacerbations nonresponsive to initial therapy for asthma or COPD

IV: 2 g as a single dose over 20 minutes

NOTE –> IV Mg is also used for:
-eclampsia/preeclampsia w/ severe features, seizure prophylaxis and tx
-hypomagnesemia
-torsades de pointes

MPJE + NAPLEX 2023 PREP (16 decks)

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