Asthma & COPD Meds - Clinical Pearls Flashcards
Albuterol (ProAir, Ventolin, Proventil)
- Chronic use (>2 times daily) indicates poor control
- Correct use with a holding chamber is equally effective as mebulizer treatment for mild/moderate exacerbations
Levalbuterol (Xopenex)
- Reserved for patients who do not respond to albuterol
Ipratropium (Atrovent HFA)
- Should not be used as first line therapy
Albuterol/Ipratropium (DuoNeb)
- May be used up for up to 3 hours for initial management of severe exacerbation
Methylprednisolone
- Can be used in patients taking ICS before exacerbation
- Can be used as chronic therapy in COPD and Asthma for severe stages
Prednisolone
- Can be used in patients taking ICS before exacerbation
- Can be used as chronic therapy in COPD and Asthma for severe stages
Prednisone
- Can be used in patients taking ICS before exacerbation
- Can be used as chronic therapy in COPD and Asthma for severe stages
Dexamethasone
- Can be used in patients taking ICS before exacerbation
- Can be used as chronic therapy in COPD and Asthma for severe stages
Methylprednisolone Acetate
- Can be used in patients taking ICS before exacerbation
- Can be used as chronic therapy in COPD and Asthma for severe stages
- Repository injection for patients with vomiting or adherence issues
Epinephrine
- No proven benefit of systemic use over aerosol
- Added to standard therapy for acute asthma if anaphylaxis/angioedema suspected
Tertbutaline
- No proven benefit of systemic use over aerosol
Magnesium Sulfate IV
- Can consider if patient in life-threatening exacerbation 1 hour after therapy
- Given via IV infusion
Beclomethasone (QVAR)
- Lowest effective dose should be used
- Most effective long-term controller class
- Increased risk of pneumonia in COPD patients
Budesonide (Pulmicort)
- Lowest effective dose should be used
- Most effective long-term controller class
- Increased risk of pneumonia in COPD patients
Ciclesonide (Alvesco)
- Lowest effective dose should be used
- Most effective long-term controller class
- Increased risk of pneumonia in COPD patients
Fluticasone Propionate (Flovent)
- Lowest effective dose should be used
- Most effective long-term controller class
- Increased risk of pneumonia in COPD patients
Fluticasone Furoate (Arnuity Ellipta)
- Lowest effective dose should be used
- Most effective long-term controller class
- Increased risk of pneumonia in COPD patients
Mometasone (Asmanex)
- Lowest effective dose should be used
- Most effective long-term controller class
- Increased risk of pneumonia in COPD patients
Arformoterol Tartrate (Brovana)
- Increased risk of death as asthma monotherapy
- Boxed warning: increased hospitalizations in pediatrics
- Prolonged QT in overdose
- Not for acute symptoms
Formoterol (Perforomist)
- Increased risk of death as asthma monotherapy
- Boxed warning: increased hospitalizations in pediatrics
- Prolonged QT in overdose
- Not for acute symptoms
Indacaterol (Arcapta Neohaler)
- Increased risk of death as asthma monotherapy
- Boxed warning: increased hospitalizations in pediatrics
- Prolonged QT in overdose
- Not for acute symptoms
- Capsules should not be taken orally
Olodaterol (Striverdi Respimat)
- Increased risk of death as asthma monotherapy
- Boxed warning: increased hospitalizations in pediatrics
- Prolonged QT in overdose
- Not for acute symptoms
- Capsules should not be taken orally
Salmeterol (Serevent Diskus)
- Increased risk of death as asthma monotherapy
- Boxed warning: increased hospitalizations in pediatrics
- Prolonged QT in overdose
- Not for acute symptoms
- Capsules should not be taken orally
Aclidinium (Turdorza Pressair)
- COPD only
Revefenacin (Yupelri)
- COPD only
Glycopyrrolate (Seebri Neohaler)
- COPD only
Tiotropium (Spiriva)
- COPD only
Umeclidinium (Incruse Ellipta)
- COPD only
Montekulast (Singulair)
- Less effective than low dose ICS or ICS/LABA in asthma
- Minor substrate of CYP2C8/9 and 3A4
- Not for acute relief of symptoms
Zafirlukast (Accolate)
- Less effective than low dose ICS or ICS/LABA in asthma
- Take at least 1 hour before or 2 hours after meals
- Can increase INR
- Major substrate/minor inhibitor of CYP2C9
Zileution (Zyflo CR)
- Less effective than low dose ICS/LABA in asthma
- Weal CYPP1A2 inhibitor
- Take with food
Omalizumab (Xolair)
- Boxed warning for anaphylaxis
- Do not administer >150mg per injection site
- Dosed by weight and serum IgE
Mepolizumab (Nucala)
- Precaution for anaphylaxis
- Available as an autoinjector
Reslizumab (Cinqair)
- Boxed warning for anaphylaxis & malignancy
- IV infusion
Benralizumab (Fasenra)
- Precaution for anaphylaxis
- Available as an autoinjector
- Acts on IL-5 receptors rather than IL-5
Dupilumab (Dupixent)
- Precaution for anaphylaxis
- Available as prefilled syringes
Roflumilast (Daliresp)
- Monitor LFTs and weight
- Contraindicated in liver dysfunction
- Major substrate of CYP3A4 and minor of CYP1A2
Cromolyn (Intal)
- Less effective than low dose ICS
Theophylline (Theochron)
- Dose related toxicity: seizures, arrhythmia, tachycardia, N/V, headache
- Major substrate of CYP3A4, CYP1A2, and CYP2E1