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Therapeutics I > Asthma Medications 2.0 > Flashcards

Asthma Medications 2.0 Flashcards

1
Q

Dulera

A

Generic: Mometasone/formoterol
Class: ICS-formoterol
Indications: Asthma (Off-label: COPD, bronchitis, emyphysema)
Form: Aerosol
CI:status asthmaticus
Dosing: 2 inh BID, Max: 4
ADRs: Candiasis, pharyngitis
Counseling: Not for acute relief, rinse mouth

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2
Q

Symbicort

A

Generic: Budesonide-formoterol
Class: ICS-formoterol
Indications: Asthma, COPD, Bronchitis, Emphysema
Form: Aerosol
CI: Acture bronchospasm, status asthmaticus
Dosing: BID, Max: 4
ADRs: Candiasis, hyperglycemia, hypoglycemia
Counseling: Not for acute relief, rinse mouth

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3
Q

QVAR Redihaler

A

Generic: Beclomethasone
Class: ICS
Form: Aerosol
Indications: Asthma
CI: N/A
Dosing: BID
ADRs: dysphonia, candidiasis
Counseling: Not for acute attacks, clean mouthpiece weekly with dry cloth, rinse mouth

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4
Q

Pulmicort Flexhaler

A

Brand: Budesonide
Class: ICS
Form: Dry powder
Indications: Asthma, prophylaxis
CI: N/A
Dosing: BID
ADRs: HA, acne, candidiasis, Cushing
Counseling: Not for acute episodes, rinse mouth

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5
Q

Pulmicort

A

Brand: Budesonide
Class: ICS
Form: Suspension
Indications: Asthma, bronchospasm, prophylaxis
CI: N/A
Dosing: BID
ADRs: HA, acne, candidiasis, Cushing
Counseling: Not for acute episodes, rinse mouth

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6
Q

Alvesco

A

Brand: Circlesonide
Class: ICS
Form: Aerosol
Indications: Asthma
CI: Acute bronchospasm
Dosing: BID
ADRs: Candidiasis
Counseling: Not for acute bronchospasm, rinse mouth

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7
Q

Fluticasone furoate

A

Brand: Flovent Diskus, Arnuity Ellipta
Class: ICS
Form: Dry powder
Indications: Asthma, allergic rhinitis
CI: Acute bronchospasm, Milk allergy, Status asthmaticus
Dosing: BID
ADRs: Candidiasis, malaise, nausea, fatigue
Counseling: Rinse mouth, ot for acute attacks

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8
Q

Fluticasone proprionate

A

Brand: Flovent HFA, ArmonAir Respiclick
Class: ICS
Form: Aerosol
Indications: Asthma, allergic rhinitis
CI: Acute bronchospasm, Milk allergy, Status asthmaticus
Dosing: BID
ADRs: Candidiasis, malaise, nausea, fatigue
Counseling: Rinse mouth, not for acute attacks

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9
Q

Mometasone

A

Brand: Asmanex Twisthaler, HFA
Class: Dry powder, aerosol
Form: Dry powder
Indications: Asthma, allergic rhinitis
CI: Acute bronchospasm, Milk allergy, Status asthmaticus
Dosing: TH: QD, HFA: BID
ADRs: Candidiasis, HA, musculoskeletal pain
Counseling: Rinse mouth, not for acute episodes, discard after 45 days

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10
Q

Singulair

A

Generic: Montelukast
Class: LTRA
Form: Chews, granules, tablets
Indications: Mild-moderate asthma not controlled by ICS
CI: N/A
ADRs: Dizziness, dyspepsia, suicide
Counseling: QPM, not for acute episodes

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11
Q

Zafirlukast

A

Brand: Acculate
Class: LTRA
Form: Tablets
Indications: Asthma
CI: Hepatic disease
Dosing: BID
ADRs: Dizziness, dyspepsia
Counseling: Take 1 hr before or 2 hr after meal

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12
Q

Zileuton

A

Brand: Zyflo
Class: Leuk. enzyme inhibitor
Form: XR tablets
Indications: mild-moderate Asthma
CI: N/A
ADRs: N/A
Counseling: N/A

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13
Q

Advair Diskus, Airduo Respiclick

A

Brand: Fluticasone-salmeterol
Class: ICS-LABA
Form: Dry powder
Indications: Asthma, Bronchitis, COPD, emphysema
CI: Acute bronchospasm, Milk allergy, Status asthmaticus
Dosing: BID
ADRs: Candidiasis, HA
Counseling: Rinse mouth, wean off systemic CS

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14
Q

Breo Ellipta

A

Brand: Fluticasone-vilanterol
Class: Ultra: ICS-LABA
Form: Dry powder
Indications: Asthma, Bronchitis, COPD, emphysema
CI: Acute bronchospasm, Milk allergy, Status asthmaticus
Dosing: BID
ADRs: Infection
Counseling: N/A

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15
Q

What are the albuterol brands?

A
  1. ProAir Respiclick
  2. Ventolin
  3. Proventil
  4. Nebulized solution
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16
Q

Albuterol

A

Class: SABA
Form: Aerosol, nebulize solution
Indications: Acute bronchospasm, prophylaxis, CODP, emphysema
CI: Milk allergy (ProAir Respiclick)
Dosing: Onset: 5-15 min, DOA: 4-6 hr
ADRs: Excitabiloty, tachycardia, tremors
Counseling: Do not exceed 12 puffs QD

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17
Q

Levalbuterol

A

Brand: Xopenex HFA
Class: SABA
Form: Aerosol, nebulize solution
Indications: Acute bronchospasm, prophylaxis, CODP, emphysema
CI: N/A
ADRs: HA, Vomiting, Tachycardia
Counseling: Shake HFA well, clean mouthpiece weekly

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18
Q

Terbutaline

A

Brand: Bricanyl and Marex
Route: PO or SQ, for emergencies
Class: Emergencies (weight-based dosing)

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19
Q

Ipratropium

A

Brand: Atrovent
Class: SAMA
Form: Inhaler, nebulizer
Indications: Acute bronchospasm, allergic rhinitis, COPD (Off-label: exercise-induced, prophylaxis)
CI: Bromide HS
ADRs: Dyspnea, paridoxical bronchospasm
Counseling: Do not exceed 12 puffs/day

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20
Q

Tiotropium

A

Brand: Spiriva respimat, handihaler
Class: LAMA
Form: Solution, powder
Indications: Asthma COPD, emphysema
CI: N/A
ADRs: Infection, sinusitis, pharyngitis, xerostomia
Dosing: 2 inh QD
Counseling: Parasoxical bronchospasm, discard cartridge 3 months, Not for acute bronchospasms

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21
Q

What are relievers? What class are they?

A

SABAs
Albuterol (Ventolin, Proventil)

Levalbuterol (Vopenex)

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22
Q

How does albuterol and levalbuterol differ?

A

Lev: is R isomer
Al: racemic

But similar efficacy

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23
Q

What are the classes of controllers?

A

OGC, ICSm LABA

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24
Q

What are the classes of adjunct?

A

LTRA, LAMA

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25
Q

What is important to know about ICS?

A

Oral candiasis ADR
QD for mild
BID for moderate to severe
Preferred mono therapy or combo

26
Q

When should OGCs be used?

A

Severe exacerbations to help gain control of disease

27
Q

What are the ADRs of short term ORC use?

A

Fluid retention and weight gain, mood alterations, glucose increase, K+ decrease

28
Q

What are the ADRs of long term ORC use?

A

Growth suppression, HTN, steroid dependence, hirsutism

29
Q

What do you need to know about LABAs?

A

Not a reliever therapy
12H DOA

30
Q

What are ultra laba?

A

24h DOA
Fluticasone-vilanterol (Breo ellipta)
Olodaterol(Stiverdi)

31
Q

What is the MAO of anticholinergics?

A

Blocks bronchospasm from increase intracellular calcium and reduces mucous secretion

32
Q

What are examples of LRTA?

A

Zileuton, Zafirlukast, Montelukast

33
Q

What is the MOA of omalizumab?

A

Inhibits IgE from binding to mast cells and basophils decreasing the mediator

35
Q

Omalizumab

A

Brand: Xolair
Class: Anti-IgE
Form: SQ
Indications: Severe allergic Asthma
CI: ≥6 yr
ADR: Angioedema

36
Q

What is MOA of IL5 inhibitor?

A

Binds to IL5 regulating proliferation, maturation and effector functions of eosinophils

37
Q

What is MOA of IL5R inhibitors?

A

Depletes eosinophils by binding to IL5 receptor sites on eosinophils and basophils

38
Q

Mepolizumab

A

Brand: Nucala
Class: Anti-IL5
Form: SQ Q4Weeks
Indications: Severe eosinophilic/ type 2 asthma
CI: ≥6 yr
ADR: HA

39
Q

Reslizumab

A

Brand: CinQAir
Class: Anti-IL5
Form: IV Q4Weeks
Indications: Severe eosinophilic/ type 2 asthma
CI: ≥18yr
Counseling: Protect from light, 16 hrs stable, weight based dosing

40
Q

Benralizumab

A

Brand: Facenra
Class: Anti-IL5R
Form: SQ Q4Weeks 3 doses, 8 weeks after
Indications: Severe eosinophilic/ type 2 asthma
CI: ≥12 yr

41
Q

Dupilumab

A

Brand: Dupixent
Class: Anti-IL4R
Form: SQ
Indications: Severe eosinophilic/ type 2 asthma, maintenance OCS
CI: ≥6 yr, not for >1500 eosinophils count
Dosing: Eosinophilic asthma: 400mg initially, followed by 200mg every other week OR 600mg initially, followed by 300mg every other week.
Corticosteroid dependent asthma: 600mg initially, followed by 300mg every other week.

42
Q

Tezepelumab

A

Brand: Tezspire
Class: Anti-TSLP
Form: SQ Q4Weeks
Indications: Severe asthma
CI: ≥12 yr

EXPENSIVE!!

43
Q

What is the MAO of dupilumab?

A

Binds to IL4R, 4, 13 and interrupts the T helper cascade blocking B cell and eosinophil recruitments

44
Q

Why is theophylline last line? and MOA

A

Narrow TI
Competitive inhibitor of nonselective PDE increasing cAMP and bronchodilation

45
Q

What are the products of ICS-Formoterol?

A

Dulera (mometasone/formoterol)
Symbicort (budesonide/formoterol)

46
Q

What are examples of ICS?

A

Beclomethasone (QVAR edihaler)
Budesonide (Pulmicort)
Ciclesonide (Alvesco)
Fluticasone (Flovent)
Mometasone (Asmanex)

47
Q

What are the ICS-LABA products?

A

Breo Ellipta (fluticasone furoate/vilanterol)
Advair (Fluticasone proprianate/salmeterol)

48
Q

What are the leukotrien modifiers?

A

Montelukast (Singular)
Zafirlukast (Accollate)
Zileuton (Zyflo)

49
Q

What is a chromone product?

A

Nedocromil - nebulized solution with weak effect

50
Q

What are the LAMA products?

A

Tiotropium (Spiriva)

51
Q

How do you prep Omalizumab?

A
  1. Resconstitute with SWFI not NS
  2. Use within 8 hr (fridge), 4 hr (Room temp)
  3. instruct patient to seek immediate attention if angioedema develops
52
Q

Prednisone

A

Brand: Deltasone
Indications: Acute exacerbations for 10 days
CI: Fungal infections, Live vaccines
COunseling: Discontinue at 70% FEV1 of personal best

53
Q

Prednisolone

A

Brand: Orapred
Indications: Acute exacerbations dose for 3-10 days
CI: Fungal infections, Live vaccines
COunseling: Discontinue at 70% FEV1 of personal best

54
Q

Methylprednisolone

A

Indications: Acute exacerbations
Dosage: Oral, IV, IM
CI: Fungal infections, Live vaccines
COunseling: Discontinue at 70% FEV1 of personal best
Acetate for IM, succinate for IV

55
Q

Hydrocortisone

A

CI: Fungal infections
Forms: PO, IV, IM
COunseling: Acetate for IM, succinate for IV

56
Q

What are products for systemic CS?

A
  1. Prednisone
  2. Prednisolone
  3. Methylprednisolone
  4. Hydrocortisone
57
Q

What are SABA products?

A

Albuterol and terbutaline

58
Q

What are the SAMA products?

A

Ipratropium

59
Q

What is the toxic level of theophylline?

A

> 35mcg/mL

60
Q

How would you monitor theophylline?

A

Serum levels and warfarin

61
Q

What is a safe concentration of theophylline?

62
Q

What questions do you ask the parents of 0-5?

Therapeutics I (32 decks)

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