Asthma Medications 2.0 Flashcards by Hannah Lapos

Dulera

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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Symbicort

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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QVAR Redihaler

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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Pulmicort Flexhaler

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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Pulmicort

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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Alvesco

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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Fluticasone furoate

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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Fluticasone proprionate

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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Mometasone

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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Singulair

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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Zafirlukast

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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Zileuton

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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Advair Diskus, Airduo Respiclick

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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Breo Ellipta

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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What are the albuterol brands?

ProAir Respiclick
Ventolin
Proventil
Nebulized solution

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Albuterol

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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Levalbuterol

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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Terbutaline

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

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Ipratropium

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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Tiotropium

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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What are relievers? What class are they?

SABAs
Albuterol (Ventolin, Proventil)

Levalbuterol (Vopenex)

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How does albuterol and levalbuterol differ?

Lev: is R isomer
Al: racemic

But similar efficacy

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What are the classes of controllers?

OGC, ICSm LABA

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What are the classes of adjunct?

LTRA, LAMA

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What is important to know about ICS?

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

When should OGCs be used?

Severe exacerbations to help gain control of disease

What are the ADRs of short term ORC use?

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

What are the ADRs of long term ORC use?

Growth suppression, HTN, steroid dependence, hirsutism

What do you need to know about LABAs?

Not a reliever therapy 12H DOA

What are ultra laba?

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

What is the MAO of anticholinergics?

Blocks bronchospasm from increase intracellular calcium and reduces mucous secretion

What are examples of LRTA?

Zileuton, Zafirlukast, Montelukast

What is the MOA of omalizumab?

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

What

Omalizumab

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

What is MOA of IL5 inhibitor?

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

What is MOA of IL5R inhibitors?

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

Mepolizumab

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

Reslizumab

**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

Benralizumab

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

Dupilumab

**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.

Tezepelumab

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

What is the MAO of dupilumab?

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

Why is theophylline last line? and MOA

Narrow TI Competitive inhibitor of nonselective PDE increasing cAMP and bronchodilation

What are the products of ICS-Formoterol?

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

What are examples of ICS?

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

What are the ICS-LABA products?

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

What are the leukotrien modifiers?

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

What is a chromone product?

Nedocromil - nebulized solution with weak effect

What are the LAMA products?

Tiotropium (Spiriva)

How do you prep Omalizumab?

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

Prednisone

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

Prednisolone

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

Methylprednisolone

**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

Hydrocortisone

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

What are products for systemic CS?

1. Prednisone 2. Prednisolone 3. Methylprednisolone 4. Hydrocortisone

What are SABA products?

Albuterol and terbutaline

What are the SAMA products?

Ipratropium

What is the toxic level of theophylline?

>35mcg/mL

How would you monitor theophylline?

Serum levels and warfarin

What is a safe concentration of theophylline?

15mcg/mL

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

1. Whee