Asthma Meds Flashcards
Albuterol HFA (Proventil, Ventolin, ProAir)
Inhaled SABA
MDI: 90mcg/puff
ALL AGES: 2 puffs 5 minutes before exercise
2 puffs q4-6 hrs PRN
AE: Tachycardia, tremor, hypokalemia, irritability
Albuterol nebulizer solution
SABA
0.63mg/mL, 1.25mg/3mL, 2.5mg/3mL, 5mg/mL (0.5%)
0-4y: 0.63-2.5mg in 3mL saline q4-6hrs PRN
5-11y: 1.25-5mg in 3mL saline q 4-8H
Adults: 0.63-1.25mg Q8H PRN
Levalbuterol HFA
Xopenex
45mcg/puff Inhaled SABA only for ages >5yrs 5-11y: 2 puffs q 4-6hrs PRN Adults: 2 puffs 5 minutes before exercise, or 2puffs Q4-6hrs
Levalbuterol Nebulizer solution
Xopenex
Inhaled SABA
0-4y: .31-1.25mg in 3mL q 4-6H PRN
5-11y: 0.31 -0.63mg Q8H PRN
Adults: 0.63 - 1.25mg Q8H PRN
Ipratropium HFA
Atrovent
Anticholinergic- quick relief MDI: 17mcg/puff (200puffs) Adults: 2-3puffs Q6H Nebulizer solution:0.25mg/mL Adults only: 0.25mg Q6H
Ipratropium with Albuterol (Combivent Respimat)
Anticholinergic - quick relief
20mcg/puff ipratropium and 100mcg/puff albuterol
1 puff Q6H
SE: Dry mouth, urine retention, infection, sinusitis, bronchitis
Methylprednisolone
Systemic Corticosteroid. decreases inflammation and increases response to B2 agonists.
2,4,6,8,16,32 mg tablets.
0-4y = “Burst” 1-2mg/kg/day PO (Max:60mg/day for 3-10 days) or long term: 0.25-2mg/kg daily in a single dose or every other day.
5-11y = Burst 40-60mg/day PO as single or divided dose for 3-10 days. long term: 0.25-2mg/kg daily in a single dose or every other day.
Adults: Burst - 40-60mg/day PO as single or 2 divided doses for 3-10 days. or long term 7.5-60mg daily in a single dose or every other day.
Prednisolone
Systemic Corticosteroid. decreases inflammation and increases response to B2 agonists.
5mg oral tabs, 5mg/5mL and 15mg/5mL oral liquid
0-4y = “Burst” 1-2mg/kg/day PO (Max:60mg/day for 3-10 days) long term: 0.25-2mg/kg daily in a single dose or every other day.
5-11y = Burst 40-60mg/day PO as single or divided dose for 3-10 days. long term: 0.25-2mg/kg daily in a single dose or every other day.
Adults: Burst - 40-60mg/day PO as single or 2 divided doses for 3-10 days. or long term 7.5-60mg daily in a single dose or every other day.
Prednisone
Systemic Corticosteroid. decreases inflammation and increases response to B2 agonists.
1,2.5,5,10,20, and 50mg tablets; 5mg/5mL oral liquid
0-4y = “Burst” 1-2mg/kg/day PO (Max:60mg/day for 3-10 days) long term: 0.25-2mg/kg daily in a single dose or every other day.
5-11y = Burst 40-60mg/day PO as single or divided dose for 3-10 days. long term: 0.25-2mg/kg daily in a single dose or every other day.
Adults: Burst - 40-60mg/day PO as single or 2 divided doses for 3-10 days. or long term 7.5-60mg daily in a single dose or every other day.
Methylprednisolone acetate
Systemic Corticosteroid. decreases inflammation and increases response to B2 agonists. Repository injection. 40mg/mL or 80mg/mL 0-4: 7.5mg/kg IM one 5-11: 240mg IM once Adults: 240mg IM once
Adverse effects, Contraindications, Drug interactions for Systemic corticosteroids short term
AE: Short term use - hyperglycemia, increased appetite, fluid retention, demargination of WBCs, psychiatric disturbances
CI: Systemic fungal infections, administration of live vaccines if immunocompramised
DI: Warfarin INR elevated; decreased efficacy of inactivated vaccines
Magnesium sulfate
Smooth muscle relaxation through inhibition of calcium influx into smooth muscle cells.
IV: 10, 20, 40 or 80mg/mL
0-11: 26-75mg/kg max 2 gm IV once
Adults: 2gm IV once
**consider if patient remains in life threatening exacerbation after 1 hour of therapy.
AE: Flushing, hypotension, vasodilation
CI: heart block, caution in renal dysfunction
What ICS medications are used in children ages 0-4?
Budesonide nebulizer solution (pulmicort Respules) and Fluticasone HFA (MDI)(Flovent)
Belomethasone HFA (MDI)(QVAR)
ICS controller med 40 or 80mcg/puff NOT for under 5yrs 5-11: 80-160mcg, >160-320mcg, >320mcg Adults: 80-240mcg, >240-480, >480mcg
Budesonide DPI (pulmicort)
ICS controller med
90,180, or 200mcg/puff
5-11y: 180-400mcg, >400-800, >800mcg
Adults: 180-600mcg, >600-1200, >1200
Budesonide nebulizer solution (pulmicort Respules)
ICS
0-4: 0.25-0.5mg, >0.5-1mg, >1mg
5-11y: 0.5mg, 1mg, 2mg
Flunisolide HFA (AeroBid)
ICS
5-11:160mcg, 320mcg, 640mcg and above
Adults: 320mcg,>320-640, 640mcg and above
Fluticasone HFA (MDI)(Flovent)
ICS controller med 4,100, or 200mcg/puff 0-4: 176mcg, >176-352, >352 5-11: 88-176, >176-352, >352 Adult: 88-264, >264-440, >440
Fluticasone DPI
ICS Controller med 50, 100 or 250mcg/inhalation 5-11: 100-200mcg, >200-400,>400mcg Adult: 100-300, >300-500, >500mcg
Mometasone DPI (Asmanex)
ICS for control
200 mcg/inhalation
ADULTS only: 200mcg, 400mcg, >400mcg
Ciclesonide HFA (Avelsco)
ICS for contro
80 or 160mcg/puff
5-11: 160-320mcg,>320-640, >640
Adults: 160-320mcg, >320-640, >640
Adverse Effects, contraindications, drug interactions of long term corticosteroids
AE: osteoporosis, cataracts, fat redistribution, immunosuppression, peptic ulcer disease, weight gain, adrenal suppression.
CI: systemic fungal infections, administration of live vaccines if immunocompromised
DI: Warfarin INR increases. Decreases efficiency of inactivated vaccines
PEDS: ages 0-11 the lower dose 1mg/kg/day experience fewer behavioral side effects and appear to be equally effective.
Salmeterol (Serevent)
LABA
DPI 50mcg/blister
5-11y and Adults: contents of one blister Q12H
Formoterol (Foradil)
LABA
DPI 12mcg/capsule
5-11 and Adults: Contents of one capsule Q12H
Alformoterol tartrate (Brovana)
LABA
1mcg/2mL nebulizer solution
ADULTS: 15mcg Q12H
Indacaterol (Arcapta Neohaler)
LABA
DPI 75mcg/capsule
Adults: contents of one capsule daily
What do LABA’s do to help control asthma?
increase cAMP to cause bronchial smooth muscle relaxation and inhibit hypersensitivity mediators from mast cells (histamine and leukotrienes)
What are the ADVERSE effects from LABA’s?
Tachycardia, tremor, hypokalemia, increase in asthma exacerbations, prolonged QT seen with intentional overdoses
Special considerations with LABA’s in asthma
Should not be used alone for asthma management.
Not for acute symptoms
May be helpful for exercise induced bronchospasm
Do not take inhaler capsules orally.
Most kids <4y cannot inhale deeply enough for DPI inhalers
Fluticasone/Salmeterol
Advair
Combined ICS/LABA
DPI: 100/50, 250/50, 500/50
HFA MDI 45mcg/21mcg, 115/21, 230/21
5 and older: one inhalation BID (DPI). 2 inhalations BID (HFA)
Budesonide/Formoterol (Symbicort)
Combined ICS/LABA Products
HFA MDI 80mcg/4.5mcg
160mcg/4.5mcg
Ages 5-adult: 2 puffs BID
Formoterol/Mometasone
Dulera
Combined ICS/LABA Products
MDI 100mcg/5mcg; 200mcg/5mcg
ADULTS: 2puffs BID
Vilanterol/Fluticasone (Breo Ellipta)
Combined ICS/LABA products
DPI 100 mcg/25mcg
Adults only: 1 puff once daily
Cromolyn
Mast Cell Stabalizer
MDI 0.8mcg/puff
Ages 0-Adult: 2 puffs QID
Nebulizer solution: 20mg/ampule. 0-4y: one ampule QID (no safety data in children <2y)
cromolyn Adverse Effects?
high incidence of unpleasant taste, Rare cardiac arrhythmias, coughing, dyspnea, sore throat, N/V/D if absorbed systemically, relatively well tolerated.
Is cromolyn more or less effective at controlling persistent asthma than ICS?
cromolyn is less effective
What stage of asthma are the combination ICS/LABA products best used in?
moderate persistent asthma
Montelukast (singulair)
Leukotriene Modifier
Long term control
only one in this class approved for kids less than 5y
4 or 5mg chewable tablets, 4mg granule packet, 10mg tablet
1-5: 4mg at bedtime
6-14: 5mg at bedtime
adult: 10mg at bedtime
Zafirlukast (Accolate)
leukotriene modifier
10 or 20 mg tablets
7-11y: 10mg BID
Adult: 20mg BID
Zileuton (Zyflo CR)
leukotriene modifier
600mg tablets
ONLY ADULTS: 1200mg BID
Adverse Effects for leukotriene modifiers
Neuropsychiatric events, rare but serious Churg- Strauss syndrome, increased hepatic transaminases, Generally well tolerated
What are the special considerations to remember with leukotriene modifiers?
weak inhibitors of CYP2C8 and 2C9
Major substrate of CYP2C9 and 3A4
Not for acute relief of symptoms
Take at least 1 hour or 2 hours after a meal
Can increase INR
Moderate CYP1A2 inibitor and minor CYP1A2, 2C9, 3A4 substrate
Theophylline
Methyxanthine
ER tabs 100,200,300,400,450,600mg
Capsule ER: 100,200,300,400mg
Liquid 80mg/15mL
0-4y: starting dose 10mg/kg/day, <1y:0.2 age in wks
5-11y: starting dose 10mg/kg/day. max 16mg/kg/day
Adult: start dose 10mg/kg/day up to 300mg max or 800mg max per day
Adverse effects, contraindications and drug interactions of Methylxanthines
Ex: Theophylline
AE: Insomnia, GI upset, hyperactivity, hypotension, dose related toxicity, tachycardia, nausea, vomiting, HA, Seizures, arrythmia
CI: peptic ulcer disease, arrhythmias, seizure disorders
DI: major substrate of CYP3A4,1A2, 2E1
Increased concentration: cimetidine, erythromycine, clarithromycin, ciprofloxacin, ticlopidine
decreased concentration: phenobarb, phenytoin, carbamazepine, rifampin
COMMENTS: Monitor serum concentrations - target range: 8-12mcg/mL. Smoking increases metabolism, monitor for increased concentrations if patient stops smoking.
PDE 3 inhibition likely cause for hypotension,tachycardia, and nausea
Omalizumab (Xolair)
Immunomodulator
SQ inj 150mg/1.2mL after reconstitution with 1.4mL of sterile water for injection
Only for ADULTS: 150-375 mcg SQ every 2-4wks dependingon body weight and pretreatment serum IgE levels.
BLACK BOX: Anaphylaxis
How do immune modulators help asthma patients
for allergy induces asthma, these medications (Xolair) inhibit IgE binding to receptors on mast cells and basophils, inhibit mediator release and attenuation of early and late phase allergic response.
What are the adverse effects of Omalizumab
Xolair
HA, injection site reactions, arthralgias, thrombocytopenia, pharyngitis, sinusitis, URI
**Do not inject more than 150mg per injection site.
Monitor for 2 hours after at least the first 3 injections.
What inhaled SABAs are used in asthma exacerbations?
Albuterol nebulizer solutions, Albuterol MDI, levalbuterol MDI and nebulizer solution for kids and adults
Albuterol nebulizer solution exacerbation dose for adults and children?
Children: 0.15mg/kg (min: 2.5mg) Q20minutes x 3 doses or 0.5mg/kg/hour by continuous nebulization
Adults: 2.5-5mg Q20minutes x 3 doses, then 2.5-10mg/hour Q1-4 hours or 10-15mg/hour by continuous nebulization
Can mix with ipratropium solution
Albuterol inhaler dose for asthma exacerbation for kids and adults
Kids: 4-8 puffs Q 20minutes x 3 doses, then every 1-4hrs inhalation maneuver PRN.
Adults:4-8 puffs Q20minutes up to 4 hrs then Q1-4 hours PRN
Levalbuterol nebulizer solution dose for asthma exacerbations?
Kids: 0.075 mg/kg (min 1.25mg) Q20minutes x 3 doses, then 0.075-0.15mg/kg up to 5mg Q1-4 hours PRN
What is the levalbuterol inhaler dose for exacerbations of asthma?
Kids: 4-8 puffs Q 20minutes x 3 doses, then every 1-4hrs inhalation maneuver PRN.
Adults:4-8 puffs Q20minutes up to 4 hrs then Q1-4 hours PRN
What are two systemic B2 agonists that can be injected during an asthma exacerbation?
Epinipherine and Terbutaline
no proven adv over aerosol therapy
What is the Epinephrine dose for asthma exacerbations?
1mg/kg concentration
Kids: 0.01mg/kg up to 0.3-0.5mg Q20mins for 3 doses SC
Adults: 0.3-0.5mg Q20minutes for 2 doses SC
What is Terbutaline dose for asthma exacerbations?
1mg/mL concentration
Kids: 0.01mg/kg Q20mins x 3 doses, then every 2-6 hrs SC PRN
Adults: 0.5mg Q 20mins x 3 doses then PRN
