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Antipsychotics For Pup > Asthma Meds > Flashcards

Asthma Meds Flashcards

1
Q

Albuterol HFA (Proventil, Ventolin, ProAir)

A

Inhaled SABA
MDI: 90mcg/puff
ALL AGES: 2 puffs 5 minutes before exercise
2 puffs q4-6 hrs PRN
AE: Tachycardia, tremor, hypokalemia, irritability

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2
Q

Albuterol nebulizer solution

A

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

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3
Q

Levalbuterol HFA

Xopenex

A 
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
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4
Q

Levalbuterol Nebulizer solution

Xopenex

A

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

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5
Q

Ipratropium HFA

Atrovent

A 
Anticholinergic- quick relief
MDI: 17mcg/puff (200puffs)
Adults:  2-3puffs Q6H
Nebulizer solution:0.25mg/mL
Adults only: 0.25mg Q6H
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6
Q

Ipratropium with Albuterol (Combivent Respimat)

A

Anticholinergic - quick relief
20mcg/puff ipratropium and 100mcg/puff albuterol
1 puff Q6H
SE: Dry mouth, urine retention, infection, sinusitis, bronchitis

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7
Q

Methylprednisolone

A

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.

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8
Q

Prednisolone

A

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.

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9
Q

Prednisone

A

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.

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10
Q

Methylprednisolone acetate

A 
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
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11
Q

Adverse effects, Contraindications, Drug interactions for Systemic corticosteroids short term

A

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

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12
Q

Magnesium sulfate

A

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

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13
Q

What ICS medications are used in children ages 0-4?

A

Budesonide nebulizer solution (pulmicort Respules) and Fluticasone HFA (MDI)(Flovent)

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14
Q

Belomethasone HFA (MDI)(QVAR)

A 
ICS controller med
40 or 80mcg/puff
NOT for under 5yrs
5-11: 80-160mcg, >160-320mcg, >320mcg
Adults: 80-240mcg, >240-480, >480mcg
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15
Q

Budesonide DPI (pulmicort)

A

ICS controller med
90,180, or 200mcg/puff
5-11y: 180-400mcg, >400-800, >800mcg
Adults: 180-600mcg, >600-1200, >1200

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16
Q

Budesonide nebulizer solution (pulmicort Respules)

A

ICS
0-4: 0.25-0.5mg, >0.5-1mg, >1mg
5-11y: 0.5mg, 1mg, 2mg

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17
Q

Flunisolide HFA (AeroBid)

A

ICS
5-11:160mcg, 320mcg, 640mcg and above
Adults: 320mcg,>320-640, 640mcg and above

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18
Q

Fluticasone HFA (MDI)(Flovent)

A 
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
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19
Q

Fluticasone DPI

A 
ICS Controller med
50, 100 or 250mcg/inhalation
5-11: 100-200mcg,
 >200-400,>400mcg
Adult: 100-300, >300-500, >500mcg
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20
Q

Mometasone DPI (Asmanex)

A

ICS for control
200 mcg/inhalation
ADULTS only: 200mcg, 400mcg, >400mcg

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21
Q

Ciclesonide HFA (Avelsco)

A

ICS for contro
80 or 160mcg/puff
5-11: 160-320mcg,>320-640, >640
Adults: 160-320mcg, >320-640, >640

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22
Q

Adverse Effects, contraindications, drug interactions of long term corticosteroids

A

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.

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23
Q

Salmeterol (Serevent)

A

LABA
DPI 50mcg/blister
5-11y and Adults: contents of one blister Q12H

24
Q

Formoterol (Foradil)

A

LABA
DPI 12mcg/capsule
5-11 and Adults: Contents of one capsule Q12H

25
Q

Alformoterol tartrate (Brovana)

A

LABA
1mcg/2mL nebulizer solution
ADULTS: 15mcg Q12H

26
Q

Indacaterol (Arcapta Neohaler)

A

LABA
DPI 75mcg/capsule
Adults: contents of one capsule daily

27
Q

What do LABA’s do to help control asthma?

A

increase cAMP to cause bronchial smooth muscle relaxation and inhibit hypersensitivity mediators from mast cells (histamine and leukotrienes)

28
Q

What are the ADVERSE effects from LABA’s?

A

Tachycardia, tremor, hypokalemia, increase in asthma exacerbations, prolonged QT seen with intentional overdoses

29
Q

Special considerations with LABA’s in asthma

A

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

30
Q

Fluticasone/Salmeterol

Advair

A

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)

31
Q

Budesonide/Formoterol (Symbicort)

A

Combined ICS/LABA Products
HFA MDI 80mcg/4.5mcg
160mcg/4.5mcg
Ages 5-adult: 2 puffs BID

32
Q

Formoterol/Mometasone

Dulera

A

Combined ICS/LABA Products
MDI 100mcg/5mcg; 200mcg/5mcg
ADULTS: 2puffs BID

33
Q

Vilanterol/Fluticasone (Breo Ellipta)

A

Combined ICS/LABA products
DPI 100 mcg/25mcg
Adults only: 1 puff once daily

34
Q

Cromolyn

A

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)

35
Q

cromolyn Adverse Effects?

A

high incidence of unpleasant taste, Rare cardiac arrhythmias, coughing, dyspnea, sore throat, N/V/D if absorbed systemically, relatively well tolerated.

36
Q

Is cromolyn more or less effective at controlling persistent asthma than ICS?

A

cromolyn is less effective

37
Q

What stage of asthma are the combination ICS/LABA products best used in?

A

moderate persistent asthma

38
Q

Montelukast (singulair)

A

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

39
Q

Zafirlukast (Accolate)

A

leukotriene modifier
10 or 20 mg tablets
7-11y: 10mg BID
Adult: 20mg BID

40
Q

Zileuton (Zyflo CR)

A

leukotriene modifier
600mg tablets
ONLY ADULTS: 1200mg BID

41
Q

Adverse Effects for leukotriene modifiers

A

Neuropsychiatric events, rare but serious Churg- Strauss syndrome, increased hepatic transaminases, Generally well tolerated

42
Q

What are the special considerations to remember with leukotriene modifiers?

A

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

43
Q

Theophylline

A

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

44
Q

Adverse effects, contraindications and drug interactions of Methylxanthines

A

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

45
Q

Omalizumab (Xolair)

A

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

46
Q

How do immune modulators help asthma patients

A

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.

47
Q

What are the adverse effects of Omalizumab

Xolair

A

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.

48
Q

What inhaled SABAs are used in asthma exacerbations?

A

Albuterol nebulizer solutions, Albuterol MDI, levalbuterol MDI and nebulizer solution for kids and adults

49
Q

Albuterol nebulizer solution exacerbation dose for adults and children?

A

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

50
Q

Albuterol inhaler dose for asthma exacerbation for kids and adults

A

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

51
Q

Levalbuterol nebulizer solution dose for asthma exacerbations?

A

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

52
Q

What is the levalbuterol inhaler dose for exacerbations of asthma?

A

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

53
Q

What are two systemic B2 agonists that can be injected during an asthma exacerbation?

A

Epinipherine and Terbutaline

no proven adv over aerosol therapy

54
Q

What is the Epinephrine dose for asthma exacerbations?

A

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

55
Q

What is Terbutaline dose for asthma exacerbations?

A

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

Antipsychotics For Pup (4 decks)

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