Controller Medication - Asthma and COPD Flashcards
ICS - Meds
beclomethasone, budesonide, ciclesonide, fluticasone propionate, fluticasone furoate, mometasone
LABA - Meds
arformoterol tartrate, formoterol, indacaterol, olodaterol, salmeterol
LAMA - Meds
aclidinium, glycopyrrolate, revefenacin, tiotropium, umeclidinium
ICS/LABA - Meds
fluticasone/salmeterol, budesonide/formoterol, mometasone/formoterol, fluticasone/vilanterol
LABA/LAMA - Meds
olodaterol/tiotropium, vilanterol/umeclidinium, indacaterol/glycopyrronium, formoterol/glycopyrronium, formoterol aclidinium
LABA/LAMA/ICS - Meds
fluticasone/umeclidinium/vilanterol
budesonide/glycopyrrolate/formoterol fumarate
Mast cell stabilizer - Meds
cromolyn
Leukotriene Modifiers - Meds
montelukast, zafirlukast, zileuton
Methylxanthine - Meds
theophylline
Anti-IgE - Meds
omalizumab
Anti-IL5 - Meds
mepolizumab, reslizumab, benralizumab
Anti-IL4/IL13 - Meds
dupilumab
Phosphodiaesterase-4 Inhibitors - Meds
roflumilast
ICS - Adverse Effects
Oral thrush (candidiasis), cough, dysphonia
ICS - Clinical Pearls
- Pts should rinse their mouth and spit after use to prevent oral thrush
- Most effective long-term control therapy for asthma (improve quality of life, increase lung function, and reduce the risk of exacerbations)
- May increase the risk of pneumonia in pts w/ COPD
- Titrate to lowest effective dose - see low, medium and high dose conversion table
- High doses increase the risk for systemic side effects
LABA - Adverse Effects
tachycardia, headache, tremor, hypokalemia
LABA - Clinical Pearls
- Boxed warning for increased risk of asthma related death w/ monotherapy use & increasing hospitalizations in pediatric and adolescent pts
- Prolonged QT seen w/ intentional overdoses
- Not for acute symptoms
- May be helpful for exercise induced bronchospasm
- Pediatric considerations: most children <4 yo cannot provide sufficient inspiratory flow for adequate lung delivery w/ a DPI
LAMA - Adverse Effects
dry mouth, dizziness, blurred vision, upper respiratory infections and paradoxical bronchospasms
LAMA - Clinical Pearls
Combination products developed to create convenient packaging and assist w/ pt adherence
LABA/LAMA - Clinical Pearls
Not indicated for treatment of acute deteriorations
Mast Cell Stabilizer - Adverse Effects
high incidence of unpleasant taste in mouth, rare cardiac arrythmias, coughing, dyspnea, sore throat, nausea, vomiting, diarrhea if absorbed systemically
Mast Cell Stabilizer - Clinical Pearls
- Less effective than low-dose ICS
- Prevents increase in bronchial hyperreactivity seen in allergy season
Leukotriene Modifiers - Adverse Effects
neuropsychiatric events (agitation, anxiety, abnormal dreams, hallucinations, depression, suicidal thinking), Churh-Strauss syndrome, increased hepatic transaminases
Leukotriene Modifiers - Clinical Pearls
- Less effective than low dose ICE and ICS/LABA in asthma
- Used for asthma only; has not bee adequately trialed in COPD
Methylxanthines - Adverse Effects
insomnia, GI upset, hyperactivity, hypotension, tremor
Methylxanthines - Dose related toxicity
tachycardia, nausea, vomiting, headache, seizures, arrythmias
Methylxanthines - Contraindications
peptic ulcer disease, arrythmias, seizure disorders
Methylxanthines - Drug Interactions
Major substrate of CYP3A4, 1A2, 2E1
Inducers: cimetidine, erythromycin, clarithromycin, ciprofloxacin, ticlopidine
Inhibitors: phenobarbital, phenytoin, carbamazepine, rifampin, smoking
- PDE III inhibition likely cause for hypotension, tachycardia and nausea
Anti-IgE - Adverse Effects
headache, injection site reactions, arthralgias, thrombocytopenia, pharyngitis, sinusitis, upper respiratory tract infections
Anti-IgE - Clinical Pearls
- Boxed warning: anaphylaxis
- Do not give more than 150mg per injection site
- Monitor for anaphylaxis before and after injection
- FDA approved for moderate to severe persistent asthma in pts w/ a positive skin test or reactivity to a perennial aeroallergen and symptoms that are inadequately controlled w/ ICS
