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Controller Medications Asthma/COPD Flashcards

1
Q

beclomethasone brand name?

A

QVAR

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2
Q

beclomethasone dosage form

A

Redihaler (MDI - metered dose inhaler)

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3
Q

budesonide (inhaler) brand name?

A

Pulmicort

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4
Q

budesonide dosage form?

A

Flexhaler

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5
Q

budesonide (nebulizer solution) brand name?

A

Pulmicort Respules

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6
Q

ciclesonide brand name?

A

Alvesco

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7
Q

ciclesonide dosage form?

A

HFA (hydrofluoroalkane)

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8
Q

fluticasone propionate brand name(s)?

A

Floventil, ArmonAir Digihaler

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9
Q

fluticasone propionate dosage form(s)?

A

HFA, DPI (dry powder inhaler), Aerosol Powder Inhaler

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10
Q

fluticasone furoate brand name?

A

Arnuity Ellipta

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11
Q

fluticasone furoate dosage form?

A

Ellipta

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12
Q

mometasone brand name?

A

Asmanex

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13
Q

mometasone dosage form?

A

HFA, Twisthaler

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14
Q

Inhaled Corticosteroid use?

A

prevent and control inflammation

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15
Q

ICS Adverse Effects?

A

Oral thrush (candidiasis), cough, dysphonia (difficulty speaking)

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16
Q

ICS Counseling Tips?

A
  • Rinse mouth and spit after use to prevent thrush
  • ICS are most effective long-term control therapy for asthma (improves quality of life, increases lung function, reduces risk of exacerbations)
  • ICSs may increase risk of pneumonia for COPD patients
  • Titrate to lowest effective dose
  • Pulmicort Respules should use Jet Nebulizer, not to be mixed with other nebulizer meds
  • High doses increase risk for systemic side effects
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17
Q

Which ICSs can 0-4 y/o patients use?

A

budesonide (Pulmicort Respules) and fluticasone propionate (Flovent, ArmonAir Digihaler)

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18
Q

Which ICSs can 5-11 y/o patients use?

A

All ICS medications listed

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19
Q

Which ICS is not for adult use?

A

budesonide (Pulmicort Respules - nebulizer solution)

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20
Q

Long Acting Beta Agonists (LABA) use?

A

increase cAMP –> bronchial smooth muscle relaxation and inhibits hypersensitivity mediators from mast cells (histamine and leukotrienes)

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21
Q

arformoterol tartrate brand name?

A

Brovana

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22
Q

arformoterol dosage form?

A

nebulizer solution

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23
Q

formoterol brand name?

A

Perforomist

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24
Q

formoterol dosage form?

A

nebulizer solution

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25
Q

indacaterol brand name?

A

Arcapta Neohaler

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26
Q

indacaterol dosage form?

A

Neohaler

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27
Q

olodaterol brand name?

A

Striverdi Respimat

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28
Q

olodaterol dosage form?

A

Respimat

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29
Q

salmeterol brand name?

A

Serevent

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30
Q

salmeterol dosage form?

A

Diskus

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31
Q

LABA Adverse Effects?

A

tachycardia, headache, tremor, hypokalemia

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32
Q

LABA Boxed Warnings

A
  • Increased risk of asthma related death for all monotherapy LABA use (should not be used alone for asthma management)
  • Increasing hospitalizations in pediatric and adolescent patients
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33
Q

LABA Side Effects/Comments

A
  • Prolonged QT with intentional overdose
  • Not for acute symptoms!
  • May be helpful for exercise induced bronchospasm
  • Formoterol and indacaterol capsules should not be taken orally
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34
Q

LABA Pediatric Considerations?

A
  • Most children < 4 y/o cannot provide sufficient inspiratory flow for adequate lung delivery with a DPI (dry powder inhaler)
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35
Q

Which LABAs can 0-4 y/o patients use?

A

NONE

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36
Q

Which LABA can 5-11 y/o patients use?

A

salmeterol (Serevent) only

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37
Q

Which LABAs can adults use?

A

All medications listed

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38
Q

Long Acting Antimuscarinic (LAMA) use?

A

block the bronchoconstrictor effects of acetylcholine on M3 and M2 receptors

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39
Q

aclidinium brand name?

A

Turdorza Pressair

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40
Q

aclidinium dosage form?

A

DPI (dry powder inhaler)

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41
Q

glycopyrrolate brand name?

A

Seebri Neohaler

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42
Q

glycopyrrolate dosage form?

A

DPI, Nebulization solution

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43
Q

revefenacin brand name?

A

Yupelri

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44
Q

revefenacin dosage form?

A

nebulization solution

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45
Q

tiotropium brand name?

A

Spiriva

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46
Q

tiotropium dosage form?

A

HandiHaler, Respimat

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47
Q

umeclidinium brand name?

A

Incruse Ellipta

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48
Q

umeclidinium dosage form?

A

DPI

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49
Q

LAMA Adverse Effects?

A

dry mouth, dizziness, blurred vision, upper respiratory infections, and paradoxical bronchospasms

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50
Q

LAMA note

A

tiotropium has been approved for use in asthma as an add-on option for children 12 years and older

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51
Q

Which LAMAs can 0-4 y/o patients use?

A

NONE

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52
Q

Which LAMA can 5-11 y/o patients use?

A

tiotropium (Spiriva) respimat for patients 6 years and older

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53
Q

fluticasone/salmeterol brand name?

A

Advair, AirDuo, AirDuo Digihaler

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54
Q

fluticasone/salmeterol dosage forms?

A

DPI and HFA MDI (Advair), Respiclick DPI (AirDuo & AirDuo Digihaler)

55
Q

budesonide/formoterol brand name?

56
Q

budesonide/formoterol dosage form?

57
Q

mometasone/formoterol brand name?

58
Q

mometasone/formoterol dosage form?

59
Q

fluticasone/vilanterol brand name?

A

Breo Ellipta

60
Q

fluticasone/vilanterol dosage form?

61
Q

ICS/LABA Adverse Effects?

A

individualized

62
Q

ICS/LABA Clinical Pearls?

A
  • Guidelines recommend combo LABA with ICS in asthma, as LABA should not be used as monotherapy
  • Combo products developed to create convenient packaging and assist with patient adherence
63
Q

Which ICS/LABA can 0-4 y/o patients use?

64
Q

Which ICS/LABA can 5-11 y/o patients use?

A

Advair DPI (fluticasone/salmeterol) and Symbicort HFA MDI (budesonide/formoterol)

65
Q

Which ICS/LABA can adults use?

A

All medications listed

66
Q

olodaterol/tiotropium brand name?

A

Stiolto Respimat

67
Q

olodaterol/tiotropium dosage form?

68
Q

vilanterol/umeclidinium brand name?

A

Anoro Ellipta

69
Q

vilanterol/umeclidinium dosage form?

70
Q

indacaterol/glycopyrronium brand name?

A

Utibron Neohaler

71
Q

indacaterol/glycopyrronium dosage form?

72
Q

formoterol/glycopyrronium brand name?

A

Bevespi Aerosphere

73
Q

formoterol/glycopyrronium dosage form?

A

Aerosphere

74
Q

formoterol/aclidinium brand name?

A

Duaklir Pressair

75
Q

formoterol/aclidinium dosage form?

76
Q

LABA/LAMA AE/Clinical Pearls?

A
  • Individualized effects
  • Not indicated for treatment of acute deteriorations
77
Q

LABA/LAMA age usage?

A

Adults only and COPD only

78
Q

fluticasone/umeclidinium/vilanterol brand name?

A

Trelegy Ellipta

79
Q

flutcasone/umeclidinium/vilanterol dosage form?

80
Q

budesonide/glycopyrrolate/formoterol fumarate brand name?

A

Breztri Aerosphere

81
Q

budesonide/glycopyrrolate/formoterol fumarate dosage form?

A

Aerosphere

82
Q

LABA/LAMA/ICS age use?

A

Adults only

83
Q

fluticasone/umeclidinium/vilanterol use?

A

asthma and COPD

84
Q

budesonide/glycopyrrolate/fomoterol fumarate use?

85
Q

cromolyn brand name?

86
Q

cromolyn dosage form?

A

nebulizer solution

87
Q

mast cell stabilizer adverse effects/clinical pearls?

A
  • High incidence of unpleasant taste in mouth (>10%), rare cardiac arrhythmias, coughing, dyspnea, sore throat, N/V/D if absorbed systemically
  • Less effective than low-dose ICS
  • Prevents increase in bronchial hyperactivity seen in allergy season
88
Q

Leukotriene modifiers action?

A

block production of leukotrienes

89
Q

montelukast brand name?

90
Q

montelukast dosage form?

A

tablets (chewable), granule packets

91
Q

montelukast adverse effects/clinical pearls?

A
  • minor substrate for CYP2C8/9 and 3A4
  • not for acute relief of symptoms
  • Boxed warning: neuropsychiatric events
92
Q

zafirlukast brand name?

93
Q

zafirlukast dosage form?

94
Q

zafirlukast adverse effects/clinical pearls?

A
  • take at least 1 hour before or 2 hours after meals
  • can increase INR (blood clot timing)
  • major substrate, minor inhibitor of CYP2C9
95
Q

zileuton brand name?

96
Q

zileuton dosage form?

A

IR tablets, ER tablets

97
Q

zileuton adverse effects/clinical pearls?

A
  • weak CYP1A2 inhibitor
  • take with food
98
Q

Which leukotriene modifier can 0-4 y/o patients use?

A

montelukast only

99
Q

Which leukotriene modifier can 5-11 y/o patients use?

A

montelukast or zafirlukast

100
Q

Which leukotriene modifier can adults use?

A

all medications listed

101
Q

leukotriene modifiers adverse effects/clinical pearls?

A
  • neuropsychiatric events (agitation, anxiety, abnormal dreams, hallucinations, depression, suicidal thinking), Churg-Strauss syndrome (rare), increased hepatic transaminases (zafirlukast and zileuton)
  • less effective than low dose ICS and ICS/LABA in asthma
  • have not been adequately trialed in COPD
102
Q

methylxanthines action?

A

bronchodilation through inhibition of PDE III and PDE IV

103
Q

theophylline brand name?

104
Q

theophylline dosage form?

A

ER 12 hr tablets, ER 24 hr tablets, ER 24 hr capsules, liquid

105
Q

methylxanthines adverse effects/clinical pearls?

A
  • Insomnia, GI upset, hyperactivity, hypotension, tremor
  • Dose related toxicity: tachycardia, nausea, vomiting, headache, seizures, arrhythmias
  • CI: peptic ulcer disease, arrhythmias, seizure disorders
  • DI: major substrate for CYP3A4, 1A2, 2E1
    –> increased [ ]: cimetidine, erythromycin, clarithromycin, ciprofloxacin, ticlopidine
    –> decreased [ ]: phenobarbital, phenytoin, carbamazepine, rifampin; smoking
  • PDE III inhibition likely cause for hypotension, tachycardia and nausea
106
Q

methylxanthines age use?

A

Adults only
- Acute exacerbation (loading dose, typically given IV as aminophylline, followed by maintenance IV infusion)
- Chronic management (dosing differs based on smokers vs non-smokers)

107
Q

Anti-IgE action?

A

inhibit IgE binding to receptors on mast cells and basophils, inhibit mediator release and attenuation of early and late phase allergic responses

108
Q

omalizumab brand name?

109
Q

omalizumab dosage form?

110
Q

Anti-IgE adverse effects/clinical pearls?

A
  • Headache, injection site reactions, arthralgias, thrombocytopenia, pharyngitis, sinusitis, upper respiratory tract infections
  • Boxed warning: anaphylaxis
  • Do not give more than 150mg/injection site
  • Monitor for anaphylaxis before and after injection
  • FDA approved for moderate to severe persistent asthma in patients with a positive skin test or reactivity to a perennial aeroallergen and symptoms that are inadequately controlled with ICS
111
Q

Anti-IL5 action?

A

blocks binding of IL-5 to the alpha chain of the IL-5 receptor complex, resulting in reduced production and survival of eosinophils

112
Q

mepolizumab brand name?

113
Q

mepolizumab dosage form?

A

injection (auto-injector or reconstituted injection)

114
Q

mepolizumab adverse effects/clinical pearls?

A
  • Headache, injection site reactions, arthralgias, Herpes Zoster infection
  • Precaution: anaphylaxis
  • Available as in-clinic or at-home injection
  • Monitor for anaphylaxis before and after injection
  • Indicated for add-on maintenance treatment of patients with severe asthma with an eosinophilic phenotype
115
Q

reslizumab brand name?

116
Q

reslizumab dosage form?

117
Q

reslizumab adverse effects/clinical pearls?

A
  • Injection site reactions, myalgias, increased creatinine phosphokinase
  • Boxed Warning: anaphylaxis, malignancies
  • Monitor for anaphylaxis before and after injection
  • Indicated for add-on maintenance treatment of patients with severe asthma with an eosinophilic phenotype
117
Q

reslizumab adverse effects/clinical pearls?

A
  • Injection site reactions, myalgias, increased creatinine phosphokinase
  • Boxed Warning: anaphylaxis, malignancies
  • Monitor for anaphylaxis before and after injection
  • Indicated for add-on maintenance treatment of patients with severe asthma with an eosinophilic phenotype
118
Q

benralizumab brand name?

119
Q

benralizumab dosage form?

A

injection (auto-injector or pre-filled syringe)

120
Q

benralizumab adverse effects/clinical pearls?

A
  • Injection site reactions, antibody development, headache, pharyngitis, fever
  • Precaution: anaphylaxis
  • Available as in-clinic or at-home injection
  • Indicated for add-on maintenance treatment of severe asthma in adults and children 12 years and older with eosinophilic phenotype
  • Acts on IL-5 receptors, others act on IL-5
121
Q

Which Anti-IL5s can 0-4 y/o patients use?

122
Q

Which Anti-IL5s can 5-11 y/o patients use?

A

mepolizumab (Nucala) only

123
Q

Which Anti-IL5s can adults use?

A

All listed medications

124
Q

Anti-IL4/IL13 action?

A

blocks binding of IL4 to reduce eosinophil trafficking and IgE reactions while also blocking IL13 to reduce mucus secretion and airway remodeling

125
Q

dupilumab brand name?

126
Q

dupilumab dosage form?

127
Q

dupilumab adverse effects/clinical pearls?

A
  • injection site reactions, antibody development, arthralgias, conjunctivitis
  • Precaution: anaphylaxis
  • Available as pre-filled syringe for in-office or at-home administration
  • Indicated as an add-on maintenance treatment in patients with moderate to severe asthma aged 12 and older with eosinophilic phenotype or with oral corticosteroid dependent asthma
128
Q

Which age group can use Anti-IL4/IL13s?

A

Adults aged 12 and older only

129
Q

Phosphodiesterase-4 Inhibitors action?

A

inhibit PDE4, leading to increased cAMP

130
Q

roflumilast brand name?

131
Q

roflumilast dosage form?

132
Q

roflumilast adverse effects/clinical pearls?

A
  • HA, weight loss, diarrhea, nausea
  • Monitor: liver function test, weight
  • DI: CYP3A4 (major), CYP1A2 (minor)
  • CI: Child-Pugh class B or C

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