Controller Meds Asthma/COPD Flashcards
Name generic name, drug class, age group, dosage form, and adverse effects/clinical pearls
Prevent and control inflammation
Inhaled corticosteroids (ICS)
QVAR
ICS
Beclomethasone
Redihaler (MDI)
5yrs-adult
Adverse effects for ICS
oral thrush, cough, dysphonia
Counseling tips for ICS
*Rinse mouth and spit after use to prevent thrush
*Most effective long-term control therapy for asthma
*May increase the risk of pneumonia in patients with COPD
*Titrate to lowest effective dose
*Budesonide (Pulmicort Respules) should use jet nebulizer and should not be mixed with other nebulizer meds
*High doses increase the risk for systemic side effect
Pulmicort
ICS
Budesonide
Flexhaler
5 yrs-Adult
Pulmicort Respules
ICS
Budesonide
Nebulizer Solution
0yr-11yrs
Alvesco
ICS
Ciclesonide
HFA
5yrs-adult
Flovent
ArmonAir Digihaler
ICS
Fluticasone Propionate
HFA, DPI, Aerosol Powder Inhaler
0yrs-adult
Arnuity Ellipta
ICS
Fluticasone Furoate
Ellipta
5yrs-adult
Asmanex
ICS
Mometasone
HFA, Twisthaler
5yrs-adult
Bronchial smooth muscle relaxation and inhibit hypersensitivity mediators from mast cells (histamines, leukotrienes)
Long Acting Beta Agonist (LABA)
(increases cAMP)
LABA Adverse Effects
tachycardia, headache, tremor, hypokalemia
LABA Box warning
*Should not be used alone for asthma management (increased risk of asthma related death)
*Increasing hospitalizations in pediatric and adolescent patients
*Prolonged QT seen with intentional overdoses
*Not for acute symptoms
*May be helpful for exercise induce bronchospasm
*Formoterol and indacaterol capsules should not be taken orally
LABA Peds considerations
Most children <4 yo cannot provide sufficient inspiratory flow for adequate lung delivery with a DPI
Brovana
LABA
Arformoterol tartrate
Nebulizer Solution
Adult COPD only
Perforomist
LABA
Formoterol
Nebulizer solution
Adult COPD only unless combo with ICS
Arcapta Neohaler
LABA
Indacaterol
Neohaler
Adult COPD only
Striverdi Respimat
LABA
Olodaterol
Respimat
Adult COPD only
Serevent
LABA
Salmeterol
Diskus
5yrs-adult
Blocks the bronchoconstrictor effects of ACh on M3 and M2 receptors
LAMA
LAMA adverse effects
dry mouth, dizziness, blurred vision, upper RI, and paradoxical bronchospasms
Turdorza Pressair
LAMA
Aclidinium
DPI
Adult COPD only
Seebri Neohaler
LAMA
Glycopyrrolate
DPI, Nebulization soln
Adult COPD only
Yupelri
LAMA
Revefenacin
Nebulization solution
Adult COPD only
Spiriva
LAMA
Tiotropium
HandiHaler, Respimat
Handi- adult COPD
Respimate- 12yrs-adult
Incruse Ellipta
LAMA
Umeclidinium
DPI
Adult COPD only
ICS/LABA Clinical Pearls
LABA is recommended in combo with ICS. This assist with patient adherence
Advair
ICS/LABA
Fluticasone/Salmeterol
DPI, HFA MDI
5yrs- adult
AirDuo and AirDuo Digihaler
ICS/LABA
Fluticasone/Salmeterol
Respiclick (DPI)
Adult
Symbicort
ICS/LABA
Budesonide/Formoterol
HFA MDI
5yrs-adult
Dulera
ICS/LABA
Mometasone/Formoterol
MDI
Adult
Breo Ellipta
ICS/LABA
Fluticasone/Vilanterol
DPI
Adult
LABA/LAMA clinical pearls
*COPD only
*Not indicated for treatment of acute deteriorations
Stiolto Respimat
LABA/LAMA
Olodaterol/Tiotropium
Respimate
Adult COPD only
Anoro Ellipta
LABA/LAMA
Vilanterol/Umeclidinium
Ellipta
Adult COPD only
Utibron Neohaler
LABA/LAMA
Indacaterol/Glycopyrronium
Neohaler
Adult COPD only
Bevespi Aerosphere
LABA/LAMA
Formoterol/Glycopyrronium
Aerosphere
Adult COPD only
Duaklir Pressair
LABA/LAMA
Formoterol/Aclidinium
DPI
Adult COPD only
Trelegy Ellipta
LABA/LAMA/ICS
Fluticasone/Umeclidinium/Vilanterol
Ellipta
Adult- Asthma/COPD
Breztri Aerosphere
LABA/LAMA/ICS
Budesonide/Glycopyrrolate/Formoterol Fumarate
Aerosphere
Adult COPD only
Intal
Mast cell stabilizer
Cromolyn
Nebulizer solution
2yrs-adult
Mast cell stabilizer Adverse Effects
High incidence of unpleasant taste, rare cardiac arrhythmias, coughing, dyspnea, sore throat
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, Churg-Strauss Syndrom, increased hepatic transaminases
Leukotriene modifiers clinical pearls
*Less effective than low dose ICS and ICS/LABA in asthma
*Have not be adequately trialed in COPD
Singulair
Leukotriene Modifiers
Montelukast
Tablets (chewable), granule packets
1 yr-adult
Accolate
Leukotriene Modifiers
Zafirlukast
Tablets
5 yrs-adult
Zyflo CR
Leukotriene Modifiers
Zileuton
IR, ER tablets
Adult
Bronchodilation through inhibition of PDE III and PDE IV
Methylxanthines
Methylxanthines adverse effects
insomnia, GI upset, hyperactivity, hypotension, tremor
Theochron
Methylxanthines
Theophylline
ER 12, 24 hr tablets
ER 24 hr capsules
Liquid
Inhibits binding to receptors on mast cells and basophils, inhibit mediator release and attenuation of early- and late-phase allergic response
Anti-IgE
Xolair
Anti-IgE
Omalizumab
Syringe with reconstitution
6yrs-adult
Anti-IgE adverse effects
headache, injection site reaction, arthralgias, thrombocytopenia, pharyngitis, sinusitis, upper RT infection
Anti-IgE clinical pearls
*Do not give more than 150mg per injection site
*Monitor for anaphylaxis before and after injection
*Approved for mod-severe asthma in patients w inadequately controlled use of ICS
Blocks binding to the alpha chain of the IL-5 receptor complex, which results in reduced production and survival of eosinophils
Anti-IL5
Nucala
Anti-IL5
Mepolizumab
Injection
6yrs-adult
Cinqair
Anti-IL5
Reslizumab
Solution for injection
Adult
Fasenra
Anti-IL5
Benralizumab
Auto inject or prefilled syringe
adult
Blocks binding to reduce eosinophil trafficking and IgE reactions while also blocking IL-13 to reduce mucus secretion and airway remodeling
Anti-IL4/IL13
Dupixent
Anti-IL4/IL13
Dupilumab
Injection
Adult
Daliresp
Phosphodiaesterase-4 Inhibitors
Roflumilast
Tablets
Adult- COPD only