COPD/Asthma adverse effects and clinical protocols Flashcards
What are the adverse effects for ICS inhalers
oral thrush (candidiasis), cough, dysphonia
what are the counseling points for ICS inhalers?
- rinse mouth and spit after each use to prevent thrush
- may increase pneumonia risk in pts with COPD
- titrate to lowest effective dose
- high doses increase the risk for systemic side effects
what is a counseling point for pulmicort respules?
use jet nebulizer and should not mix with other neb medications
what are the adverse effects for LABA inhalers?
tachycardia, headache, tremor, hypokalemia
what are the clinical pearls for LABAs?
- prolonged QT seen in intentional overdoses
- not for acute symptoms
- may be helpful to exercise for induce bronchospasm
- formoterol and indacaterol capsules shouldn’t be taken orally
what are the black box warnings for LABAs?
- for increased risk of asthma related death for all monotherapy LABA use should not be used alone for asthma management
- for increasing hospitalizations in pediatric and adolescent patients
what are the adverse effects for LAMAs?
dry mouth, dizziness, blurred vision, upper respiratory infections, and paradoxical bronchospasms
what is a clinical pearl for LAMA inhaler Spiriva?
has been approved for asthma > or equal to 12yo
what are some clincal pearls for ICS/LABA combo inhalers?
- guidelines recommend combo LABA/ICS in asthma, as LABA shouldn’t be used as monotherapy
- combo products developed to create convenient packaging and adherence
what is the clinical pearl for LABA/LAMA combo?
not indicated in use for asthma
what are the adverse effects for leukotriene modifiers?
neuropsych events (agitation, anxiety, hallucinations, depression), Churg-Strauss syndrome (rare), increased hepatic transaminases (zafirlukast/ zileuton)
what are the clinical pearls for leukotriene modifiers?
- less effective than low dose ICS and ICS/LABA in athma
- have not been adequately trailed in COPD
what are the specific clinical pearls for monteukast?
- minor substrate CYP2C8/9 and 3A4
- not for acute asthma relief
- boxed warning: neuropsych events
what are the specific clinical pearls for zafirlukast?
- take at least 1 hr b4 or 2 hrs after meals
- can increase INR
- major substrate: minor inhibitor of CYP2C9
what are the specific clinical pearls for zileuton?
- weak CYP1A2 inhibitor
- take with food
what are the adverse effects of theophylline?
insomnia, GI upset, hyperactivity, hypotension, tremor
what are the clinical pearls for theophylline?
- major GI best; can mess it up
- lots of interactions with medications
- can cause seizures, peptic ulcer disease, arrhythmias
- has dose related toxicity related to nausea, vomiting, tachycardia
what are the Adverse effects for omalizumab?
headache, injection site reactions, arthralgias, thrombocytopenia, pharyngitis, sinusitis, upper respiratory tract infections
what are the clinical pearls for omalizumab?
- no more than 150mg per injection site
- monitor for anaphylaxis b4 and after inj
- BLACK BOX: anaphylaxis
- FDA approved for moderate to severe persistent asthma in patients with positive skin test or reactivity to a perennial aeroallergen and symptom’s inadequately controlled with ICS
what are the adverse effects for mepolizumab?
headache, injection site reactions, arthralgias, herpes zoster infection
what are the adverse effects for reslizumab?
injections site reactions, myalgias, increased creatine phosphokinase
what are the clinical pearls for mepolizumab?
- PREcaution: anaphylaxis
- available in clinic or at home injections
- indicated for add on maintenance treatment of patients with severe asthma with an eosinophilic phenotype
- monitor before and after for anaphylaxis
what are the clinical pearls for reslizumab?
- BLACK BOX warning: malignancies, anaphylaxis
- monitor for anaphylaxis before and after inj
- indicated for add on maintenance treatment of patients with severe asthma with an eosinophilic phenotype
what are the adverse effects for benrralizumab?
injection site reactions, antibody development, headaches, fever, pharyngitis
what are the clinical pearls for benralizumab?
- PREcaution: anaphylaxis
- indicated for add on maintenance treatment of patients with severe asthma with an eosinophilic phenotype
- available in clinic or at home injection
- acts on IL-5R while others act on IL-5
what are the adverse effects for dupixent?
injection site reactions, antibody development, arthralgias, conjunctivitis
what are the clinical pearls for dupixent?
- PREcaution: anaphylaxis
- available in pre-filled syringe for in office or at home admin
- indicated as add on maintenance in moderate-severe asthma ages 12 and older with eosinophilic phenotype or with oral corticosteroid dependent asthma
what are the adverse effects for daliresp?
Headache, weight loss, diarrhea, nausea
what are the adverse effects for inhaled short acting B2 agonists (albuterol)?
tachycardia, tremor, hypokalemia, irritability
what are the clinical pearls for daliresp?
- monitoring: weight, liver function test
- DI: CYP3A4 (major), CYP1A2 (minor)
CI: child-pugh class B or C
what are the clinical pearls for inhaled short acting B2 agonists (albuterol)?
- chronic use (>2x a day) indicated poor asthma control
- may mix neb sol with cromolyn sol, budesonide inhalent suspension or ipratropium sol
- in mild to mod exacerbations, MDI plus valved holding chamber is as effective as neb therapy with appropriate admin technique and coaching by trained personnel
what are the adverse effects for inhaled short acting B2 agonists (levoalbuterol)?
tachycardia, tremor, hypokalemia, irritability
what are the clinical pearls for inhaled short acting B2 agonists (levoalbuterol)?
- reserved for pts who do not respond to albuterol quickly
- neb sol compatible with budesonide inhalant suspension
- has not been evaluated by continuous neb
- levoalbuterol admin in 1/2 mg dose of albuterol provides comparable efficacy and safety
what are the adverse effects for short acting anticholinergics (ipratropium)?
dry mouth, urinary retention, infection, sinuitits, bronchitits
what are the clinical pearls for short acting anticholinergics (ipratropium)?
- used in combo with albuterol for asthma exacerbation treatment
- may mix in same neb with albuterol
- should not be used as first line therapy; should be added as SABA therapy for severe exacerbations
what is another clinical pearl specific to duoneb?
may be used for up to 3 hrs in initial management of severe exacerbations
what are the adverse effects of systemic corticosteroids?
hyperglycemia, increased appetite, fluid retention, demmargination of WBCs, psych disturbances
what are the clinical pearls for inhaled corticosteroids?
- CI: systemic fungal infections, admin of live vaccines if immunocompromised
- DI: warfarin INR inc. ; dec. efficacy of inactivated vaccines
- may be used with ICS if already taking before hospitalization
- may be used for chronic therapy in both asthma COPD only in severe stages
- bursts effective for establishing control when initiating therapy or during period of gradual deterioration
- injection may be used in place of burst if adherence is an issue or patient is vomiting
what are the additional comments related to epinephrine in the use of asthma exacerbations?
- no proven advantage of systemic therapy over aerosol
- indicated in addition to standard therapy for acute asthma associated with anaphylaxis and angioedema
what are the additional comments related to terbutaline in the use of asthma exacerbations?
no proven advantage of systemic therapy over aerosol
what are the adverse effects for magnesium sulfate in the use for asthma exacerbations?
flushing, hypotension, vasodilation
what are the additional comments for magnesium sulfate in the use for asthma exacerbations?
- CI: heart block, caution in renal dysfunction
- consider if patient remains life threatening exacerbations after 1 hour of therapy
