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Asthma > Drugs > Flashcards

Drugs Flashcards

0
Q

Racepinephrine. OTC

A

Asthmanefrin

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1
Q

Beta-2 agonist MOA

A

Relax bronchial smooth muscle. Relieve symptoms

(Asthma is chronic inflammatory disorder. Inflamed airways are hyperresponsive causing obstruction and airflow limitation due to bronchospasm)

Inflammation –> bronchospasm –> symptoms

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2
Q

Albuterol

A

Proair HFA, Proventil HFA, Ventolin HFA

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3
Q

Levalbuterol

A

Xopenex, Xopenex HFA

R-albuterol

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4
Q

Side effects of beta-2 agonist

A

Tremors, shakiness, lightheadedness, cough

Hyperglycemia, hypokalemia, tachycardia, palpitation

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5
Q

ProAir dosing (MDI)

A

1-2 inhalation q4-6 hours PRN

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6
Q

Priming (when and how) albuterol

A

Before first use and if NOT used for > 2 weeks

3-4 sprays

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7
Q

If using SABA > 2 weeks increase maintenance dose.

A

..

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8
Q

Salmeterol

A

Serevent Diskus

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9
Q

Advair

A

Salmeterol/fluticasone

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10
Q

Difference between Advair HFA and Advair Diskus

A

Advair HFA (45, 115, 230 mcg fluticasone + 21 mcg salmeterol ) ages 12 and older

Advair Diskus - ages 4 and older (100, 250, 500 mcg fluticasone + 50 mcg salmeterol)

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11
Q

Formoterol

A

Foradil

Capsule must be refrigerated, patient can keep at room temp for 4 months

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12
Q

Symbicort

A

Formoterol/budesonide

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13
Q

LABA Diskus dosing and MDI dosing

A

MDI 2 inhal BID

Diskus 1 inhal BID

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14
Q

LABA BBW

A

Increase of asthma related death

Contraindicated as monotherapy for asthma

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15
Q

Beclomethasone

A

Qvar

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16
Q

Budesonide

A

Pulmicort

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17
Q

Ciclesonide

A

Alvesco

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18
Q

Flunisolide ( built in spacer)

A

Aerospan

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19
Q

Fluticasone

A

Flovent

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20
Q

Mometasone

A

Asmanex

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21
Q

Which two ICS do not need to be shaken before use

A

Qvar, Alvesco

They are solution

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22
Q

Qvar

Low dose
Medium dose
High dose

A

< 240 low dose

< 480 medium

> 480 high

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23
Q

Flovent HFA vs Diskus dose

A

< 265 mcg (300 mcg for Diskus)

< 440mcg ( 500 mcg for Diskus)

> 440 mcg (500 mcg for Diskus)

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24
Q

Dulera

A

Mometasone+formoterol

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25
Q

ICS contraindication

A

Primary treatment of status asthmaticus or acute episode of asthma or COPD

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26
Q

ICS side effect

A

Thrust, dysphonia, cough, increase risk of fracture, pneumonia, growth retardation in children with high dose

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27
Q

ICS monitoring

A

Growth retardation, bone mineral density, oral candidiasis

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28
Q

Pulmicort respules has a jet nebulizer

A

Must use jet nebulizer only

29
Q

Two type of steroid

A

Glucocorticoid: made by the body in response to stress or given exogenously

Mineralocorticoid: regulate sodium and water balance. (Fludrocortisone)

Fludrocortisone used to increase sodium and Addison dx (replace some of the function of aldosterone)

30
Q

Difference between the two types of steroid

A

Glucocorticoid used mainly for inflammation

Mineralocorticoid is not for inflammation

31
Q

Long term side effect of steroid

A

Cushing syndrome (excess cortisol)

  • fat in abdomen
  • moon face (fat in face)
  • buffalo hump (fat in shoulder)
  • impaired wound healing
  • thinning/bruising
Psychiatric (delirium, mood swings)
Sodium and water retention
Hypokalemia 
Hyperglycemia
Immunosuppression
Glaucoma 
Osteoporosis
Hirsutism(women)
GI bleeding/ulcers
32
Q

Oral steroid dose equivalent

Short acting
Intermediate acting
Long acting

A

Cortisone 25mg
Hydrocortisone 20 mg

Intermediate
Methylprednisolone/ triamcinolone 4mg
Prednisone/prednisolone 5 mg

Long
Betamethasone 0.6mg
Dexamethasone 0.75 mg

33
Q

Why do you taper steroid

A

Due to suppression of the hypothalamic-pituitary-adrenal axis (HPA). It gives the body time to increase its own endogenous cortisol production ( which decrease over extended steroid use)

34
Q

When do you taper steroid

A

If on steroid for more than 10 - 14 days

35
Q

Cortisone is

A

Prodrug for cortisol

36
Q

Hydrocortisone

A

Solu-cortef

37
Q

Methylprednisolone

A

Medrol or solu-medrol

38
Q

Prednisone is

A

Prodrug for prednisolone

39
Q

Prednisolone

A

Millipred or orapred

40
Q

Triamcinolone

A

Kenalog

Aristospan

41
Q

Steroid contraindication

A

Live vaccine (immunosuppression)

42
Q

Oral steroid short term side effect (<1 month)

A

Increase appetite/weight gain, fluid retention, insomnia, bitter taste

High dose: increase blood pressure and increase blood glucose

43
Q

Oral steroid monitor

A

Growth retardation, bone density, IOP, other

44
Q

When should you take steroid

A

7am - 8am to mimic the body diurnal release of cortisol

45
Q

Relative anti inflammatory potency

A

Betamethasone/dexamethasone > methylprednisolone/triamcinolone > prednisone/prednisolone > hydrocortisone > cortisone

46
Q

Leukotriene modifying agent MOA

A

Leukotriene receptor antagonists of LT D4 (zafirlukast and singulair) and E4 (zafirlukast)

Reduce airway edema, construction and inflammation

47
Q

Zafirlukast

A

Accolate

48
Q

Montelukast

A

Singulair

49
Q

Zileuton

A

Zyflo

50
Q

LTRA contraindication

A

Hepatic impairment (zafirlukast)

Active liver disease or LFT 3x above UNL (zileuton)

51
Q

LTRA warning

A

Neuropsychiatric event

52
Q

LTRA side effect

A

Headaches, dizziness, LFT increase, sinusitis

53
Q

Zileuton monitoring

A

LFT every month fir the first 3 months then every2-3 months for the first years

54
Q

Which drug increase zafirlukast level?

A

Carvedilol (beta blocker), theophylline, warfarin

55
Q

Which drug reduce zafirlukast level?

A

Macrolide, theophylline and food

56
Q

Zafirlukast counseling

A

Take on empty stomach
1 hour before meal or 2 hours after

Must stay in original container

57
Q 
Singulair dosing (adult)
6-14 years

1-5 years

A

10 mg daily in evening

6-14 years : 5 mg daily

1-5 years: 4 mg daily

58
Q

Theophylline MOA

A

Block phosphodiesterase causing increase cAMP which promotes release of epinephrine from adrenal medulla cells –> bronchodilation, diuresis, CNS and cardiac stimulation and gastric secretion

59
Q

Theophylline therapeutic range

A

5-15mcg/mL ( measure peak after 3 days of oral dosing

60
Q

Theophylline active metabolites

A

Caffeine and 3-methylxanthine

61
Q

Theophylline is caution is what patients

A

Cardiovascular dx, hyperthyroidism,PUD, seizure

62
Q

Theophylline signs of toxicity

A

Persistent vomiting, seizure, ventricular tachycardia

63
Q

What weight is used to dose theophylline

A

IBW

64
Q

IV aminophylline has how much theophylline

A

80% of theophylline

65
Q

Theophylline side effect

A

Nausea, loose stool, insomnia,tremor, tachycardia, headache

66
Q

Drugs that increase theophylline

A

Macrolide, FQ, beta blocker, LTRA, allopurinol, alcohol, CCB,cirrhosis, liver disease, CHF, hypothyroidism

67
Q

Drugs that reduce theophylline

A

Carbamazepine, rifampin, phenytoin, phenobarbital, ritonavir, St. John wort, levothyroxine, high protein, charbroiled

68
Q

Omalizumab

A

Xolair

69
Q

Xolair BBW

A

Anaphylaxis

Must be given in doctors office and monitor for anaphylaxis

70
Q

Priming for ICS

A

> 7 days

Asthma (3 decks)

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