Inhaled Corticosteroids

Question 1

Budesonide (brand, dosage form)

Answer 1

Pulmicort Respules, nebulizer solution

Pulmicort, flexhaler

Question 2

fluticasone furoate (brand, dosage form)

Answer 2

Arnuity, ellipta

Question 3

fluticasone propionate (dosing for 5-11 yo)

*include both HFA and DPI, max doses

Answer 3

HFA: 88 mcg inhaled BID (max dose)
DPI: 50 mcg inhaled BID (max 100 BID)

Question 4

Ciclesonide (adult dosing)

Answer 4

80-640 mcg once daily

Question 5

Fluticasone propionate (dosage forms)

Answer 5

HFA, DPI –> Flovent

Respiclick –> ArmonAir

Question 6

Flunisolide (adult dosing, max dose)

Answer 6

160 mcg inhaled twice daily (max 320 BID)

Question 7

Ciclesonide (brand, dosage form)

Answer 7

Alvesco, HFA

Question 8

Mometasone (5-11 yo dosing)

Answer 8

Twisthaler only: 110 mcg QD in the evening

Question 9

Beclomethasone (adult dosing, max dose)

Answer 9

40-160 mcg inhaled BID (max 320 BID)

Question 10

Arnuity Ellipta (adult dosing, max dose)

Answer 10

100-200 mcg inhaled BID (max 200 mcg BID)

Question 11

Mometasone (brand, dosage form)

Answer 11

Asmanex, HFA & Twisthaler

Question 12

Flunisolide (5-11 yo dosing, max dose)

Answer 12

*must be >6 yo

80 mcg inhaled BID (max 160 BID)

Question 13

Beclomethasone (5-11 yo dosing, max dose)

Answer 13

40 mcg BID (max 80 BID)

Question 14

Fluticasone Propionate (Respiclick dosing)

Answer 14

adults only: 55, 113, or 232 mcg inhaled BID

Question 15

Ciclesonide (5-11 yo dosing)

Answer 15

80-160 mcg inhaled QD

Question 16

Budesonide Respules dosing

Answer 16

1-8 yo: 0.25 mg QD
previous bronchodilator: 0.5 mg QD
prev. ICS use: 1 mg QD

all can be single or divided doses

Question 17

Budesonide flexhaler (5-11 yo dosing, max dose)

Answer 17

if >6 yo: 180 mcg inhaled BID (max 360 BID)

Question 18

Beclomethasone (brand, dosage form)

Answer 18

QVAR, HFA

Question 19

Fluticasone Propionate (adult HFA and DPI dosing, max doses)

Answer 19

HFA: 88 mcg inhaled BID (max 440 BID)
DPI: 100 mcg inhaled BID (max 500 BID)

Question 20

Budesonide flexhaler (adult dosing, max dose)

Answer 20

360 mcg inhaled BID (max 720 BID)

Question 21

most common side effects with ICS use

Answer 21

oral candidiasis, cough, dysphonia, increased susceptibility to pneumonia

Question 22

When managing a patient’s asthma, ICS should be titrated to the _______ ________ _____.

Answer 22

lowest possible dose

Question 23

A patient comes to you concerning their 3 yo child’s asthma. Their PCP has suggested budesonide and another nebulizer solution. They state that, for simplicity, they have been mixing the medications in the medicine cup of the nebulizer. What advice should be offered?

Answer 23

Budesonide nebulizer solution should not be mixed with other medications if given via nebulizer. Though it is inconvenient, they will either have to separate the two nebulizer treatments or ask their doctor for an appropriate alternative dosage form for the other medication.

Question 24

What is unique about the design of Flunisolide (Aerospan)?

hint: It’s in the brand name.

Answer 24

It is designed with a spacer (hence the name Aerospan).

Question 25

As you increase the ICS dose, what happens to the risk of systemic side effects?

Answer 25

increases

Question 26

Of the available ICS products, which two are only dosed for adult use?

Answer 26

Fluticasone Propionate (Respiclick) and Fluticasone Furoate (ellipta)

Question 27

Mometasone (adult HFA and DPI dosing, max doses)

Answer 27

HFA: 200 mcg inhaled BID (max 400 BID)
DPI: 220 mcg inhaled BID (max 440 BID)

Question 28

Flunisolide (brand, dosage form)

Answer 28

Aerospan, HFA