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Therapuetics - Exam 3 > leukotriene modifiers, methylxanthines, and anti-IgE > Flashcards

leukotriene modifiers, methylxanthines, and anti-IgE Flashcards

1
Q

montelukast brand

A

singulair

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2
Q

montelukast (singulair) dosage form

A

tablets (chewable) - 4mg, 5mg, and 10mg
granule packets - 4mg

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3
Q

zafirlukast brand

A

accolate

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4
Q

zafirlukast (accolate) dosage form

A

10 or 20 mg

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5
Q

zileuton brand

A

zyflo CR

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6
Q

zileuton (zyflo cr) dosage forms

A

IR tablets - 600 mg
ER tablets - 600 mg

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7
Q

leukotriene modifiers

A

block the production of leukotrienes
montelukast (singulair)
zafirlukast (accolate)
zileuton (zyflo)

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8
Q

montelukast (singulair) dosing in 0-4 yos

A

approved for 1 to 5 yos
4 mg qhs

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9
Q

montelukast (singulair) dosing in 5-11 yos

A

approved for 6 to 14 yos
5mg qhs

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10
Q

zafirlukast (accolate) dosing in 5-11 yos

A

10 mg bid

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11
Q

montelukast (singulair) dosing in adults

A

10mg qhs

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12
Q

zafirlukast (accolate) dosing in adults

A

20 mg bid

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13
Q

zileuton (zyflo cr) dosing in adults

A

IR - 600 mg qid
ER - 1200 mg bid

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14
Q

adverse effects of leukotriene modifiers

A

neuropsychiatric events (agitation, anxiety, abnormal dreams, hallucinations, depression, suicidal thinking)
churg-strauss syndrome (rare)
increases transaminases (specifically zafirlukast and zileuton)

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15
Q

clinical pearls of leukotriene modifiers

A

less effective than low dose ICS and ICS/LABA combos in asthma
have not been adequately trialed in COPD

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16
Q

montelukast (singulair) clinical pearls

A

minor substrate of CYP2C8/9 and 3A4
not for acute relief of symptoms
boxed warning for neuropsychiatric events

17
Q

zafirlukast (accolate) clinical pearls

A

take at least 1 hour before or 2 hours after meals
can increase INR
major substrate, minor inhibitor of CYP 2C9

18
Q

zileuton (zyflo cr) clinical pearls

A

weak cyp1A2 inhibitor
take with food

19
Q

methylxanthines

A

bronchodilation through inhibition of PDE 2 and 4
theophylline (theochron)

20
Q

theophylline brand

21
Q

theophylline (theochron) dosage form

A

ER 12H tabs - 100, 200, 300, 400, and 450 mg
ER 24H tabs - 400 and 600 mg
ER 24H Caps - 100, 200, 300, and 400 mg
Liquid - 80mg/15mL

22
Q

theophylline (theochron) acute exacerbation dosing in adults

A

loading dose typically given IV as aminophylline
followed by maintenance IV infusion

23
Q

theophylline (theochron) chronic management dosing in adults

A

smokers - 16mg/kg/day divided
nonsmokers - 13mg/kg/day divided

24
Q

theophylline (theochron) dosing in adults

A

doses based on serum concentrations and treatment of acute exacerbations or chronic management
target range 5-15mcg/mL
toxic is greater than 20 mcg/mL

25
Q

adverse effects of theophylline (theochron)

A

insomnia
gastrointestinal upset
hyperactivity
hypotension (PDE 3 inhibition)
tremor

26
Q

dose related toxicity of theophylline (theochron)

A

tachycardia (PDE 3 inhibition)
nausea (PDE 3 inhibition)
vomiting
headache
seizures
arrhythmias

27
Q

contraindications of theophylline (theochron)

A

peptic ulcer disease
arrhythmias
seizure disorders

28
Q

drug interactions of theophylline (theochron)

A

major substrate of cyp3a4, 1a2, and 2e1
increase concentration - cimetidine, erythromycin, clarithromycin, ciprofloxacin, ticlopidine
decrease concentration - phenobarbital, phenytoin, carbamazepine, rifampin (and smoking)

29
Q

anti-IgE drugs

A

inhibit IgE binding to receptors on mast cells and basophils
inhibit mediator release and attenuation of early and late phase allergic response
omalizumab (xolair)

30
Q

omalizumab brand

31
Q

omalizumab (xolair) dosage forms

A

150mg/1mL prefilled syringe
75mg/0.5mL prefilled syringe
150mg/1.2mL after reconstitution with 1.4mL of sterile water for injection

32
Q

omalizumab (xolair) dosing in 5-11 yos

A

approved for over 6 yos
150 to 375 mg sq every 2 to 4 weeks depending on body weight and pretreatment serum IgE levels

33
Q

omalizumab (xolair) dosing in adults

A

150 to 375 mg sq every 2 to 4 weeks depending on body weight and pretreatment serum IgE levels

34
Q

adverse effects of omalizumab (xolair)

A

headache
injection site reactions
arthralgias
thrombocytopenia
pharyngitis
sinusitis
upper respiratory tract infections

35
Q

boxed warning for omalizumab (xolair)

A

anaphylaxis

36
Q

clinical pearls of omalizumab (xolair)

A

do not give more than 150mg per injection
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

Therapuetics - Exam 3 (12 decks)

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