Long-Term Control Medications in Asthma and COPD Flashcards
Class: Beclomethasone
inhaled corticosteroid
Brand Name: Beclomethasone
QVAR
Dosage Form: Beclomethasone
Redihaler (MDI)
Age Groups: Beclomethasone
5-11 yo, adults
Class: Budesonide
inhaled corticosteroids (ics)
Brand Name: Budesonide
Pulmicort
Dosage Form: Budesonide
Flexhaler
Age Groups: Budesonide
5-11 yo, adults
Class: Budesonide Solution
inhaled corticosteroids
Brand Name: Budesonide Solution
Pulmicort Respules
Dosage Form: Budesonide Solution
Nebulizer Solution
Age Group Dosing: Budesonide Solution
0-4, 5-11 yo
Class: Ciclesonide
inhaled corticosteroid
Brand Name: Ciclesonide
Alvesco
Dosage Form: Ciclesonide
HFA
Age Group Dosing: Ciclesonide
5-11 yo, adults
Class: Fluticasone Propionate
inhaled coritcosteroid
Brand Name: Fluticasone Propionate
Flovent (HFA, DPI), ArmonAir (Aerosol Powder Inhaler)
Dosage Form: Fluticasone Propionate
HFA, DPI, Aerosol Powder Inhaler
Age Group Dosing: Fluticasone Propionate
HFA ( 4+ yo)
DPI (4+ yo)
MDPI (adult only)
Class: Fluticasone Furoate
inhaled corticosteroids
Brand Name: Fluticasone Furoate
Arnuity Ellipta
Dosage Form: Fluticasone Furoate
Ellipta
Age Group Dosing: Fluticasone Furoate
5-11 yo, adults
Class: Mometasone
inhaled corticosteroid
Brand Name: Mometasone
Asmanex
Dosage Form: Mometasone
HFA, Twisthaler
Age Group Dosing: Mometasone
HFA: 5-11 yo, adult
Twisthaler: 4-11 yo, adult
Adverse Effects: ICS
oral thrush (candidiasis)
cough
dysphonia
Education Tips: ICS
patients should rinse their mouth and spit after use to prevent oral thrust
ICS are most effective long-term control therapy for asthma (improve QOL, increase lung function, and reduce risk of exacerbations)
Titrate to lowest effective dose: see low, medium, and high dose conversion tables
Pulmicort Respules should use Jet Nebulizer and should not be mixed with other nebulizer medications
High doses increase the risk for systemic side effects
Uses: ICS
prevent and control inflammation
Class: Arformoterol Tartrate
long acting beta agonist (LABA)
Brand Name: Arformoterol Tartrate
Brovana
Dosage Form: Arformoterol Tartrate
Nebulizing Solution
Age Group Dosing: Arformoterol Tartrate
Adults (COPD only)
Class: Formoterol
long acting beta agonist (LABA)
Brand Name: Formoterol
Perforomist
Dosage Form: Formoterol
Nebulizer Solution
Age Group Dosing: Formoterol
Adults (COPD only unless used in combination with ICS)
Class: Indacaterol
long acting beta agonist (LABA)
Brand Name: Indacaterol
Arcapta Neohaler
Dosage Form: Indacaterol
Neohaler
Age Group Dosing: Indacaterol
Adults (COPD only)
Class: Olodaterol
long acting beta agonist (LABA)
Brand Name: Olodaterol
Striverdi Respimat
Dosage Form: Olodaterol
Respimat
Age Group Dosing: Olodaterol
Adult (COPD only)
Class: Salmeterol
long acting beta agonist (LABA)
Brand Name: Salmeterol
Serevent
Dosage Form: Salmeterol
Diskus
Age Group Dosing: Salmeterol
4+ yo, adults
Adverse Effect: Long Acting Beta Agonists (LABA)
tachycardia
headache
tremor
hypokalemia
Education Tips: Long Acting Beta Agonists
Boxed Warning: increased risk of asthma related death for all monotherapy. LABA should not be used alone for asthma management
Boxed Warning: increasing hospitalizations in pediatric and adolescent patients
Prolonged QT seen with intentional overdoses
Not for acute symptoms
May be helpful for exercise induced bronchospasm
Formoterol and indacaterol capsules should not be taken orally
Pediatric Considerations: most children > 4 yo cannot provide sufficient inspiratory flow for adequate lung delivery with a DPI
Use: Long Acting Beta Agonist (LABA)
increase cAMP
bronchial smooth muscle relaxation and inhibit hypersensitivity mediators from mast cells (histamine and leukotrienes)
Class: Aclindium
long acting antimuscarinics (LAMA)
Brand Name: Aclindinium
Turdorza Pressair
Dosage From: Aclindinium
DPI
Age Group Dosing: Aclindinium
Adult (COPD only)
Class: Glycopyrrolate
long acting antimuscarinics (LAMA)
Brand Name: Glycopyrrolate
Seebri Neohaler
Dosage Form: Glycopyrrolate
DPI, Nebulizing Solution
Age Group Dosing: Glycopyrrolate
Adult (COPD Only)
Class: Revefenacin
long acting antimuscarinics (LAMA)
Brand Name: Revefenacin
Yupelri
Dosage From: Revefenacin
Nebulizing solution
Age Group Dosing: Revefenacin
Adult (COPD only)
Class: Tiotropium
long acting antimuscarinics (LAMA)
Brand Name: Tiotropium
spirivia
Dosage From: Tiotropium
HandiHaler
Respimat
Age Group Dosing: Tiotropium
Handihaler: Adult (COPD only)
Respimat: 6+ yo
Class: Umeclidinium
long acting antimuscarinics (LAMA)
Brand Name: Umeclinidium
Incruse Ellipta
Dosage From: Umeclindinium
DPI
Age Group Dosing: Umeclindinium
Adult (COPD only)
Adverse Effect: Long Acting Antimuscarinics
dry mouth
dizziness
blurred vision
upper respiratory infections
paradoxical bronchospasms
Education Tips: Long Acting Antimuscarinics
tiotropium has been approved for use in asthma as an add-on option for children 12+ yo
Uses: Long Acting Antimuscarinics
block the bronchoconstrictor effects of acetylcholine on M3 and M2 receptors
Class: Fluticasone/Salmeterol
ICS/LABA Combo
Brand Name: Fluticasone/Salmeterol
HFA MDI and DPI: Advair
Respiclick: AirDuo and AirDuo Digihaler
Dosage Form: Fluticasone/Salmeterol
DPI
HFA MDI
Respiclick
Age Group Dosing: Fluticasone/Salmeterol
DPI: 4+ yo, adult
HFA: adult
Respiclick: adult
Class: Budesonide/Formoterol
ICS/LABA
Brand Name: Budesonide/Formoterol
Symbicort
Dosage Form: Budesonide/Formoterol
HFA MDI
Age Group Dosing: Budesonide/Formoterol
5-11 yo, adult
Class: Mometasone/Formoterol
ICS/LABA Combo
Brand Name: Mometasone/Formoterol
Dulera
Dosage Form: Mometasone/Formoterol
MDI
Age Group Dosing: Mometasone/Formoterol
Adult
Class: Fluticasone/Vilanterol
ICS/LABA
Brand Name: Fluticasone/Vilanterol
Breo Ellipta
Dosage Form: Fluticasone/Vilanterol
DPI (Ellipta)
Age Group Dosing: Fluticasone/Vilanterol
Adult
Adverse Effects: ICS/LABA Combo
see individual products
Education Tips: ICS/LABA Combo
guidelines recommend combo LABA with ICS in asthma, as LABA should not be used as monotherapy
combo products developed to created convenient packaging and assist with patient adherence
Class: Olodaterol/Tiotropium
LABA/LAMA Combination
Brand Name: Olodaterol/Tiotropium
Stiolto Respimat
Dosage Form: Olodaterol/Tiotropium
Respimat
Age Group Dosage: Olodaterol/Tiotropium
adult (COPD only)
Class: Vilanterol/Umeclidinium
LAMA/LABA Combo
Brand Name: Vilanterol/Umeclidinium
Anoro Ellipta
Dosage Form: Vilanterol/Umeclidinium
Ellipta
Age Group Dosing: Vilanterol/Umeclindium
adult (COPD only)
Class: Indacaterol/Glycopyrronium
LABA/LAMA combo
Brand Name: Indacaterol/Glycopyrronium
Utibron Neohaler
Dosage Form: Indacaterol/Glycopyrronium
Neohaler
Age Group Dosage: Indacaterol/Glycopyrronium
adult (COPD only)
Class: Formoterol/Glycopyrronium
LABA/LABA combination
Brand Name: Formoterol/Glycopyrronium
Bevespi Aerosphere
Dosage Form: Formoterol/Glycopyrronium
Aerosphere
Age Group Dosing: Formoterol/Glycopyrronium
adult (COPD only)
Class: Formoterol/Aclindinium
LABA/LABA combo
Brand Name: Formoterol/Aclindinium
Duaklir Pressair
Dosage Form: Formoterol/Aclindinium
DPI
Age Group Dosing: Formoterol/Aclindinium
Adult (COPD only)
Class: Fluticasone/Umeclindinium/Vilanterol
LABA/LAMA/ICS Combo
Brand Name: Fluticasone/Umeclindinium/Vilanterol
Trelegy Ellipta
Dosage Form: Fluticasone/Umeclindinium/Vilanterol
Ellipta
Age Group Dosing: Fluticasone/Umeclindinium/Vilanterol
Adult (COPD and Asthma)
Class: Budesonide/Glycopyrrolate/Formoterol Fumarate
LABA/LAMA/ICS
Brand Name: Budesonide/Glycopyrrolate/Formoterol Fumarate
Breztri Aerosphere
Dosage Form: Budesonide/Glycopyrrolate/Formoterol Fumarate
Aerosphere
Age Group Dosing: Budesonide/Glycopyrrolate/Formoterol Fumarate
adult (COPD only)
Education Tips: LABA/LAMA
not indicated for treatment of acute deteriorations
Class: Cromolyn
Mast Cell Stabilizer
Brand Name: Cromolyn
Intal
Dosage Form: cromolyn
nebulizer solution
Age Group Dosing: Cromolyn
0-4, 5-11 yo, adult
Adverse Effect: Cromolyn
high incidence of unpleasant taste in mouth, rare cardiac arrhythmias, coughing, dyspnea, sore throat, N/V/D if absorbed systemically
less effective than low-dose ICS
prevents increase in bronchial hyperactivity seen in allergy season
Class: Montelukast
Leukotriene Modifiers
Brand Name: Montelukast
Singulair
Dosage Form: Montelukast
tablets
granule packts
Age Group Dosing: Montelukast
1-11 yo, adult
Class: Zafirlukast
Leukotriene Modifiers
Brand Name: Zafirlukast
Accolate
Dosage Form: Zafirlukast
tablet
Age Group Dosing: Zafirlukast
5-11 yo, adult
Class: Zileuton
leukotriene modifiers
Brand Name: Zileuton
Zyflo CR
Dosage Form: Zileuton
IR and ER tablets
Age Group Dosing: Zileuton
adult
Class: Theophylline
methylxanthines
Brand Name: Theophylline
Theochron
Dosage Form: Theophylline
ER 12 Hour Tablets
ER 24 Hour Tablets
ER 24 Hour Capsules
Liquid
Age Group Dosing: Theophylline
Adult: acute exacerbation, chronic management
Adverse Effect: Theophylline
insomnia
gastrointestinal upset
hyperactivity
hypertension
tremor
Clinical Pearls: Theophylline
Dose Related Toxicity: tachycardia, nausea, vomiting, headache, seizures, arrhythmias
CI: peptic ulcer disease, arrhythmias, seizure disorders
DI: major substrate of CYP 34A, 1A2, 2E1
Increase Concentration: cimetidine, erythromycin, clarithromycin, ciprofloxacin, ticlopidine
Decrease Concentration: phenobarbital, phenytoin, carbamazepine, rifampin, smoking
PDE III inhibition likely cause for hypotension, tachycardia, and nausea
Uses: methylzanthines
bronchodilation through inhibition of PDE III and PDE IV
Class: omalizumab
Anti-Ige
Brand Name: omalizumab
Xolair
Dosage From: omalizumab
injection
solution vial
Age Group Dosing: omalizumab
6 yo+
Adverse Effect: Omalizumab
headache
injection site reactions
arthralgia
thrombocytopenia
pharyngitis
sinusitis
upper respiratory tract infections
Clinical Pearls: omalizumab
Boxed Warning: anaphylaxis
do not give more than 150 mg per injection site
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
Class: Mepolizumab
Anti-IL 5
Brand Name: Mepolizumab
Nucala
Dosage Form: Mepolizumab
autoinjector
solution vial
Age Group Dosing: mepolizumab
6+ yo
Class: reslizumab
Anti-IL5
Brand Name: reslizumab
Cinqair
Dosage Form: reslizumab
solution
Age Group Dosing: Reslizumab
18+ yo
Class: Benralizumab
Anti-IL 5
Brand Name: Benralizumab
Fasenra
Dosage Form: Benralizumab
autoinjector
pre-filled syringe
Age Group Dosing: Benralizumab
adult
Class: Dupilumab
Anti- IL4/IL-13
Brand Name: Dupilumab
dupixent
Dosage Form: Dupilumab
injection
Age Group Dosing: Dupilumab
adult
Class: Roflumilast
PDE4 Inhibitor
Brand Name: Roflumilast
Daliresp
Dosage Form: Roflumilast
Tablets
Age Group Dosing: Roflumilast
Adult (COPD only)
Adverse Effect: Roflumilast
HA
weight loss
diarrhea
nausea
Clinical Pearls: Roflumilast
Monitoring: liver function test, weight
DI: cyp3A4 (major), CYP 1A2 (minor)
CI: Child Pugh class B or C