Long-Term Control Medications in Asthma and COPD - Mast Cell Stabilizers, Leukotriene Modifiers, Methylxanthines, and Phosphodiaesterase-4 Inhibitors

Question 1

cromolyn is a…

Answer 1

mast cell stabilizer

Question 2

cromolyn brand name

Answer 2

Intal

Question 3

cromolyn dosage form

Answer 3

nebulizer solution

Question 4

cromolyn dosing in 0-4 year olds

Answer 4

1 ampule qid

safety/efficacy not established for children under 2

Question 5

cromolyn adverse effects

Answer 5

• unpleasant taste in mouth
• rare cardiac arrhyrhmias
• coughing
• dyspnea
• sore throat
• N/V/D os aborbed systemically

Question 6

cromolyn clinical pearls

Answer 6

• less effective than low dose ICS
• prevents increase in bronchial hyperreactivity seen in allergy season

Question 7

montelukast, zafirlukast, and zileuton are…

Answer 7

leukotriene modifiers

Question 8

montelukast brand name

Answer 8

Singulair

Question 9

motelukast dosage forms

Answer 9

• tablets (chewable)
• granule packets

Question 10

montelukast dosing for age 0-adult

Answer 10

take at bedtime

Question 11

zafirlukast brand name

Answer 11

Accolate

Question 12

zarfirlukast dosage form

Answer 12

tablets

Question 13

zafirlukast dosing ages

Answer 13

5-11 and adults

Question 14

zileuton brand name

Answer 14

Zyflo CR

Question 15

zileuton dosage froms

Answer 15

• IR tab
• ER tab

Question 16

zileuton dosing ages

Answer 16

adults

Question 17

leukotriene modifier adverse effects

Answer 17

• neuropsychiatric events
• (rare) Churg-Strauss syndrome
• increased hepatic tranaminases (zarfirlukasr and zileuton)

Question 18

leukotriene modifier clinical pearls

Answer 18

• less effective than low dose ICS and ICS/LABA in asthma
• not for COPD

Question 19

montelukast clinical pearls

Answer 19

• minor substrate of CYP2C8/9 and CYP3A4
• not for acute relief of symptoms
• black box warning

Question 20

zafirlukast clinical pearls
* take at least ___ before or ___ after meals
* can increase ___
* major substrate, minor inhibitor id CYP___

Answer 20

• 1h, 2h
• INR
• CYP2C9

Question 21

zileuton clinical pearls
* weak CYP___ inhibitor
* take with __

Answer 21

• CTP1A2
• food

Question 22

theophylline is a…

Answer 22

methylxanthines

Question 23

theophylline brand name

Answer 23

Theochron

Question 24

theophylline dosage forms

Answer 24

• ER 12h tab
• ER 24h tab
• ER 24h cap
• liquid

Question 25

theophylline dosing ages

Answer 25

adult

acute exacerbation AND chronic managment

Question 26

theophylline adverse effects

Answer 26

• insomnia
• GI upset
• hyperactivity
• hypotension
• tremor

Question 27

theophylline dose related toxicity

Answer 27

• tachycardia
• N/V
• headache
• seizures
• arrhythmias

Question 28

theophylline is a major substrate of CYP___, ___, and ___
* 5 meds that increase theophylline concentration
* 4 meds that decrease theophylline concentration

PDE ___ inhibition likely cause for hypotension, tachycardia and nausea

Answer 28

• CYP3A4, 1A2, 2E1
• cimetidine, erythromycin, clarithromycin, ciprofloxacin, ticlopidine
• phenobarbital, phenytoin, cabamazepine, rifampin (and smoking)

III

Question 29

how do methylxanthines work?

Answer 29

bronchodilation through inhibition of PDE III and PDE IV

Question 30

roflumilast is a…

Answer 30

PDE-4 inhibitor

Question 31

roflumilast brand name

Answer 31

Daliresp

Question 32

roflumilast dosage form

Answer 32

tablets

Question 33

roflumilast dosing ages

Answer 33

adults

COPD ONLY

Question 34

roflumilast adverse effects

Answer 34

• headache
• weight loss
• diarrhea
• nausea

Question 35

roflumilast monitoring:
___ function test
* CYP ___ (major),
* CYP___ (minor)

Answer 35

liver
* CYP3A4
* CYP1A2

Question 36

how do PDE-4 inhibitors work?

Answer 36

inhibits PDE4 leading to increased cAMP