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Pharm 825 > Long-Term Control Medications in Asthma and COPD > Flashcards

Long-Term Control Medications in Asthma and COPD Flashcards

1
Q

What are the 11 different classes used at long-term therapy for COPD and asthma?

A 
ICS
LABA
LAMA
LABA/LAMA
ICS/LABA
Leukotriene modifiers
methylxanthines
Anti-IgE
Anti-IL5
Mast cell stabilizers
Phosphodiesterase-4 inhibitors
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2
Q

How do ICS work

A

controlling and preventing inflammation

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3
Q

AE’s of ICS

A

oral thrush, cough, dysphonia

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4
Q

Most common long-term ICS Medications

A 
Belomethasone
Budesonide*
Circlesonide
flunisolide
Fluticasone proprionate*
fluticasone furoate
mometasone
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5
Q

ICS are the most effective LTC treatment for asthma becuase?

A

imporve Quality of Life
INC lung function
reduce risk of exacerbation

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6
Q

What do we want to do in regards to ICS dose?

A

Titrate to lowest effective dose

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7
Q

generic: belmethasone

A

brand: QVAR

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8
Q

dosage form of belmethasone?

A

HFA

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9
Q

Strength of belmethasone HFA inhaler

A

40 or 80 mcg/inhalation

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10
Q

generic: budesonide

A

brand: Pulmicort

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11
Q

available dosage forms of budesonide?

A

Flexhaler or Nebulizer soln

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12
Q

Strength of the budesonide flexhaler

A

90 or 180 mcg/inhalation

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13
Q

Strength of budesonide nebulizer soln

A

(Pulmicort Respules)
0.25mg/2ml
0.5mg/2ml
1mg/2ml

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14
Q

generic: ciclesonide

A

brand: Alvesco

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15
Q

dosage form of ciclesonide and strength

A

HFA

80 or 160 mcg/inhalation

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16
Q

generic: flunisolide

A

brand: Aerospan

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17
Q

dosage form and strength of flunisolide

A

HFA inhaler 80mcg/inhalation

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18
Q

generic: Fluticasone Proprionate

A

Brand: Flovent or Armon Air

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19
Q

available dosage form of fluticasone proprionate

A

HFA
DPI
Respiclick

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20
Q

Strength of HFA Fluticasone Prop

A

44,110, or 220 mcg/inhalation

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21
Q

Strength of DPI Fluticasone Prop

A

50, 100, or 250 mcg/inhalation

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22
Q

Strength of RespiClick Fluticasone Prop

A

55,113,232 mcg/inhalation

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23
Q

generic: fluticasone furoate

A

brand: Arunity Ellipta

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24
Q

dosage form of fluticasone furoate

A

Ellipta inhaler

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25
Q

strength of fluticasone furoate ellipta inhaler

A

100 and 200 mcg/ inhalation

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26
Q

generic: mometasone

A

brand: Asmanex

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27
Q

dosage forms mometasone comes in

A

HFA and Twistihaler

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28
Q

Strength of mometasone HFA

A

100 and 200 mcg/inhalation

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29
Q

strength of mometasone Twistihaler

A

110 and 220 mcg/ inhalation

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30
Q

Which long term ICS is approved for children ages 0-4

A

budesonide nebulizer soln

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31
Q

Counseling tip with pulmincort respules

A

should use jet nebulizer , do not mix with other nebulizer medications

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32
Q

Which ICS has a built in spacer?

A

Aerospan, which is flunisolide

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33
Q

W/ ICS when do we see an increased risk for systemic side effects

A

at high doses

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34
Q

How do LABA’s work?

A

INC cAMP which will cause bronchial SM relaxation & inhibit hypersensitivity mediators from the mast cells ( histamines and leukotrienes)

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35
Q

AE’s of LABAs

A

tachycardia, headache, tremor, hypokalemia

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36
Q

Boxed warning for LABAs

A
  • INC risk of asthma related death for all monotherapy LABA use; DO NOT use alone for asthma management
  • Increasing hospitalizations in peeds and adolescents
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37
Q

In regards to LABA’s, what is clinically observed in intentional overdoses

A

prolonged QT ( irregular heart rhythm)

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38
Q

Counseling points for LABA’s

A
  • will not help acute symptoms

- may be helpful for exercise induced spasms

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39
Q

When a pt has an inhaler that contains capsules, what should you make sure that they know?

A

Capsules should not be taken orally

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40
Q

Which two LABA’s come with capsules

A

Formoterol and indacaterol

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41
Q

What is important to note , in regard to pediatrics on LABA’s

A

most children under the age of 4t/o cannot provide sufficient inspiratory flow for adequate lung delivery with a DPI

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42
Q

generic: arformoterol tartrate

A

brand: Brovana

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43
Q

dosage form of arformoterol tartrate

A

nebulizer solution

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44
Q

Strength of arformoterol tartrate

A

1mcg/ 2ml

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45
Q

generic: formoterol

A

brand: Foradil Aerolizer

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46
Q

dosage form of formoterol

A

aerolizer with capsules

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47
Q

strength of formoterol

A

12mcg/ capsule

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48
Q

generic: indacaterol

A

brand: Arcapta Neohaler

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49
Q

dosage form and strength of indacaterol

A

Neohaler with capsules

75 mcg/ capsule

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50
Q

generic: olodaterol

A

brand: Striverdi Respimat

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51
Q

dosage form that olodaterol comes in

A

Respimat inhaler

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52
Q

strength of olodaterol respimat inhaler

A

2.5mcg/ inhalation

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53
Q

Which LABA comes in a dosage form that utilizes blister packs

A

salmeterol

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54
Q

generic: salmeterol

A

brand: Serevent

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55
Q

dosage and strength of salmeterol

A

Diskus

50 mcg/ blister

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56
Q

Which LABA’s should be used for COPD ONLY

A

Arformoterol
Indacaterol
Olodaterol

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57
Q

Which LABA’s can be used for treatment in asthma

A

Salmeterol and formoterol;however, remember there is a Boxed warning for LABA use as a monotherapy for asthma

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58
Q

How do LAMA’s work in long acting treatment of asthma and COPD

A

block constricting effects of ACh on M3 and M2 receptors

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59
Q

AE’s of LAMA’s

A

Think antimuscarinic effects: dry mouth, dizziness, blurred vision, UpperRI, paradoxial bronchospasms

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60
Q

generic: aclidinium

A

brand: Tudorza Pressair

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61
Q

dosage form of aclidinium

A

DPI

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62
Q

strength of aclimidium

A

400mcg/ inhalation

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63
Q

generic: tiotropium

A

brand: Spiriva

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64
Q

Dosage form(s) that tiotropium comes in

A

Handihaler and Respimat

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65
Q

tiotrpoium handihaler strength

A

18mcg/ capsules

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66
Q

tiotropium respimat strength

A

2.5mcg/inhalation

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67
Q

Which LAMA uses capsules?

A

Spiriva Handihaler

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68
Q

generic: umeclidinium

A

brand: Incruse Ellipta

69
Q

Available dosage form and strength of umeclidinium

A

DPI; 62.5 mcg/ inhalation

70
Q

Which LAMA’s are used for COPD ONLY

A

Aclidinium
Tiotropium- handihaler
Umeclidinium

71
Q

Which LAMA has been approved for asthma therapy, as well is used for COPD

A

Tiotropium respimat inhaler

72
Q

When would you use tiotropium respimat inhaler in asthmatics?

A

Use as an add-on option in step 4 or 5 ( this is when there is a history of exacerbation, despite ICS/LABA use)

73
Q

What are the 4 most common ICS/LABA combo products

A

Fluticasone/salmeterol
budesonide/ salmeterol
mometasone/ formoterol
fluticasone/ vilanterol

74
Q

generic: fluticasone/ salmeterol

A

brand: Advair

75
Q

What dosage form is fluticasone/ salmeterol available in?

A

DPI
HFA MDI
Respiclick ( also a DPI)

76
Q

Available dose/ strength of Advair DPI

A

100mcg/50mcg
250mcg/50mcg
500mcg/50mcg

77
Q

Available dose strength of fluticasone/ salmeterol HFA in

A

45mcg/21mcg
115mcg/21mcg
230mcg/21mcg

78
Q

Brand : AirDuo

A

Generic: fluticasone/salmeterol Respiclick inhaler

79
Q

Dose strength of the AirDuo Respiclick inhaler

A

55mcg/14mcg
113mcg/14mcg
232 mcg/ 14mcg

80
Q

generic: budesonide/formoterol

A

brand: Symbicort

81
Q

Dosage form and strength of budesonide/formoterol

A

HFA MDI
80mcg/4.5mcg
160mcg/4.5 mcg

82
Q

generic: mometasone/formoterol

A

brand: Dulera

83
Q

dosage form and strength of mometasone/formoterol

A

MDI
100mcg/5mcg
200mcg/5mcg

84
Q

generi: fluticasone/ vilanterol

A

brand: Breo Ellipta

85
Q

Dosage form of fluticasone/vilanterol

A

DPI

86
Q

Dosage strength of Breo Ellipta

A

100mcg/25mcg

200mcg/25mcg

87
Q

AE’s of ICS/ LABA combo products

A

adverse effects are the same AE’s associated with ea. individual class

88
Q

Why were combination products developed?

A

To create convenient packaging and to assist with patient adherence

89
Q

Most common LABA/ LAMA products

A

olodaterol/tiotropium
vilanterol/umeclidinium
indacaterol/glycopyrronium
formoterol/ glycopyrronium

90
Q

Counseling points for LABA/LAMA

A

not indicated for treatment of acute deterioration

91
Q

Which LABA/LAMA combo products are approved for asthma treatment

A

none, they are all used only in COPD

92
Q

generic: olodaterol/ tiotropium

A

brand: Stiloto Respimat

93
Q

dosage form and strength of olodaterol/ tiotropium

A

respimat inhaler

2.5mcg/2.5mcg per inhalation

94
Q

generic: vilanterol/ umeclidinium

A

brand:Anoro Ellipta

95
Q

dosage form and strength of vilanterol/umeclidinium

A

Ellipta inhaler

62.5mcg/ 25mcg per inhalation

96
Q

generic: indacanterol/ glycopyrronium

A

brand:Utibron Neohaler

97
Q

dosage form and strength of indacanterol/ glycopyrronium

A

neohaler inhaler

27.5 mcg/15.6mcg capsules

98
Q

generic: formoterol/ glycoprronium

A

brand: Bevespi Aerosphere

99
Q

formoterol/ glycoprronium dosage form and strength

A

Aerosphere

4.8 mcg/9mcg per inhalation

100
Q

Which LABA/LAMA combo product uses capsules

A

Utibron Neohaler

101
Q

Which LABA/LAMA only requires use once daily?

A

Stiloto Respimat and Anoro Ellipta

102
Q

Which ICS/ LABA requires only one inhalation once daily

A

Breo Ellipta

103
Q

most common mast cell stabalizer

A

cromolyn

104
Q

wht dosage form does cromolyn come in?

A

nebulizer solution

105
Q

Strength of cromolyn nebulizer soln?

A

20mg/ampule

106
Q

AE of mast cell stabalizers

A

unpleasant taste in mouth ( common), rare cardiac arrythmias, coughing, dyspnea,sore throat, N/V/D if absorbed systemically

107
Q

Which is more effective: low dose ICS or mast cell stabalizer

A

LD ICS

108
Q

Why are mast cells beneficial?

A

Prevents INC in bronchial hyperactivity seen during allergy season

109
Q

Common lekotriene modifiers

A

montelukast, zafirlukast, zileuton

110
Q

how do leukotriene modifiers work?

A

block the production of leukotrienes

111
Q

generic: montelukast

A

brand: singulair

112
Q

generic: zafirlukast

A

brand: Accolate

113
Q

generic: Zileuton

A

brand: Ayflo CR

114
Q

dosage form and strength of montelukast

A

tablets, chewable
4mg, 5mg, 10mg
granule packets-4mg

115
Q

dosage form and strength of zafirlukast

A

tablets

10 or 20 mg

116
Q

dosage form and strength of zileuton

A

600mg tablets

117
Q

AE’s of leukotriene modifiers

A

neuropsych events such as agitation, anxiety, abnormal dreams, hallucinations, depression, suicidal thoughts. Chung-Strauss syndrome, INC hepatic transaminases ( not montelukast)

118
Q

For asthma, which of the following would be least effective: Low dose ICS, ICS/LABA or Leuko modifier

A

Leukotriene modifier

119
Q

Why would we, or why we would not use lekotrienes in COPD

A

they have not been adequately trialed

120
Q

Counseling points unique to Zafirlukast

A

Take at least one hour before or two hours after meals

can increase INR

121
Q

counseling points unique for montelukast

A

weak inhibitor of CYP2C8 and 2C9
major substrate for CYP2C9 and 3A4
not acute relief of symptoms

122
Q

counseling points unique to Zileuton

A

moderate CYP 1A2 inhibitor

minor substrate for CYP1A2, 2C9 and 3A4

123
Q

how do methylxanthines work?

A

dialation thru inhibition of PDE III and PDE IV

124
Q

most common methylxanthines

A

theophylline

125
Q

What dosage form does theophylline come in

A

ER tabs, ER capsules, liquid

126
Q

Strength of theophylline ER tabs

A

100,200,300,400,450,600 mg

127
Q

Strength of theophylline ER capsules

A

100,200,300,400mg

128
Q

Strength of theophylline Liquid

A

80mg/15ml

129
Q

what age group can you use mast cell stabalizers?

A

Any age group

130
Q

Which leukotriene modifier is FDA approved for ages 0-4

A

montelukast

131
Q

AE of methylxanthines

A

insomnia, GI upset, hyperactivity, hypotension

132
Q

What kind of injuries do we tend to see with methylxanthines?

A

dose related injury

133
Q

Methylxanthine dose related injuries include:

A

tachycardia,N/V, headache, seizures,arrthymias

134
Q

CI of methylxanthines ( contraindications)

A

perptic ulcer disease, arrythmias, seizure disorders

135
Q

Drug interactions of methylxanthines

A

major substrate of CYP 3A4 and 1A2,and 2E1

136
Q

Methylxanthines are CYP substrates. What are some drugs that you’ll see with INC concentration

A

cimetidine, erythromycin, clarithromycin, ciprofloxacin,ticlopidine

137
Q

Methylxanthines are CYP substrates. What are some drugs that you’ll see with DEC concentration

A

pheobarbital, phenytoin, carbamzepine,rifampin, smoking

138
Q

normal drug serum concentration

A

5-15 mcg/mL

139
Q

What is the likely cause of hypotension when taking methylxanthines

A

PDE III

140
Q

How do Anti-IgE medications work?

A

htey inhibit IgE binding to receptors on mast cells and basophils, inhibit mediator release and attenuation of early- and late-phase allergic responses

141
Q

Most common Anto-IgE medication(s)

A

Omalizumab

142
Q

generic: omalizumab

A

brand: Xolair

143
Q

Dosage form of Xolair

A

150mg/ 1.2ml after reconstitution with 1.4 mL sterile water for injection

144
Q

AE’s of Anti IgE drugs

A

headache, reactions at injection site, arthralgias, thrombocytopenia, pharyngitis, sinusitis, upper resp tract infections

145
Q

Boxed warning woth omalizumab

A

anaphylaxis

146
Q

Counseling points with omalizumab

A

DO NOT admin more than 150 mg/ injection site

monitor for anaphylaxis before and after injection

147
Q

Xolair has been FDA approved for moderate to severe persistent asthma in pt w/ positive skin test OR?

A

reactivity to a perennial aeroallergen and symptoms that are inadequately controlled with ICS

148
Q

How do Anti IL5’s work?

A

block the binding of IL-5 to the alpha chain of the IL-5 receptor complex, which results in reduced production and survival of eosinophils

149
Q

Most common anti IL-5’s?

A

Mepolizumab

Reslizumab

150
Q

Generic: Mepolizumab

A

brand: Nucala

151
Q

Generic: reslizumab

A

brand: Cinqair

152
Q

AE’s of anti IL-5’s ( specific to mepolizumab)

A

headache, reaction at injection site, arthalgias, Herpes Zoster injection*

153
Q

Dosage form and strength of Nucala

A

100 mg/1.2 mL after reconstituted with 1.2 ml sterile water for injection

154
Q

Dosage from and strength of Cinqair

A

100mg/10ml ( no reconstitution needed)

155
Q

What age population should you use anti IL-5’s in?

A

adults only

156
Q

What age group is it approved to use Anti-IgE’s in ?

A

5-11 y/o and adults

157
Q

AE’s specific to the anti IL-5 Reslizumab

A

reactions at injection site, myalgias, INC creatinine phosphokinase

158
Q

Which anti-IL5 does not have a boxed warning for anaphylaxis?

A

Nucala- mepolizumab

-only has a precaution warning

159
Q

counseling points of mepolizumab and reslizumab

A
  • monitor for anaphylaxis before and after injection

- indicated for add on maintenance tx of pt w/ severe asthma w/ and eosinophil phenotype

160
Q

Boxed warning on reslizumab

A

anaphylaxis and malignancies

161
Q

How do phosphodiaesterases-4 inhibitors work?

A

inhibit PDE4 which leads to inc cAMP

162
Q

Most common PDE -4 inhibitor?

A

roflumilast

163
Q

generic: roflumilast

A

brand: Daliresp

164
Q

dosage form and strength of Daliresp

A

500 mcg tablets

165
Q

what age group is it safe to use roflumilast

A

adults only

166
Q

Is Dalireso used for asthma, COPD or both

A

COPD only

167
Q

What you should monitor for while on PDE-4’s?

A

weight and liver function

168
Q

Drug interactions of Daliresp

A

CYP3A4 (major) CYP1A2 ( minor)

169
Q

Contraindication of roflumilast

A

Child-Pugh class B or C

Pharm 825 (5 decks)

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