Long-Term Control Medications in Asthma and COPD Flashcards
What is the brand of Belomethasone?
QVAR
What is the generic of QVAR?
Belomethasone
What is the dosage form of Belomethasone and QVAR?
HFA inhaler
How many mcg/inhalation do Belomethasone and QVAR have? (2 available strengths)
40 or 80 mcg/inhalation
What are the brands of Budesonide? (2)
Pulmicort and Pulmicort Respules
What is the generic of Pulmicort?
Budesonide
What is the dosage form of Budesonide and Pulmicort?
Flexhaler
How many mcg/inhalation do Budesonide and Pulmicort have? (2 available strengths)
90 or 180 mcg/inhalation
What is the generic of Pulmicort Respules?
Budesonide
What is the dosage form of Budesonide and Pulmicort Respules?
Nebulizer Solution
What are the strengths of Budesonide and Pulmicort Respules? (3)
0.25mg/2mL
0.5mg/2mL
1mg/2mL
What is the brand of Ciclesonide?
Alvesco
What is the generic of Alvesco?
Ciclesonide
What is the dosage form of Ciclesonide and Alvesco?
HFA inhaler
How many mcg/inhalation do Ciclesonide and Alvesco have? (2 available strengths)
80 or 160 mcg/inhalation
What is the brand of Flunisolide?
Aerospan
What is the generic of Aerospan?
Flunisolide
What is the dosage form of Flunisolide and Aerospan?
HFA inhaler
How many mcg/inhalation do Flunisolide and Aerospan have?
80 mcg/inhalation
What are the brands of Fluticasone Propionate?
Flovent and ArmonAir
What is the generic of Flovent?
Fluticasone Propionate
What are the dosage forms of Fluticasone Propionate and Flovent? (2)
HFA and DPI
What are the available strengths of Fluticasone Propionate and Flovent in HFA form? (3)
44, 110 or 220 mcg/inhalation
What are the available strengths of Fluticasone Propionate and Flovent in DPI form? (3)
50, 100 or 250 mcg/inhalation
What is the generic of ArmonAir?
Fluticasone Propionate
What is the dosage form of Fluticasone Propionate and ArmonAir?
RespiClick
What are the available strengths of Fluticasone Propionate and ArmonAir? (3)
55, 113 or 232 mcg/inhalation
What is the brand of Fluticasone Furoate?
Arnuity Ellipta
What is the generic of Arnuity Ellipta?
Fluticasone Furoate
What is the dosage form of Fluticasone Furoate and Arnuity Ellipta?
Ellipta inhaler
What are the available strengths of Fluticasone Furoate and Arnuity Ellipta? (2)
100 or 200 mcg/inhalation
What is the brand of Mometasone?
Asmanex
What is the generic of Asmanex?
Mometasone
What are the dosage forms of Mometasone and Asmanex? (2)
HFA and Twisthaler
What are the available strengths of Mometasone and Asmanex in HFA form? (2)
100 or 200 mcg/inhalation
What are the available strengths of Mometasone and Asmanex in Twisthaler form? (2)
110 or 220 mcg/inhalation
What are some side effects/adverse events with ICS?
Oral thrush (candidiasis), cough, dysphonia (voice disorder - hard to talk normally)
What is a counseling tip for patients who are taking an ICS?
Rinse mouth and spit after use to prevent oral thrush
What is the most effective long-term control therapy for asthma?
ICS
What are some benefits to taking an ICS?
Improve quality of life, increase lung function, reduce the risk of exacerbations
How to dose ICS
Titrate to lowest effective dose
What drug should use Jet Nebulizer and should not be mixed with other nebulizer medications?
Pulmicort Respules
(T/F): Aerospan has a built in spacer
True
What increases the risk of systemic side effects with ICS drugs?
High doses
How do ICS medications work?
Prevent and control inflammation
What medication class is Belomethasone (QVAR)?
ICS
What medication class is Budesonide (Pulmicort and Pulmicort Respules)?
ICS
What medication class is Ciclesonide (Alvesco)?
ICS
What medication class is Flunisolide (Aerospan)?
ICS
What medication class is Fluticasone Propionate (Flovent and ArmonAir)?
ICS
What medication class is Fluticasone Furoate (Arnuity Ellipta)?
ICS
What medication class is Mometasone (Asmanex)?
ICS
How do LABAs work?
Increase cAMP, cause bronchial smooth muscle relaxation, inhibit hypersensitivity mediators from mast cells (histamine and leukotrienes)
What is the brand of Arformoterol tartrate?
Brovana
What is the generic of Brovana?
Arformoterol tartrate
What is the dosage form of Arformoterol tartrate?
Nebulizer Solution
What is the brand of Formoterol?
Foradil Aerolizer
What is the generic of Foradil Aerolizer?
Formoterol
What is the dosage form of Formoterol (Foradil Aerolizer)?
Aerolizer
What is the brand of Indacaterol?
Arcapta Neohaler
What is the generic of Arcapta Neohaler?
Indacaterol
What is the dosage form of Indacaterol (Arcapta Neohaler)?
Neohaler
What is the brand of Olodaterol?
Striverdi Respimat
What is the generic of Striverdi Respimat?
Olodaterol
What is the dosage form of Olodaterol (Striverdi Respimat)?
Respimat inhaler
What is the brand of Salmeterol?
Serevent
What is the generic of Serevent?
Salmeterol
What is the dosage form of Salmeterol (Serevent)?
Diskus inhaler
What are some side effects/adverse events with LABAs?
tachydardia, headache, tremor, hypokalemia
What is the boxed warning for LABAs? (related to monotherapy)
Increased risk of asthma related death for all monotherapy LABA use
Should LABAs be used alone for asthma management?
NO!
What is the other boxed warning for LABAs? (related to age of patients)
Increasing hospitalizations in pediatric and adolescent patients
What is seen with intentional overdoses of LABAs?
Prolonged QT (irregular heart beats)
Should LABAs be used to treat acute symptoms?
No!
Would a LABA be potentially helpful for exercise induced bronchospams?
Yes
(T/F): Formoterol and Indacaterol capsules should be taken orally
False!!
Most children < 4 years old cannot provide sufficient inspiratory flow for adequate lung deliver with a….
DPI
What medication class is Arformoterol tartrate (Brovana)?
LABA
What medication class is Formoterol (Foradil Aerolizer)?
LABA
What medication class is Indacaterol (Arcapta Neohaler)?
LABA
What medication class is Olodaterol (Striverdi Respimat)?
LABA
What medication class is Salmeterol (Serevent)?
LABA
What three LABAs are used in COPD patients only?
Arformoterol tartrate (Brovana), Indacaterol (Arcapta Neohaler) and Olodaterol (Striverdi Respimat)
How do LAMAs work?
Block the bronchoconstrictor effects of acetylcholine on M3 and M2 receptors
What is the brand of Aclidinium?
Tudorza Pressair
What is the generic of Tudorza Pressair?
Aclidinium
What is the dosage form of Aclidinium (Tudorza Pressair)?
DPI
What is the brand of Tiotropium?
Spiriva
What is the generic of Spirivia?
Tiotropium
What are the dosage forms of Tiotropium and Sprivia? (2)
HandiHaler and Respimat
What is the brand of Umeclidinium?
Incruse Ellipta
What is the generic of Incruse Ellipta?
Umeclidinium
What is the dosage form of Umeclidinium (Incruse Ellipta)?
DPI
What are some side effects/adverse events with LAMAs?
dry mouth, dizziness, blurred vision, upper respiratory infections and paradoxical bronchospams
What LAMA has been approved for use in asthma as an add-on option in step 4 or 5 (history of exacerbations despite ICS + LABA use)
Tiotropium
What medication class is Aclidinium (Tudorza Pressair)?
LAMA
What medication class is Tioptropium (Spiriva)?
LAMA
What medication class is Umeclidinium (Incruse Ellipta)?
LAMA
All LAMAs are only to be used in patients with what?
COPD
What are the brands of Fluticasone/Salmeterol? (2)
Advair and AirDuo
What is the generic of Advair?
Fluticasone/Salmeterol
What are the dosage forms of Fluticasone/Salmeterol (Advair)? (2)
DPI and HFA MDI
What is the generic of AirDuo?
Fluticasone/Salmeterol
What is the dosage form of Fluticasone/Salmeterol and AirDuo?
Respiclick (DPI)
What is the brand of Budesonide/Formoterol?
Symbicort
What is the generic of Symbicort?
Budesonide/Formoterol
What is the dosage form of Budesonide/Formoterol (Symbicort)?
HFA MDI
What is the brand of Mometasone/Formoterol?
Dulera
What is the generic of Dulera?
Mometasone/Formoterol
what is the dosage form of Mometasone/Formoterol (Dulera)?
MDI
What is the brand of Fluticasone/Vilanterol?
Breo Ellipta
What is the generic of Breo Ellipta?
Fluticasone/Vilanterol
What is the dosage form of Fluticasone/Vilanterol (Breo Ellipta)?
DPI
What are some side effects/adverse events with ICS/LABA combo products?
See individual products (ICS and LABA)
Guidelines recommend combination ____ with ____ in asthma, as ____ should not be used as monotherapy
LABA, ICS, LABA
Combination products were developed to create convenient packaging and assist with _____
patient adherence
What medication class is Fluticasone/Salmeterol (Advair)?
ICS/LABA
What medication class is Fluticasone/Salmeterol (AirDuo)?
ICS/LABA
What medication class is Budesonide/Formoterol (Symbicort)?
ICS/LABA
What medication class is Mometasone/Formoterol (Dulera)?
ICS/LABA
What medication class is Fluticasone/Vilanterol (Breo Ellipta)?
ICS/LABA
What is the brand of Olodaterol/Tiotropium?
Stiolto Respimat
What is the generic of Stiolto Respimat?
Olodaterol/Tiotropium
What is the dosage form of Olodaterol/Tiotropium (Stiolto Respimat)?
Respimat inhaler
What is the brand of Vilanterol/Umeclidinium?
Anoro Ellipta
What is the generic of Anoro Ellipta?
Vilanterol/Umeclidinium
What is the dosage form of Vilanterol/Umeclidinium (Anoro Ellipta)?
Ellipta inhaler
What is the brand of Indacanterol/Glycopyrronium?
Utibron Neohaler
What is the generic of Utibron Neohaler?
Indacanterol/Glycopyrronium
What is the dosage form of Indacanterol/Glycopyrronium (Utibron Neohaler)
Neohaler
What is the brand of Formoterol/Glycopyrronium?
Bevespi Aerosphere
What is the generic of Bevespi Aerosphere?
Formoterol/Glycopyrronium
What is the dosage form of Formoterol/Glycopyrronium (Bevespi Aerosphere)?
Aerosphere
All LABA/LAMA combo products are only to be used in patients with what?
COPD
What are some side effects/adverse events with LABA/LAMA combo products?
See individual products (LABA and LAMA)
What medication class is not indicated for treatment of acute deteriorations?
LABA/LAMA
What medication class is Olodaterol/Tioptropium (Stiolto Respimat)?
LABA/LAMA
What medication class is Vilanterol/Umeclidinium (Anoro Ellipta)?
LABA/LAMA
What medication class is Indacanterol/Glycopyrronium (Utibron Neohaler)?
LABA/LAMA
What medication class is Formoterol/Glycopyrronium (Bevespi Aerosphere)?
LABA/LAMA
What is Cromolyn?
Mass cell stabilzer
What is the dosage form of Cromolyn?
Nebulizer Solution
What are some side effects/adverse events with Cromolyn?
High incidence of unpleasant taste in mouth (>10%), rare cardiac arrhythmias, coughing, dyspnea (shortness of breath), sore throat, N/V/D if absorbed systemically
Is Cromolyn less or more effective than a low-dose ICS?
Less effective
Cromolyn prevents an increase in _______ seen in allergy season
bronchial hyperreactivity
What is the brand of Montelukast?
Singular
What is the generic of Singulair?
Montelukast
What are the dosage forms of Montelukast and Singulair? (2)
Tablets (chewable) and Granule Packets
What is the brand of Zafirlukast?
Accolate
What is the generic of Accolate?
Zafirlukast
What is the dosage form of Zafirlukast and Accolate?
Tablet
What is the brand of Zileuton?
Zyflo CR
What is the generic of Zyflo CR?
Zileuton
What is the dosage form of Zileuton and Zyflo CR?
Tablet
How do leukotriene modifiers work?
Block the production of leukotrienes
What are some side effects/adverse events with leukotriene modifiers?
Neuropsychiatric events (agitation, anxiety, abnormal dreams, hallucinations, depression, suicidal thinking), Churg-Strauss syndrome (Rare)
Zafirlukast and Zileuton may cause increased…
hepatic transaminases
Are leukotriene modifiers more or less effective than a low dose ICS or ICS/LABA in asthma?
Less effective
(T/F): Leukotriene modifiers have been adequately trialed in COPD patients
False
Montelukast is a weak inhibitor of…. (2 enzymes)
CYP2C8 and 2C9
Monteluast is a major substrate of… (2 enzymes)
CYP2C9 and 3A4
Montelukast is not for….
acute relief of symptoms
Zafirlukast should be taken at least ____ before or ____ after meals
1 hour before or 2 hours after
Zafirlukast can increase…
INR
Zileuton is a moderate inhibitor of…
CYP1A2
Zileuton is a minor substrate of…. (3 enzymes)
CYP1A2, 2C9 and 3A4
What medication class is Montelukast (Singulair)?
Leukotriene modifier
What medication class is Zafirlukast (Accolate)?
Leukotriene modifier
What medication class is Zileuton (Zyflo CR)?
Leukotriene modifier
How do methylxanthines work?
Cause bronchodilation through inhibition of PDE III and PDE IV (reduced breakdown of cAMP to AMP)
What medication class is Theophylline?
Methylxanthines
What are the dosage forms of Theophylline? (3)
ER tablets, ER capsules, liquid
What are some side effects/adverse events with Theophylline? (4)
Insomnia, GI upset, hyperactivity, hypotension
What are some one dose related toxicities for Theophylline? (6)
Tachycardia, nausea, vomiting, headache, seizures, arrhythmias
What are some contraindications of Theophylline?
Peptic ulcer disease, arrhythmias, seizure disorders
Theophylline is a major substrate of… (3 enzymes)
CYP 3A4, 1A2 and 2E1
There is an increased concentration of these drugs when Theophylline reacts with CYP 3A4, 1A2 or 2E1 (5)
cimetidine, erythromycin, clarithromycin, ciprofloxacin and ticlopidine
What is a decreased concentration of these drugs when Theophylline reacts with CYP 3A4, 1A2 or 2E1 (5)
Phenobarbital, phenytoin, carbamazepine, rifampin, smoking
PDE III inhibition from Theophylline is the likely cause of____, ___ and _____
hypotension, tachycardia and nausea
How do Anti-IgE monoclonal antibodies work?
Inhibit IgE from binding to receptors on mast cells and basophils, thus inhibiting degranulation
What is the brand of Omalizumab?
Xolair
What is the generic of Xolair?
Omalizumab
Omalizumab (Xolair) is dosed depending on _____ and pretreatment serum _____
body weight, IgE levels
What are some side effects/adverse events with Omalizumab (Xolair)? (7)
Headache, injection site reactions, arthralgias (joint pain), thrombocytopenia (not enough platelets in blood), pharyngitis (inflammation of back of throat), sinusitis, upper respiratory tract infections
What is a boxed warning for Omalizumab (Xolair)?
Anaphylaxis
Do not administer Omalizumab (Xolair) more than ___ per injection site
150mg
Monitor patient for ___ before and after injection of Omalizumab (Xolair)
anaphylaxis
Omalizumab (Xolair) is FDA approved for ____ to ____ persistent asthma in patients with a positive skin test or reactivity to a perennial aeroallergen and symptoms that are inadequately controlled wth ICS
moderate to severe
What medication class is Omalizumab (Xolair)?
Anti-IgE monoclonal antibody
How do Anti-IL5 monoclonal antibodies work?
Prevent IL-5 from binding to IL-5 receptor, thus reducing production and survival of eosinophils
What is the brand of Mepolizumab?
Nucala
What is the generic of Nucala?
Mepolizumab
What are some side effects/adverse events with Mepolizumab (Nucala)? (4)
Headache, injection site reactions, arthralgias, Herpes Zoster infection
What is a precaution with Mepolizumab (Nucala)?
Anaphylaxis (NOT A BOXED WARNING LIKE THE OTHERS)
Monitor for ____ before and after injection of Mepolizumab (Nucala)
anaphylaxis
Mepolizumab (Nucala) is indicated for add-on maintenance treatment of patients with ____ asthma with an _____ phenotype
severe, eosinophilic
What is the brand of Reslizumab?
Cinqair
What is the generic of Cinqair?
Reslizumab
What are some side effects/adverse events with Reslizumab (Cinqair)? (3)
injection site reactions, myalgias (muscle pain), increased creatinine phosphokinase
What are the boxed warnings for Reslizumab (Cinqair)? (2)
Anaphylaxis, malignancies (cancerous growths)
Monitor for ___ before and after injection of Reslizumab (Cinqair)
Anaphylaxis
Reslizumab (Cinqair) is indicated for add-on maintenance treatment of patients with ___ severe asthma with an _____ phenotype
severe, eosinophilic
What medication class is Mepolizumab (Nucala)?
Anti-IL5 monoclonal antibody
What medication class is Reslizumab (Cinqair)?
Anti-IL5 monoclonal antibody
How do Phosphodiaesterase-4 inhibitors work?
Inhibit PDE4, thus decreasing breakdown of cAMP to AMP, ultimately increasing cAMP levels
What is the brand of Roflumilast?
Daliresp
What is the generic of Daliresp?
Roflumilast
What is the dosage form of Roflumist and Daliresp?
Tablet
Roflumilast and Daliresp are indicated for ____ patients only
COPD
Patients taking Roflumilast and Daliresp need to have _____ and monitor their ____
liver function tests and weight
What are some drug interactions with Roflumilast and Daliresp? (2)
CYP3A4 (major), CYP1A2 (minor)
What are contraindications for Roflumilast and Daliresp?
Child-Pugh class B or C
What medication class is Roflumilast (Daliresp)?
PDE4 inhibitor
