Rescue Medications (Asthma/COPD)

Question 1

Inhaled short acting beta-2 agonists (SABA) action?

Answer 1

increase cAMP, antagonize bronchoconstriction –> smooth muscle relaxtion (reverse obstruction and improve airflow)

Question 2

albuterol HFA brand names?

Answer 2

ProAir, Ventolin, Proventil, ProAir Respiclick, ProAir Digihaler

Question 3

albuterol HFA dosage forms?

Answer 3

MDI, Aerosol Powder Inhaler, nebulizer solution (albuterol only, not HFA)

Question 4

albuterol adverse effects/clinical pearls?

Answer 4

• Tachycardia, tremor, hypokalemia, irritability
• Chronic use (> 2x/day) indicates poor asthma control
• May mix nebulizer solution with cromolyn solution, budesonide inhalant suspension, or ipratropium solution
• In mild to moderate exacerbations, MDI plus valved holding chamber is as effective as nebulized therapy with appropriate administration technique and coaching by trained personnel

Question 5

albuterol age usage?

Answer 5

All ages can use albuterol

Question 6

levalbuterol HFA brand name?

Answer 6

Xopenex

Question 7

levalbuterol HFA dosage form?

Answer 7

MDI, nebulizer solution (levalbuterol only, not HFA)

Question 8

levalbuterol adverse effects/clinical pearls?

Answer 8

• Tachycardia, tremor, hypokalemia, irritability
• Reserved for patients who do not respond to albuterol for quick relief
• Nebulizer solution compatible with budesonide inhalant suspension
• Levalbuterol administration in 1/2 the mg dose of albuterol provides comparable efficacy and safety
• Has not been evaluated by continuous nebulization

Question 9

levalbuterol age usage?

Answer 9

All ages can use levalbuterol

Question 10

Short acting anticholinergics action?

Answer 10

Competitively inhibit cholinergic receptors in bronchial smooth muscle –> decrease cGMP leading to bronchodilation

Question 11

ipratropium brand name?

Answer 11

Atrovent

Question 12

ipratropium dosage forms?

Answer 12

MDI, nebulizer solution

Question 13

ipratropium adverse effects/clinical pearls?

Answer 13

• Dry mouth, urinary retention, infection, sinusitis, bronchitis
• Used in combo with albuterol for asthma exacerbation treatment
• May mix in same nebulizer with albuterol
• Should not be used as first-line therapy; should be added to SABA therapy for severe exacerbations

Question 14

ipratropium/albuterol brand name?

Answer 14

Combivent Respimat, DuoNeb

Question 15

ipratropium/albuterol dosage forms?

Answer 15

MDI, Nebulizer Solution

Question 16

ipratropium/albuterol adverse effects/clinical pearls?

Answer 16

• Adverse effects are individualized
• Nebulizer solution may be used for up to 3 hours in initial management of severe exacerbations

Question 17

Short acting anticholinergic age usage?

Answer 17

All ages can use them

Question 18

System corticosteroids action?

Answer 18

decrease inflammation, increase response to beta-2 agonists

Question 19

methylprednisolone dosage form

Answer 19

tablets

Question 20

prednisolone dosage form?

Answer 20

tablets, oral liquid

Question 21

prednisone dosage form?

Answer 21

tablets, oral liquid

Question 22

dexamethasone dosage form?

Answer 22

oral liquid, tablets, injection

Question 23

methylprednisolone acetate dosage form?

Answer 23

repository injection

Question 24

systemic corticosteroids adverse effects/clinical pearls?

Answer 24

• Short term use: hyperglycemia, increased appetite, fluid retention, demargination of WBCs, psychiatric disturbances
• CI: systemic fungal infections, administration of live vaccines if immunocompromised
• DI: Warfarin increases INR, decreases efficacy of inactivated vaccines
• May be used with ICS if patient is already taking ICS before hospitalization
• May also be used for chronic therapy in both asthma (and COPD) only in severe stages
• “Bursts” effective for establishing control when initiating therapy or during period of gradual deterioration
• Injection may be used in place of “burst” if adherence is an issue or patient is vomiting

Question 25

epinephrine comments

Answer 25

• no proven advantage of systemic therapy over aerosol
• indicated in addition to standard therapy for acute asthma associated with anaphylaxis and/or angioedema

Question 26

terbutaline comments

Answer 26

• no proven advantage of systemic therapy over aerosol

Question 27

systemic subcutaneous beta-2 agonists

Answer 27

epinephrine and terbutaline

Question 28

magnesium sulfate action?

Answer 28

smooth muscle relaxation through inhibition of calcium influx into smooth muscle cells