Respiratory Medicine

Question 0

Short Acting Bronchodilator Agents
SABA’s
All Beta-2 receptor preference
4-6 hour duration

Answer 0

Metaproterenol (ALUPENT)
SVN, tab, or syrup

Albuterol (ACCUNEB, PROAIR, PROVENTIL, VENTOLIN, VOSPIRE)
SVN: 0.5ml(2.5mg): 0.63 or 1.25ml/2.5 mg, MDI: 90ug/puff
Continuos 10-15mg/hour

Levalbuterol (XOPENEX)
HFA MDI, SVN: (TID), 0.31, 0.63, 1.25mg/3mL, or 1.25mg/0.5mL

Pirbuterol acetate (MAXAIR)
   AutoHaler: MDI 200ug/puff, 2 puffs q4-6hrs

Question 1

Anti-Leukotrienes

Answer 1

CysLT receptor antagonists

Montelukast (SINGULAIR)
Tablets: 10, 5, 4mg (4mg granules for 6-23 months)
One tablet daily

Zafirlukast (ACCOLATE)
Tablets: 10, 20 mg (adults, 20 mg twice daily w/out food)

5-LO enzyme inhibitor

Zileuton (ZYFLO)
Tablets: One 600mg, 4 times a day

Question 2

Long-Acting Adrenergic Bronchodilating Agent
LABA’s
All Beta-2 receptor preference
12 hour duration

Answer 2

Arformoteral  (BROVANA)
   SVN 
Formoterol (FORADIL, PERFORMIST)
   DPI or SVN
Salmeterol (SEREVENT)
   DPI: 50ug/blister bid
Indacaterol (ARCAPTA)

Question 3

Anti-Cholinergics (Anti-muscarinic) (Parasympatholytic)

Answer 3

TERTIARY
Atropine (no longer aerosolized) (large doses to increase HR)
Used in CPR to treat sinus bradycardia

QUATERNARY

aclidinium bromide (TUDORZA) (M3)
    400ug/actuation bid

ipratropium bromide (ATROVENT) (antagonist of M1, M2, M3) (4-6hrs)
HFA MDI: 17ug/puff (2 puffs qid)
SVN: 0.02% solution (0.2mg/mL), 500ug tid/qid
Nasal spray: 21/42ug, 2 sprays, bid/qid

tiotropium bromide (SPIRIVA) (M1, M3) (24 hours)
    DPI: 18ug/inhalation, once daily

Question 4

Corticosteroids (anti-inflammatory)

Answer 4

beclomethasone (QVAR)
MDI: 40 or 80ug/puff, twice daily

flunisolide (AeroBid, AeroSpan(HFA))
AeroSpan: MDI 80ug/puff, 2 puffs bid

budesonide (PULMICORT)
DPI: 90 or 180ug/actuation, adults 180-360ug bid

fluticasone (FLOVENT, HFA or Diskus)
MDI: 44, 110, 220ug/puff (adults, 88ug bid)
DPI: 50, 100, 250 ug (adults, 100ug bid)

mometasone furoate (ASMANEX) 
   Twisthaler: DPI (110 or 220ug/actuation) (adults, 220-880ug daily)

ciclesonide (ALVESCO)
MDI: 40 or 80ug/puff (adults, 80-160ug bid)

Question 5

Corticosteroid and LABA

Answer 5

budesonide and formoterol (SYMBICORT)
HFA MDI: 80 or 160ug budesonide/4.5ug formoterol (adults, bid)

fluticasone and salmeterol (ADVAIR)
Diskus: 100, 250, 500ug fluticasone/ 50ug salmeterol (bid)
MDI: 45, 115, 230ug fluticasone/21ug salmeterol (2 inhalations, bid)

mometazone and formoterol (DULERA)
MDI: 100, 200ug mometasone/5ug formoterol (bid)

Question 6

Anti-Cholinergic and SABA

Answer 6

ipratropium bromide and albuterol (COMBIVENT, MDI Respimat) (SVN DuoNeb)

Combivent MDI: ipratropium 18ug/ albuterol 90ug/puff, 2 puffs qid

DuoNeb SVN: ipratropium 0.5mg and albuterol 2.5mg

Question 7

MucoActive agents

Answer 7

(MUCOMYST) N-acetyl-l-cysteine (acetaminophen overdose) (not a mucous clearing agent) (lowers viscosity of secretions by breaking disulfide bonds)
SVN: 10% or 20%, 3-5mL

Dornase alfa (PULMOZYME) (reduce extra-cellular DNA, for tenacious secretions in CF patients)
SVN: 2.5mg/ampoule (once daily)

Question 8

Expectorants

Answer 8

Oligosaccharides
Guaifenesin
Hyperosmolar (7% saline)

Question 9

Mucoregulatory

Answer 9

Steroids
Anticholinergics
Atropine

Question 10

Mast Cell Stabilizer

Answer 10

Cromolyn Sodium (NasalCrom, Gastrocrom)
SVN: 20mg ampoule, 4 times daily
Spray: One 40mg/mL (5.2mg per spray) each nostril, 3-6 times/day
Oral concentrate: 100mg/mL

Question 11

Monoclonal Antibody

Answer 11

Omalizumab (XOLAIR)
Subcutaneous injection every 4 weeks
Dose dependent on weight and serum IgE level