asthma copd inhalers Flashcards by Brittany Galloway

MDI counseling points

-need to prime (prime 4x b4 use)
-inhale slowly, deeply
-normally shake (UNLESS if solution then DONT shake)
-if need to shake, shake 10 to 15 times
-can use a spacer

solution MDI so don’t shake: alvesco, atrovent

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respimat: soft, mist

DO NOT SHAKE

P-TOP

~prime it
~turn it
~open it
~press it

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DPI counseling points

-inhale quickly and deeply (to pull into lungs)
-do NOT shake
-all are contraindicated in milk protein allergy
-store at room temp in a dry place
-do NOT exhale into the container
-single dose devices require placement of a capsule into the device immediately before each treatment (ex: indacaterol - arcapta neohaler, tiotropium - spiriva handihaler, indacaterol + glycopyrrolate - utibron)

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asthma medication triggers

NSAIDs (including ASA) and beta blockers

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albuterol dosage forms

-MDI
-DPI
-Nebulization
-Syrup
-Tablets (ER, IR)

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albuterol: MDI examples

-ventolin HFA

-Proventil HFA

-ProAir HFA

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albuterol: DPI examples

-ProAir RespiClick

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levalbuterol (forms)

xopenex (R-isomer of albuterol)

xopenex HFA, MDI

xopenex nebulization

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terbutaline (forms)

oral

injectable (SQ/IV)

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beclomethasone (forms)

breath-actuated aerosol inhaler

QVAR redihaler, MDI

NO SPACER

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budesonide (forms)

pulmicort flexhaler (DPI)

pulmicort respules (contains liquid for nebulizer)

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mometasone (forms)

asmanex HFA, MDI

asmanex twisthaler DPI

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fluticasone (forms)

flovent HFA (MDI)

flovent diskus (DPI)

arnuity ellipta (DPI)

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ciclesonide (forms)

alvesco (MDI)

*prodrug requires hydrolyzation in the lung to form the active metabolite
*MDI BUT IS A SOLUTION –> DO NOT SHAKE

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flunisolide (forms)

aerospan HFA (D/C’ed)

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systemic steroids for acute tx of asthma
(along with a SABA)

-oral prednisone: 40 - 60mg QD x3 - 10 days

-dexamethasone: 16mg/d PO QD x1 - 2 days

-methylprednisolone (medrol dose pack): Taper 24 to 0 mg PO over 6 days. Start with 6, 5 –> 1mg (all tabs are 4 mg, total of 21 tabs)

-rayos (delayed release prednisone): QHS; coated to delay drug about 4 hr after the dose is taken

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oral prednisolone formulations

-millipred: 10mg/5 mL, 5 mg tablet

-prelone: 5mg/5 mL, 15 mg/5 mL; contains 5% alcohol

-veripred 20: 20 mg/5 mL solution; REFRIGERATE

-generic: 15mg/5 mL

-orapred: 10, 15, 30 mg ODT

*administer with food or milk to decrease GI upset
*prednisone is a prodrug to prednisolone

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salmeterol (forms)

[salmeterol is a CYP3A4 substrate]

-serverent diskus: 1 puff 30 to 60 minutes before exercise

-if includes fluticasone = Advair (Diskus / HFA)
*also approved for maintenance of COPD

-if includes fluticasone = AirDuo RespiClick (DPI)

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formoterol (forms)

-formoterol + budesonide (Symbicort)

-formoterol + mometasone (Dulera)

*drug interactions:
-beta blockers may reduce efficacy
-theophylline, caffeine, thiazides, loop diuretics may increase
-beta-agonist-induced decreased K

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montelukast (forms)

-singulair: tabs, chewable tabs, granules packet (if mixed, use within 15 minutes)
*indications: asthma, allergic rhinitis (seasonal or perennial), prevention of exercise-induced asthma (must be taken 2 hours before exercise)

10mg QHS: >/= 15 years old
5mg QHS: 6 - 14 years old
4mg QHS: 2 - 5 years old
4mg granules: 6 months - 23 months (QD)

*chewable tab has phenylalanine
*watch for mood and behavioral changes
*restlessness is a side effect

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zafirlukast (forms)

-accolate: tabs
*indication: prophylaxis/chronic treatment of asthma

Dose:
-if >/= 12, 20 mg BID on an empty stomach (1 h ac or 2 h pc)
-if 5 - 11, 10 mg BID on an empty stomach

Drug interactions:
-major CYP2C9 substrate / inhibits 2C9
-theophylline may decrease accolate levels
-accolate increases warfarin levels: monitor INR

Caution:
-hepatotoxicity

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zileuton (forms)

zyflo, zyflo CR (IR, ER tabs)

Indication: asthma for patients >/= 12

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omalizumab

Xolair: subQ (IgG1k mAb)

Indications:
-allergic asthma: >/= 6 years
-chronic idiopathic urticaria (hives): >/= 12 years

*not used for the tx of acute asthma

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reslizumab

meplizumab

benralizumab

(forms)

interleukin-5 receptor antagonists

reslizumab (cinqair): IV in NS (IV q4 weeks)

meplizumab (nucala): subQ (subQ q4 weeks)

benralizumab (fasenra): subQ (subQ q4 weeks), then q8 weeks thereafter

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theophylline (forms)

elixophyllin: elixir theo-24: ER caps, QHS theochron ER-12H: ER tabs -MOA: phosphodiesterase inhibitors -MAX = 900mg/d -DI: strong cyp1a2 substrate & minor 3a4 substrate -also in IV Therapeutic levels: -Children: 5 - 10 mcg/ml -Adults: 5 - 15 mcg/ml

theophylline - Aminophylline conversion

PO T = IV A x 0.8

methylxanthines used in apnea of prematurity

-caffeine CITRATE: IV -theophylline

cromolyn (forms)

mast-cell stabilizer Indications: -asthma, maintenance -prophylaxis of bronchospasm (allergen or exercise-induced) Dosage form: nebulized solution 20mg/2 mL

ipratropium (forms)

atrovent HFA (MDI) = solution (DO NOT SHAKE) 2-3 puffs QID SE: dry mouth, cough, blurred vision

albuterol + ipratropium (forms)

combivent respimat = DO NOT SHAKE QID NOT contraindicated with soybean or peanut allergy Discard after 3 months after the cartridge is inserted

albuterol + ipratropium solution

DuoNeb: Nebulizer solution QID PRN

tiotropium (forms)

advantage = QD spiriva handihaler DPI spiriva respimat SMI (soft mist inhaler) *2 inhalations

umeclidinium (forms)

incruse ellipta, dry powder dose = QD

aclidinium (forms)

tudorza pressair DPI dose = BID discard 45 days after opening

glycopyrrolate (forms)

seebri DPI w/ capsule *dose = 1 c BID lonhala magnair nebulization solution *dose = one vial inhaled BID

olodaterol + tiotropium

stiolto respimat 2 QD

indacaterol + glycopyrrolate

utibron neohaler BID

vilanterol + umeclidinium

anora ellipta 1 QD

formoterol + glycopyrrolate (forms)

bevespi aerosphere MDI 2 BID

formoterol + aclidinium

duaklir pressair 1 BID

formoterol + budesonide (forms)

symbicort MDI 2 BID

salmeterol + fluticasone

advair diskus 1 BID

vilanterol + fluticasone (forms)

breo ellipta DPI (ONLY FOR COPD) 1 QD contraindicated in milk protein allergy

trelegy ellipta

umeclidinium + vilanterol + fluticasone FDA approved for both asthma and COPD Dose = Single puff QD Contraindication = hypersensitivity to milk proteins

roflumilast

daliresp indication = COPD maintenance moa = phosphodiesterase 4 (PDE4) inhibitor not indicated for acute attack form = 250, 500 mcg tablet SE = psych, suicidality, weight LOSS, decreased appetite DI = major cyp3a4 substrate CI = moderate-severe liver impairment THIS IS LAST LINE THERAPY

most effective tx for nasal symptoms is a

CORTICOSTEROID NASAL SPRAY

beclomethasone (forms): AR

beconase (in asthma = QVAR)

flunisolide (forms): AR

...not listed

mometasone (forms): AR

nasonex OTC

ciclesonide (forms): AR

omnaris zetonna

triamcinolone (forms): AR

nasacort allergy 24 hr OTC

budesonide (forms): AR

rhinocort OTC

fluticasone furoate (forms): AR

flonase sensimist OTC

antihistamines azelastine (forms): AR

astepro

antihistamines olopatadine (forms): AR

patanase

antihistamine/steroid azelastine/fluticasone (forms): AR

dymista

antihistamine/steroid olopatadine/mometasone (forms): AR

ryaltris

mast cell stabilizer cromolyn (forms): AR

nasalcrom OTC

anticholinergic ipratropium: AR

...none listed

dupilumab

dupixent MOA: interleukin-4 receptor antagonist Indication: add on for moderate-to-severe asthma, atopic dermatitis Dose: >/= 12 yrs; 200 or 300 mg SQ once every other week Counseling: *allow solution to reach room temperature *DO NOT SHAKE *DONT USE IF DISCOLORED OR CONTAINS PARTICULATE MATTER *PREFILLED SYRINGE DOES NOT CONTAIN A PRESERVATIVE; discard unused portion

fluticasone + salmeterol [new generic formulation for advair diskus]

Wixela Inhub *THIS IS GRAY, NOT PURPLE LIKE THE DISKUS *PTS HOLD THIS VERTICALLY INSTEAD OF HORIZONTALLY

aclidinium + formoterol (forms)

duaklir pressair DPI indication: COPD dose: one inhalation BID

budesonide/glycopyrrolate/formoterol

breztri aerosphere MDI indication: COPD dose: oral inhalation; 2 inhalations BID [this is the MAX]

intravenous Mg Sulfate

off-label for severe or life-threatening exacerbations nonresponsive to initial therapy for asthma or COPD IV: 2 g as a single dose over 20 minutes NOTE --> IV Mg is also used for: -eclampsia/preeclampsia w/ severe features, seizure prophylaxis and tx -hypomagnesemia -torsades de pointes

asthma copd inhalers Flashcards

(64 cards)