Asthma Drugs Flashcards
(133 cards)
1
Q
As needed
Reduces exacerbation risk compared SABA alone
Max dose of fast acting LABA component: 72 mcg
A
ICS + Formeterol
2
Q
As needed
Quickly reverses bronchodilation
A
SABA
3
Q
IV or PO used for exacerbation or asthma that is difficult to control
A
Systemic steroids
4
Q
Reliever available OTC but not part of GINA guidelines
A
Inhaled epinephrine
5
Q
Can be used in combination with SABA to control exacerbation
A
SAMA
6
Q
Preferred anti-inflammatory and first line agent for all asthma patients
A
ICS
7
Q
Preferred add-on to ICS but avoid as monotherapy
A
LABA
8
Q
Can be used as add-on if LABA cannot be used
Can be added to an ICS-LABA
Preferred in children
A
Oral Leukotriene Receptor Antagonist
9
Q
As add-on to ICS-LABA if history of excerbation
A
LAMA
10
Q
For specific asthma type
A
Monoclonal antibodies
11
Q
Not preferred agent due to increased ADR, DI and need for level monitoring
A
Theophylline
12
Q
Monoclonal for severe allergic asthma
A
Omalizumab
13
Q
For severe eosinophollic asthma
A
Mepolizumab
Reslizumab
Benralizumab
Dupilumab
14
Q
Step 1 treatment
A
Prn ICS-Formoterol
Or
Prn SABA+ low-dose ICS
15
Q
Step 2 treatment
A
Prn ICS-Formoterol
Or
SABA (reliever) and Low dose ICS (controller)
16
Q
Step 3 treatment
A
Low dose ICS-Formoterol (R and C)
Or
SABA (R) and low dose ICS-LABA (C)
17
Q
Step 4 treatment
A
Low dose ICS-Formoterol (R) and medium dose ICS-Formoterol (C)
Or
SABA (R) and medium dose ICS-LABA (C)
18
Q
Step 5 treatment
A
Referral
Low dose ICS-Formoterol (R) and high dose ICS-Formoterol (C)
Or
SABA (R) and high dose ICS-LABA (C)
19
Q
Maintain current regemen
Or
Step down if at least 3 months of control
A
Well-controlled
20
Q
Step up 1 step
A
Partly controlled
21
Q
Step up 1-2 steps +/- short course oral steroids
A
Uncontrolled
22
Q
Proair (HFA, Respiclick, Digihaler)
Proventil HFA
Ventolin HFA
A
Albuterol
23
Q
1-2 puffs every 4-6 hr prn
A
Albuterol
24
Q
Available PO but not recommended
A
Albuterol
25
Albuterol dose/inhalation
90 mcg
26
R-isomer of albuterol
Levoalbuterol
27
Shake SABA HFA products
Yes
28
Xopenex (Concentrate, HFA)
Xopenex
Levoalbuterol
29
SABA not used due to non-selectivity for beta receptors
Inhaled epinephrine
30
Asthmaneferin
Inhaled epinephrine
31
Warning:
CVD
Glaucoma
Hyperthyroidism
Hyperglycemia
Seizures
Beta agonist
32
Serevent diskus (DPI)
Salmeterol
33
Increased risk of asthma related death and hospitalization
Slameterol
( use with ICS)
34
QVAR Redihaler (MDI)
Beclomethasone
35
Pulmicort (Flexhalers, Respule) DPI
Budesonide
36
Symbicort
Budesonide + Formoterol
37
Flovent (HFA, Diskus)
Arnuity Ellipta (DPI)
ArmonAir Digihaler (DPI)
Fluticasone
38
Advair (Diskus, HFA)
Airduo (Respiclick, Digihaler)
Wixela Inhub
Fluticasone + Salmeterol
39
Breo Ellipta
Fluticasone + Vilanterol
40
Asmanex
Mometasone
41
Dulera
Mometasone + Formoterol
42
Alvesco
Ciclesonide
43
Contraindicated in Status asthmaticus and acute asthma episodes
ICS
44
Immunosuppression
Growth retardation
Increase Fracture risk
Adrenal insufficiency
Oral thrush
Dystonia
ICS
45
ICS does not require shaking
QVAR and Alvesco
46
Only ICS nebulizer
Budesonide
Use jet nebulizer
47
Records and stores its own data
Armonair and Airduo digihalers
48
LAMA indicated for asthma use
Tiotropium
49
Spirivia respimat
Tiotropium
50
LAMA-LABA-ICS for asthma use
Trelegy ellipta
51
Trelegy ellipta
Umeclidinuim/Vilanterol/Flutocasone
52
Inhibits LTD4
Montelukast
53
Singulair
Montelukast
54
Inhibit LTD4 and LTE4
Zafirlukast
55
Accolate
Zafirlukast
56
5-lipooxygenase inhibitor. Inhibits leukotriene formation
Zileuton
57
Zyflo
Zileuton
58
Tablet, Chew, Packet
Montelukast
59
Approved for allergic rhinitis and EIB
Montelukast
60
Use 2hrs before exercise
Montelukast
61
> 14yrs: 10mg daily
6-14yrs: 5 mg daily
1-5yrs: 4mg daily
Montelukast
62
20mg BID
5-11yrs: 10mg BID
Zafirlukast
63
1hr before or 2hr after a meal
Zafirlukast
64
Not recommended for < 12yrs
Zileuton
65
Warning: Neuropsychiatric disorders
Montelukast
66
Hepatotoxicity
Zafirlukast
Zileuton
67
Granules can be mixed with soft food and used within 15 mins of opened
Montelukast
68
Dispense in original container
Zafirlukast
69
2C8/9 and 3A4 substrate
2C8/9 inhibitors
Gemfibrozil increases level
Lumefactor decreases level
Montelukast
70
2C9 substrate
2C8/9 inhibitors
Increase theophylline level
Erythromycin and theophylline increase level
Zafirlukast
71
1A2, 2C9, 3A4 substrate
1A2 inhibitors
Increase theophylline, propranolol and warfarin levels
Zileuton
72
Phosphodiesterase inhibitors= increased cAMP = release of epinephrine from adrenal medulla
Theophylline
73
Elixophyllin, Theo-24
Theophylline
74
Caffeine and 3-methylxanthine are active metabolites
Theophylline
75
Toxicity: persistent vomiting, arrhythmias, seizures
Theophylline
76
Therapeutic level: 5-15 mcg/ml
Drawn with peak at steady state or after 3 days if oral dosing
Theophylline
77
Requires loading dose at 5mg/kg of IBW
Theophylline
78
Aminophylline x 0.8
Aminophylline to Theophylline dose conversion
79
Theophylline/0.8
Theophylline to Aminophylline conversion
80
Major 1A2 and Minor 2E1 and 3A4 substrate
Theophylline
81
1A2 inhibitors will increase level
Cimetidine
Cipro
Fluvixamine
Propranolol
Zileuton
Theophylline
82
Drugs will increase theophylline level
Zafirlukast
Allopurinol
Alcohol
Estrogen
Methotrexate
Verapamil
83
Condition/Food will increase theophylline levels
CHF
Liver disease
High carb
Low protein
84
Condition/Food will decrease theophylline levels
Cystic fibrosis
Hyperthyroidism
Low carb
High protein
85
Inhibits muscarinic cholinergic receptors = reduction in vagal tone = bronchodilation
Anticholinergic
86
LAMA approved in asthmatic patients 6yrs or older with exacerbation history despite ICS-LABA
Tiotropium
87
Inhibits IgE binding to receptors of mast cell and basophil
Omalizumab
88
Xolair
Omalizumab
89
SC injections q2-4 weeks
Omalizumab
90
Approved for 6 yrs and older with severe asthma defined as a positive skin test of perennial aeroallergen or inadequate sx control at step 5
Omalizumab
91
First 3 doses administered under healthcare supervision
Self administration if no anaphylaxis after 3 doses and can properly treat anaphylaxis reactions with right injection techniques
Omalizumab
92
Warning includes: increase risk of CV and CNS ADR and malignancy
Omalizumab
93
Monitor baseline IgE level, s/sx of anaphylaxis
Omalizumab
94
Anaphylaxis reaction like with first dose or 1 year after initiation
Omalizumab
95
Cytokine responsible for eosinophilic activation in asthma patients
Interleukin
96
Interleukin 5 inhibitors
Mepolizumab
Reslizumab
Benralizumab
97
Nucala
Mepolizumab
98
Cinqair
Reslizumab
99
Fasenra
Fasenra pen
Benralizumab
100
Interleukin 3&4 inhibitors
Dupilumab
101
Dupixent
Dupilumab
102
Indicated for management of severe asthma with an eosinophillic phenotype
Mepolizumab
Reslizumab
Benralizumab
Dupilumab
103
6yrs and older
Once monthly SC injection
Mepolizumab
104
Adults
Once monthly IV injection
Warning: anaphylaxis
Reslizumab
105
12yrs and older
Once monthly SC for three doses then once every 2 montht
Benralizumab
106
12yrs and older
SC injection every other week
Dupilumab
107
Tezspire
Tezepelumab
(For asthma)
108
Take 5-15 mins before exercise
Duration 2-3h or 12hrs
SABA or ICS-Formoterol
109
Alternative to SABA in EIB
Take 30mins before
Salmeterol
110
2hrs before exercise
Duration 24hrs
Montelukast
111
Should be continued during pregnancy and preferred controller
ICS
112
Should last 30 days with a total of 60 inhalation
Advair diskus
Asmanex
113
Should last 30 days with a total of 120 inhalation
QVAR Redihaler
114
Should last 12 months with total of 200 inhalation
Albuterol MDI
115
Should last 3-4 months with total of 60 inhalation
Ventolin HFA
116
Time between each inhalation
60 seconds
117
Sequence of administration if more than one inhaler
Bronchodilator before ICS
(SABA —> LABA/LAMA —> ICS)
Wait 60 seconds before the next inhalation
118
Albuterol nebulizer concentration needs dilution in NS prior to use
0.5%
0.083% is ready to use no dilution necessary
119
Types of nebulizers
Jet
Ultrasound
Mesh
120
Do not use with spacers
DPI
MDI can be used with spacers
121
How often a spacer should be cleaned
Weekly
122
Personal best of a peak expiratory flow rate is measured with what device
Spirometry
123
Peak expiratory flow rate takes in account what factors
Age
Gender
Height
PEFR is muscle dependent
124
Developed for patient to manage asthma at home and minimize the risk of hospitalization due excerbation
Asthma action plan
125
When is peak flow best measured
In the morning with awakenings before inhaler administration
126
How is the peak flow meter cleaned
With warm water and soap only
At least weekly
127
What is green zone on peak flow meter
Within 80-100% of personal best
Indicates good control
Continue maintenance therapy as indicated
128
What is indicated by yellow zone on peak flow meter
Within 50-80% of personal best
Worsening lung function
Increase dose or add-on therapy
129
What is indicted by the red zone on a peak flow meter
< 50% of personal best
Medical emergency
Use rescue +/- steroids or ED admissions
130
When is steroids indicated in yellow zone
If sx persists and do not return to green zone after 1hr of rescue use
131
When should a patient seek medical emergency if in red zone
Still in red zone 15 minutes after rescue and oral steroids
132
Should not be cleaned by putting into water
Symbicort
Dulera
133
Budesonide ampules should be used within what timeframe of opening the aluminum package
2 weeks
