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COPD and Asthma > Controller Medications > Flashcards

Controller Medications Flashcards

1
Q

inhaled corticosteroids (ICS) - prevent and control inflammation

A

beclomethasone, budesonide, ciclesodine, fluticasone proprionate, fluticasone, furoate, mometasone

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2
Q

adverse effects and clinical pearls

A

AE: oral thrush (candidiasis), cough, dysphonia
Counseling tip: patients should rinse their mouth and spit after use to prevent oral thrush.
Inhaled corticosteroids (ICSs) are the most effective long-term control therapy for asthma (improve quality of life, increasing lung function, and reduce the risk of exacerbations)
ICSs may increase the risk of pneumonia in patients with COPD
Titrate to lowest effective dose
Pulmicort respules should use Jet Nebulizer and should not be mixed with other nebulizer medications
High doses increase the risk for systemic side effects

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3
Q

beclomethasone

A

QVAR
dosage form: redihaler (MDI)
for 5-11 year olds and adults

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4
Q

budesonide

A

pulmicort
dosage form: flexhaler
for 5-11 year olds and adults

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5
Q

budesonide

A

pulmicort respules
dosage form: nebulizer solution
for 0-4 year olds and 5-11 year olds

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6
Q

ciclesonide

A

alvesco
dosage form: HFA
for 5-11 year olds and adults

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7
Q

fluticasone proprionate

A

flovent, armonAir digihaler
dosage form: HFA, DPI, aerosol powder inhaler
for 0-4 year olds (HFA and DPI), 5-11 year olds (HFA and DPI), and adults (HFA, DPI, MDPI)

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8
Q

fluticasone furoate

A

arnuity ellipta
dosage form: ellipta
for 5-11 year olds and adults

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9
Q

mometasone

A

asmanex
dosage form: HFA and twisthaler
for 5-11 year olds and adults

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10
Q

long acting beta agonists (LABA) - increase cAMP –> bronchial smooth muscle relaxation and inhibit hypersensitivity mediators from mast cells (histamines and leukotrienes)

A

arformoterol tartate, formoterol, indacaterol, olodaterol, salmeterol

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11
Q

adverse effects and clinical pearls

A

AE: tachycardia, headache, tremor, hypokalemia;
boxed warning for increased risk of asthma related death for all monotherapy LABA use - shouldn’t be used alone for asthma treatment; boxed warning for increasing hospitalizations in pediatric and adolescent patients
prolonged QT seen with intentional overdoses; not for acute symptoms
may be helpful for exercise induced bronchospasm
formoterol and indaceterol capsules should not be taken orally
pediatric considerations: most children <4 yo cannot provide sufficient inspiratory flow for adequate lung delivery with a DPI

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12
Q

arformoterol tartate

A

brovana
dosage form: nebulizer solution
for adults only and COPD only

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13
Q

formoterol

A

perforomist
dosage form: nebulizer solution
for adults only; COPD only unless used in combo with ICS

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14
Q

indacaterol

A

arcapta neohaler
dosage form: neohaler
for adults only and COPD only

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15
Q

olodaterol

A

striverdi respimat
dosage form: respimat
for adults only and COPD only

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16
Q

salmeterol

A

serevent
dosage form: diskus
for 5-11 year olds and adults

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17
Q

long-acting antimuscarinics (LAMA) - block the bronchoconstrictor effects of ACh on M3 and M2 receptors

A

aclidinium, glycopyrrolate, revefenacin, tiotropium, umeclidinium

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18
Q

adverse effects and clinical pearls

A

AE: dry mouth, dizziness, blurred vision, upper respiratory infections and paradoxical bronchospasms
tiotropium has been approved for use in asthma as an add-on option for children >/=12yo

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19
Q

aclidinium

A

turdorza pressair
dosage form: DPI
for adults and COPD only

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20
Q

glycopyrrolate

A

seebri neohaler
dosage form: DPI and nebulization solution
for adults and COPD only

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21
Q

revefenacin

A

yupelri
dosage form: nebulization solution
for adults and COPD only

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22
Q

tiotropium

A

spiriva
dosage form: handiHaler and respimat
for 5-11 year olds (>/=6 yo respimat) and adults handiHaler (COPD only) and respimat

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23
Q

umeclidinium

A

incruse ellipta
dosage form: DPI
for adults and COPD only

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24
Q

ICS/LABA combo products

A

fluticasone/salmeterol, budesonide/formoterol, mometasone/formoterol, fluticasone vilanterol

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25
adverse effects and clinical pearls
AE: see individual products guidelines recommend combo LABA and ICS in asthma, as LABA shouldn't be used as monotherapy combo products developed to create convenient packaging and assist with patient adherence
26
fluticasone/salmeterol
advair dosage forms: DPI and HFA MDI for 5-11 year olds (DPI) and adults (DPI and HFA)
27
fluticasone/salmeterol
airDuo and airDuo digihaler dosage form: respiclick (DPI) for adults only
28
budesonide/formoterol
symbicort dosage form: HFA MDI for 5-11 year olds and adults
29
mometasone/formoterol
dulera dosage form: MDI for adults only
30
fluticasone/vilanterol
breo ellipta dosage form: DPI for adults only
31
LABA/LAMA combo products
olodaterol/tiotropium, vilanterol/umeclidinium, indacaterol/glycopyrronium, formoterol/glycopyrronium, formoterol/aclidinium
32
adverse effects and clinical pearls
AE: see individual products not indicated for treatment of acute deteriorations
33
olodaterol/tiotropium
stiolto respimat dosage form: respimat for adults and COPD only
34
vilanterol/umeclidinium
anoro ellipta dosage form: ellipta for adults and COPD only
35
indacaterol/glycopyrronium
utibron neohaler dosage form: neohaler for adults and COPD only
36
formoterol/glycopyrronium
bevespi aerosphere dosage form: aerosphere for adults and COPD only
37
formoterol/aclidinium
duaklir pressair dosage form: DPI for adults and COPD only
38
LABA/LAMA/ICS combo products
fluticasone/umeclidinium/vilanterol, budesonide/glycopyrrolate/formoterol fumarate
39
AE
see individual products
40
fluticasone/umeclidinium/vilanterol
trelegy ellipta dosage form: ellipta for adults, asthma, and COPD
41
budesonide/glycopyrrolate/formoterol fumarate
breztri aerosphere dosage form: aerosphere for adults and COPD only
42
mast cell stabilizer
cromolyn
43
adverse effects and clinical pearls
AE: high incidence of unpleasant taste in mouth (>10%), rare cardiac arrhythmias, coughing, dyspnea, sore throat, N/V/D if absorbed systemically less effective than low-dose ICS prevents increase in bronchial hyperreactivity seen in allergy season
44
cromolyn
intal dosage form: nebulizer solution for 0-4 year olds, 5-11 year olds, and adults
45
leukotriene modifiers - block the production of leukotrienes
montelukast, zafirlukast, zileuton
46
adverse effects and clinical pearls
neuropsychiatric events (agitation, anxiety, abnormal dreams, hallucinations, depression, suicidal thinking), Churg-Strauss syndrome (rare), increased hepatic transaminases (zafirlukast and zileuton) less effective than low dose ICS and ICS/LABA in asthma have not been adequately trialed in COPD
47
montelukast
singulair dosage form: tablets (chewable), granule packets for 0-4 year olds, 5-11 year olds, and adults minor substrate of CYP2C8/9 and 3A4, not for acute relief of symptoms, boxed warning: neuropsychiatric events
48
zafirlukast
accolate dosage form: tablets for 5-11 year olds and adults take at least 1 hour or 2 hours after meals, can increase INR, major substrate, minor inhibitor or CYP 2C9
49
zileuton
zyflo dosage form: IR tablets and ER tablets for adults weak CYP1A2 inhibitor, take with food
50
methylxanthines - bronchodilation through inhibition of PDE III and PDE IV
theopylline
51
adverse effects and clinical pearls
AE: insomnia, gastrointestinal upset, hyperactivity, hypotension, tremor dose related toxicity: tachycardia, nausea, vomiting, headache, seizures, arrythmias CI: peptic ulcer disease, arrhythmias, seizure disorders DI: major substrate of CYP 3A4, 1A2, 2E1- increase concentration: cimetidine, eryhtromycin, clraithromycin, ciprofloxacin, ticlopidine; decrease concentration: phenobarbital, phenytoin, carbamazepine, rifampin, smoking PDE III inhibition likely cause for hyptotension, tachycardia, and nausea
52
theophylline
theochron ER 12 hour tablets, ER 24 hour tablets, ER 24 hour capsules, liquid for adults only acute exacerbation: loading dose, typically given IV as aminophylline, followed maintenance IV fusion chronic management: smokers: 16mg/kg/day divided; nonsmokers: 13mg/kg/day divided doses based on serum concentrations, target range 5-15 mcg/mL, toxic > 20 mcg/mL
53
anti-IgE: inhibit binding to receptors on mast cells and basophils, inhibit mediator release adn attenuation of early and late phase allergic response
omalizumab
54
omalizumab
xolair dosage form: syringe for injection for 5-11 year olds and adults AE: headache, injection site reactions, arthralgias, thrombocytopenia, pharyngitis, sinusitis, upper RTI boxed warning: anaphylaxis don't give more than 150 mg per injection site FDA approved for moderate to severe persistent asthma in patients with a positive skin test or reactivity to a perennial aeroallergen and symptoms that are inaqequately controlled with ICS
55
anti-IL5: blocka binding of IL-5 to the alpha chain of the IL-5 receptor complex which results in reduced production and survival of eosinophils
mepolizumab, reslizumab, benralizumab
56
mepolizumab
nucala dosage form: auto-injector or injection for 5-11 year olds and adults AE: headache, injection site reactions, arthralgias, Herpes Zoster infection precaution: anaphylaxis available as in-clinic or at-home injection indicated for add-on maintenance treatment of patients with severe asthma with an eosinophilic phenotype
57
reslizumab
cinqair dosage form: injection for adults only AE: injection site reactions, myalgias, increased creatinine phosphokinase boxed warning: anaphylaxis, malignancies indicated for add-on maintenance treatment of patients with severe asthma with an eosinophilic phenotype
58
benralizumab
fasenra dosage form: auto-injector or pre-filled syringe for adults only AE: injection site reactionsl antibody development, headache, pharyngitis, fever precaution: anaphylaxis available as an in-clinic or at-home injection indicated for add-on maintenance treatment of severe asthma in adults and children >/= 12 years of age with an eosinophilic phenotype acts on IL-5 receptors while others act on IL-5
59
anti-IL4/IL13: blocks binding of IL/4 to reduce eosinophil trafficking and IgE reactions while also blocking IL-13 to reduce mucus secretion and airway remodeling
dupilumab
60
dupilumab
dupixent dosage form: injection for adults only AE: injection site reactions, antibody development, arthralgias, conjunctivitis precaution: anaphylaxis available in pre-filled syringe for in-office or at-home administration indicated as an add-on maintenance treatment in patients with moderate to-sever asthma aged 12 years and older with an eosinophilic phenotype or with oral corticosteroid dependent asthma
61
phosphodiasterase-4 inhibitors: inhibits PDE4 leading to increase in cAMP
roflumilast
62
roflumilast
daliresp dosage form: tablets for adults only and COPD only AE: HA, weight loss, diarrhea, nausea monitoring: liver function test, weight DI: CYP3A4 (major), CYP1A2 (minor) CI: child-pugh class B or C

COPD and Asthma (2 decks)

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