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Controller Medications Asthma/COPD Flashcards

(133 cards)

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1
Q

beclomethasone brand name?

A

QVAR

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2
Q

beclomethasone dosage form

A

Redihaler (MDI - metered dose inhaler)

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3
Q

budesonide (inhaler) brand name?

A

Pulmicort

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4
Q

budesonide dosage form?

A

Flexhaler

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5
Q

budesonide (nebulizer solution) brand name?

A

Pulmicort Respules

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6
Q

ciclesonide brand name?

A

Alvesco

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7
Q

ciclesonide dosage form?

A

HFA (hydrofluoroalkane)

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8
Q

fluticasone propionate brand name(s)?

A

Floventil, ArmonAir Digihaler

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9
Q

fluticasone propionate dosage form(s)?

A

HFA, DPI (dry powder inhaler), Aerosol Powder Inhaler

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10
Q

fluticasone furoate brand name?

A

Arnuity Ellipta

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11
Q

fluticasone furoate dosage form?

A

Ellipta

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12
Q

mometasone brand name?

A

Asmanex

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13
Q

mometasone dosage form?

A

HFA, Twisthaler

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14
Q

Inhaled Corticosteroid use?

A

prevent and control inflammation

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15
Q

ICS Adverse Effects?

A

Oral thrush (candidiasis), cough, dysphonia (difficulty speaking)

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16
Q

ICS Counseling Tips?

A
  • Rinse mouth and spit after use to prevent thrush
  • ICS are most effective long-term control therapy for asthma (improves quality of life, increases lung function, reduces risk of exacerbations)
  • ICSs may increase risk of pneumonia for COPD patients
  • Titrate to lowest effective dose
  • Pulmicort Respules should use Jet Nebulizer, not to be mixed with other nebulizer meds
  • High doses increase risk for systemic side effects
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17
Q

Which ICSs can 0-4 y/o patients use?

A

budesonide (Pulmicort Respules) and fluticasone propionate (Flovent, ArmonAir Digihaler)

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18
Q

Which ICSs can 5-11 y/o patients use?

A

All ICS medications listed

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19
Q

Which ICS is not for adult use?

A

budesonide (Pulmicort Respules - nebulizer solution)

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20
Q

Long Acting Beta Agonists (LABA) use?

A

increase cAMP –> bronchial smooth muscle relaxation and inhibits hypersensitivity mediators from mast cells (histamine and leukotrienes)

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21
Q

arformoterol tartrate brand name?

A

Brovana

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22
Q

arformoterol dosage form?

A

nebulizer solution

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23
Q

formoterol brand name?

A

Perforomist

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24
Q

formoterol dosage form?

A

nebulizer solution

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25
indacaterol brand name?
Arcapta Neohaler
26
indacaterol dosage form?
Neohaler
27
olodaterol brand name?
Striverdi Respimat
28
olodaterol dosage form?
Respimat
29
salmeterol brand name?
Serevent
30
salmeterol dosage form?
Diskus
31
LABA Adverse Effects?
tachycardia, headache, tremor, hypokalemia
32
LABA Boxed Warnings
- Increased risk of asthma related death for all monotherapy LABA use (should not be used alone for asthma management) - Increasing hospitalizations in pediatric and adolescent patients
33
LABA Side Effects/Comments
- Prolonged QT with intentional overdose - Not for acute symptoms! - May be helpful for exercise induced bronchospasm - Formoterol and indacaterol capsules should not be taken orally
34
LABA Pediatric Considerations?
- Most children < 4 y/o cannot provide sufficient inspiratory flow for adequate lung delivery with a DPI (dry powder inhaler)
35
Which LABAs can 0-4 y/o patients use?
NONE
36
Which LABA can 5-11 y/o patients use?
salmeterol (Serevent) only
37
Which LABAs can adults use?
All medications listed
38
Long Acting Antimuscarinic (LAMA) use?
block the bronchoconstrictor effects of acetylcholine on M3 and M2 receptors
39
aclidinium brand name?
Turdorza Pressair
40
aclidinium dosage form?
DPI (dry powder inhaler)
41
glycopyrrolate brand name?
Seebri Neohaler
42
glycopyrrolate dosage form?
DPI, Nebulization solution
43
revefenacin brand name?
Yupelri
44
revefenacin dosage form?
nebulization solution
45
tiotropium brand name?
Spiriva
46
tiotropium dosage form?
HandiHaler, Respimat
47
umeclidinium brand name?
Incruse Ellipta
48
umeclidinium dosage form?
DPI
49
LAMA Adverse Effects?
dry mouth, dizziness, blurred vision, upper respiratory infections, and paradoxical bronchospasms
50
LAMA note
tiotropium has been approved for use in asthma as an add-on option for children 12 years and older
51
Which LAMAs can 0-4 y/o patients use?
NONE
52
Which LAMA can 5-11 y/o patients use?
tiotropium (Spiriva) respimat for patients 6 years and older
53
fluticasone/salmeterol brand name?
Advair, AirDuo, AirDuo Digihaler
54
fluticasone/salmeterol dosage forms?
DPI and HFA MDI (Advair), Respiclick DPI (AirDuo & AirDuo Digihaler)
55
budesonide/formoterol brand name?
Symbicort
56
budesonide/formoterol dosage form?
HFA MDI
57
mometasone/formoterol brand name?
Dulera
58
mometasone/formoterol dosage form?
MDI
59
fluticasone/vilanterol brand name?
Breo Ellipta
60
fluticasone/vilanterol dosage form?
DPI
61
ICS/LABA Adverse Effects?
individualized
62
ICS/LABA Clinical Pearls?
- Guidelines recommend combo LABA with ICS in asthma, as LABA should not be used as monotherapy - Combo products developed to create convenient packaging and assist with patient adherence
63
Which ICS/LABA can 0-4 y/o patients use?
NONE
64
Which ICS/LABA can 5-11 y/o patients use?
Advair DPI (fluticasone/salmeterol) and Symbicort HFA MDI (budesonide/formoterol)
65
Which ICS/LABA can adults use?
All medications listed
66
olodaterol/tiotropium brand name?
Stiolto Respimat
67
olodaterol/tiotropium dosage form?
Respimat
68
vilanterol/umeclidinium brand name?
Anoro Ellipta
69
vilanterol/umeclidinium dosage form?
Ellipta
70
indacaterol/glycopyrronium brand name?
Utibron Neohaler
71
indacaterol/glycopyrronium dosage form?
Neohaler
72
formoterol/glycopyrronium brand name?
Bevespi Aerosphere
73
formoterol/glycopyrronium dosage form?
Aerosphere
74
formoterol/aclidinium brand name?
Duaklir Pressair
75
formoterol/aclidinium dosage form?
DPI
76
LABA/LAMA AE/Clinical Pearls?
- Individualized effects - Not indicated for treatment of acute deteriorations
77
LABA/LAMA age usage?
Adults only and COPD only
78
fluticasone/umeclidinium/vilanterol brand name?
Trelegy Ellipta
79
flutcasone/umeclidinium/vilanterol dosage form?
Ellipta
80
budesonide/glycopyrrolate/formoterol fumarate brand name?
Breztri Aerosphere
81
budesonide/glycopyrrolate/formoterol fumarate dosage form?
Aerosphere
82
LABA/LAMA/ICS age use?
Adults only
83
fluticasone/umeclidinium/vilanterol use?
asthma and COPD
84
budesonide/glycopyrrolate/fomoterol fumarate use?
COPD only
85
cromolyn brand name?
Intal
86
cromolyn dosage form?
nebulizer solution
87
mast cell stabilizer adverse effects/clinical pearls?
- 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 hyperactivity seen in allergy season
88
Leukotriene modifiers action?
block production of leukotrienes
89
montelukast brand name?
Singulair
90
montelukast dosage form?
tablets (chewable), granule packets
91
montelukast adverse effects/clinical pearls?
- minor substrate for CYP2C8/9 and 3A4 - not for acute relief of symptoms - Boxed warning: neuropsychiatric events
92
zafirlukast brand name?
Accolate
93
zafirlukast dosage form?
tablets
94
zafirlukast adverse effects/clinical pearls?
- take at least 1 hour before or 2 hours after meals - can increase INR (blood clot timing) - major substrate, minor inhibitor of CYP2C9
95
zileuton brand name?
Zyflo CR
96
zileuton dosage form?
IR tablets, ER tablets
97
zileuton adverse effects/clinical pearls?
- weak CYP1A2 inhibitor - take with food
98
Which leukotriene modifier can 0-4 y/o patients use?
montelukast only
99
Which leukotriene modifier can 5-11 y/o patients use?
montelukast or zafirlukast
100
Which leukotriene modifier can adults use?
all medications listed
101
leukotriene modifiers adverse effects/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
102
methylxanthines action?
bronchodilation through inhibition of PDE III and PDE IV
103
theophylline brand name?
Theochron
104
theophylline dosage form?
ER 12 hr tablets, ER 24 hr tablets, ER 24 hr capsules, liquid
105
methylxanthines adverse effects/clinical pearls?
- Insomnia, GI upset, hyperactivity, hypotension, tremor - Dose related toxicity: tachycardia, nausea, vomiting, headache, seizures, arrhythmias - CI: peptic ulcer disease, arrhythmias, seizure disorders - DI: major substrate for CYP3A4, 1A2, 2E1 --> increased [ ]: cimetidine, erythromycin, clarithromycin, ciprofloxacin, ticlopidine --> decreased [ ]: phenobarbital, phenytoin, carbamazepine, rifampin; smoking - PDE III inhibition likely cause for hypotension, tachycardia and nausea
106
methylxanthines age use?
Adults only - Acute exacerbation (loading dose, typically given IV as aminophylline, followed by maintenance IV infusion) - Chronic management (dosing differs based on smokers vs non-smokers)
107
Anti-IgE action?
inhibit IgE binding to receptors on mast cells and basophils, inhibit mediator release and attenuation of early and late phase allergic responses
108
omalizumab brand name?
Xolair
109
omalizumab dosage form?
injection
110
Anti-IgE adverse effects/clinical pearls?
- Headache, injection site reactions, arthralgias, thrombocytopenia, pharyngitis, sinusitis, upper respiratory tract infections - Boxed warning: anaphylaxis - Do not give more than 150mg/injection site - Monitor for anaphylaxis before and after injection - 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 inadequately controlled with ICS
111
Anti-IL5 action?
blocks binding of IL-5 to the alpha chain of the IL-5 receptor complex, resulting in reduced production and survival of eosinophils
112
mepolizumab brand name?
Nucala
113
mepolizumab dosage form?
injection (auto-injector or reconstituted injection)
114
mepolizumab adverse effects/clinical pearls?
- Headache, injection site reactions, arthralgias, Herpes Zoster infection - Precaution: anaphylaxis - Available as in-clinic or at-home injection - Monitor for anaphylaxis before and after injection - Indicated for add-on maintenance treatment of patients with severe asthma with an eosinophilic phenotype
115
reslizumab brand name?
Cinqair
116
reslizumab dosage form?
injection
117
reslizumab adverse effects/clinical pearls?
- Injection site reactions, myalgias, increased creatinine phosphokinase - Boxed Warning: anaphylaxis, malignancies - Monitor for anaphylaxis before and after injection - Indicated for add-on maintenance treatment of patients with severe asthma with an eosinophilic phenotype
117
reslizumab adverse effects/clinical pearls?
- Injection site reactions, myalgias, increased creatinine phosphokinase - Boxed Warning: anaphylaxis, malignancies - Monitor for anaphylaxis before and after injection - Indicated for add-on maintenance treatment of patients with severe asthma with an eosinophilic phenotype
118
benralizumab brand name?
Fasenra
119
benralizumab dosage form?
injection (auto-injector or pre-filled syringe)
120
benralizumab adverse effects/clinical pearls?
- Injection site reactions, antibody development, headache, pharyngitis, fever - Precaution: anaphylaxis - Available as in-clinic or at-home injection - Indicated for add-on maintenance treatment of severe asthma in adults and children 12 years and older with eosinophilic phenotype - Acts on IL-5 receptors, others act on IL-5
121
Which Anti-IL5s can 0-4 y/o patients use?
NONE
122
Which Anti-IL5s can 5-11 y/o patients use?
mepolizumab (Nucala) only
123
Which Anti-IL5s can adults use?
All listed medications
124
Anti-IL4/IL13 action?
blocks binding of IL4 to reduce eosinophil trafficking and IgE reactions while also blocking IL13 to reduce mucus secretion and airway remodeling
125
dupilumab brand name?
Dupixent
126
dupilumab dosage form?
injection
127
dupilumab adverse effects/clinical pearls?
- injection site reactions, antibody development, arthralgias, conjunctivitis - Precaution: anaphylaxis - Available as pre-filled syringe for in-office or at-home administration - Indicated as an add-on maintenance treatment in patients with moderate to severe asthma aged 12 and older with eosinophilic phenotype or with oral corticosteroid dependent asthma
128
Which age group can use Anti-IL4/IL13s?
Adults aged 12 and older only
129
Phosphodiesterase-4 Inhibitors action?
inhibit PDE4, leading to increased cAMP
130
roflumilast brand name?
Daliresp
131
roflumilast dosage form?
tablets
132
roflumilast adverse effects/clinical pearls?
- HA, weight loss, diarrhea, nausea - Monitor: liver function test, weight - DI: CYP3A4 (major), CYP1A2 (minor) - CI: Child-Pugh class B or C

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