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Asthma > Drugs > Flashcards

Drugs Flashcards

(71 cards)

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0
Q

Racepinephrine. OTC

A

Asthmanefrin

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1
Q

Beta-2 agonist MOA

A

Relax bronchial smooth muscle. Relieve symptoms

(Asthma is chronic inflammatory disorder. Inflamed airways are hyperresponsive causing obstruction and airflow limitation due to bronchospasm)

Inflammation –> bronchospasm –> symptoms

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2
Q

Albuterol

A

Proair HFA, Proventil HFA, Ventolin HFA

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3
Q

Levalbuterol

A

Xopenex, Xopenex HFA

R-albuterol

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4
Q

Side effects of beta-2 agonist

A

Tremors, shakiness, lightheadedness, cough

Hyperglycemia, hypokalemia, tachycardia, palpitation

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5
Q

ProAir dosing (MDI)

A

1-2 inhalation q4-6 hours PRN

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6
Q

Priming (when and how) albuterol

A

Before first use and if NOT used for > 2 weeks

3-4 sprays

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7
Q

If using SABA > 2 weeks increase maintenance dose.

A

..

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8
Q

Salmeterol

A

Serevent Diskus

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9
Q

Advair

A

Salmeterol/fluticasone

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10
Q

Difference between Advair HFA and Advair Diskus

A

Advair HFA (45, 115, 230 mcg fluticasone + 21 mcg salmeterol ) ages 12 and older

Advair Diskus - ages 4 and older (100, 250, 500 mcg fluticasone + 50 mcg salmeterol)

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11
Q

Formoterol

A

Foradil

Capsule must be refrigerated, patient can keep at room temp for 4 months

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12
Q

Symbicort

A

Formoterol/budesonide

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13
Q

LABA Diskus dosing and MDI dosing

A

MDI 2 inhal BID

Diskus 1 inhal BID

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14
Q

LABA BBW

A

Increase of asthma related death

Contraindicated as monotherapy for asthma

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15
Q

Beclomethasone

A

Qvar

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16
Q

Budesonide

A

Pulmicort

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17
Q

Ciclesonide

A

Alvesco

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18
Q

Flunisolide ( built in spacer)

A

Aerospan

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19
Q

Fluticasone

A

Flovent

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20
Q

Mometasone

A

Asmanex

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21
Q

Which two ICS do not need to be shaken before use

A

Qvar, Alvesco

They are solution

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22
Q

Qvar

Low dose
Medium dose
High dose

A

< 240 low dose

< 480 medium

> 480 high

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23
Q

Flovent HFA vs Diskus dose

A

< 265 mcg (300 mcg for Diskus)

< 440mcg ( 500 mcg for Diskus)

> 440 mcg (500 mcg for Diskus)

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24
Dulera
Mometasone+formoterol
25
ICS contraindication
Primary treatment of status asthmaticus or acute episode of asthma or COPD
26
ICS side effect
Thrust, dysphonia, cough, increase risk of fracture, pneumonia, growth retardation in children with high dose
27
ICS monitoring
Growth retardation, bone mineral density, oral candidiasis
28
Pulmicort respules has a jet nebulizer
Must use jet nebulizer only
29
Two type of steroid
Glucocorticoid: made by the body in response to stress or given exogenously Mineralocorticoid: regulate sodium and water balance. (Fludrocortisone) Fludrocortisone used to increase sodium and Addison dx (replace some of the function of aldosterone)
30
Difference between the two types of steroid
Glucocorticoid used mainly for inflammation Mineralocorticoid is not for inflammation
31
Long term side effect of steroid
Cushing syndrome (excess cortisol) - fat in abdomen - moon face (fat in face) - buffalo hump (fat in shoulder) - impaired wound healing - thinning/bruising ``` Psychiatric (delirium, mood swings) Sodium and water retention Hypokalemia Hyperglycemia Immunosuppression Glaucoma Osteoporosis Hirsutism(women) GI bleeding/ulcers ```
32
Oral steroid dose equivalent Short acting Intermediate acting Long acting
Cortisone 25mg Hydrocortisone 20 mg Intermediate Methylprednisolone/ triamcinolone 4mg Prednisone/prednisolone 5 mg Long Betamethasone 0.6mg Dexamethasone 0.75 mg
33
Why do you taper steroid
Due to suppression of the hypothalamic-pituitary-adrenal axis (HPA). It gives the body time to increase its own endogenous cortisol production ( which decrease over extended steroid use)
34
When do you taper steroid
If on steroid for more than 10 - 14 days
35
Cortisone is
Prodrug for cortisol
36
Hydrocortisone
Solu-cortef
37
Methylprednisolone
Medrol or solu-medrol
38
Prednisone is
Prodrug for prednisolone
39
Prednisolone
Millipred or orapred
40
Triamcinolone
Kenalog | Aristospan
41
Steroid contraindication
Live vaccine (immunosuppression)
42
Oral steroid short term side effect (<1 month)
Increase appetite/weight gain, fluid retention, insomnia, bitter taste High dose: increase blood pressure and increase blood glucose
43
Oral steroid monitor
Growth retardation, bone density, IOP, other
44
When should you take steroid
7am - 8am to mimic the body diurnal release of cortisol
45
Relative anti inflammatory potency
Betamethasone/dexamethasone > methylprednisolone/triamcinolone > prednisone/prednisolone > hydrocortisone > cortisone
46
Leukotriene modifying agent MOA
Leukotriene receptor antagonists of LT D4 (zafirlukast and singulair) and E4 (zafirlukast) Reduce airway edema, construction and inflammation
47
Zafirlukast
Accolate
48
Montelukast
Singulair
49
Zileuton
Zyflo
50
LTRA contraindication
Hepatic impairment (zafirlukast) Active liver disease or LFT 3x above UNL (zileuton)
51
LTRA warning
Neuropsychiatric event
52
LTRA side effect
Headaches, dizziness, LFT increase, sinusitis
53
Zileuton monitoring
LFT every month fir the first 3 months then every2-3 months for the first years
54
Which drug increase zafirlukast level?
Carvedilol (beta blocker), theophylline, warfarin
55
Which drug reduce zafirlukast level?
Macrolide, theophylline and food
56
Zafirlukast counseling
Take on empty stomach 1 hour before meal or 2 hours after Must stay in original container
57
``` Singulair dosing (adult) 6-14 years ``` 1-5 years
10 mg daily in evening 6-14 years : 5 mg daily 1-5 years: 4 mg daily
58
Theophylline MOA
Block phosphodiesterase causing increase cAMP which promotes release of epinephrine from adrenal medulla cells --> bronchodilation, diuresis, CNS and cardiac stimulation and gastric secretion
59
Theophylline therapeutic range
5-15mcg/mL ( measure peak after 3 days of oral dosing
60
Theophylline active metabolites
Caffeine and 3-methylxanthine
61
Theophylline is caution is what patients
Cardiovascular dx, hyperthyroidism,PUD, seizure
62
Theophylline signs of toxicity
Persistent vomiting, seizure, ventricular tachycardia
63
What weight is used to dose theophylline
IBW
64
IV aminophylline has how much theophylline
80% of theophylline
65
Theophylline side effect
Nausea, loose stool, insomnia,tremor, tachycardia, headache
66
Drugs that increase theophylline
Macrolide, FQ, beta blocker, LTRA, allopurinol, alcohol, CCB,cirrhosis, liver disease, CHF, hypothyroidism
67
Drugs that reduce theophylline
Carbamazepine, rifampin, phenytoin, phenobarbital, ritonavir, St. John wort, levothyroxine, high protein, charbroiled
68
Omalizumab
Xolair
69
Xolair BBW
Anaphylaxis Must be given in doctors office and monitor for anaphylaxis
70
Priming for ICS
> 7 days

Asthma (3 decks)

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