Long-Term Control Medications in Asthma and COPD - Mast Cell Stabilizers, Leukotriene Modifiers, Methylxanthines, and Phosphodiaesterase-4 Inhibitors

Question 1

cromolyn is a…

Answer 1

mast cell stabilizer

Question 2

cromolyn brand name

Answer 2

Intal

Question 3

cromolyn dosage form

Answer 3

nebulizer solution

Question 4

cromolyn dosing in 0-4 year olds

Answer 4

1 ampule qid

safety/efficacy not established for children under 2

Question 5

cromolyn adverse effects

Answer 5

• unpleasant taste in mouth
• rare cardiac arrhyrhmias
• coughing
• dyspnea
• sore throat
• N/V/D os aborbed systemically

Question 6

cromolyn clinical pearls

Answer 6

• less effective than low dose ICS
• prevents increase in bronchial hyperreactivity seen in allergy season

Question 7

montelukast, zafirlukast, and zileuton are…

Answer 7

leukotriene modifiers

Question 8

montelukast brand name

Answer 8

Singulair

Question 9

motelukast dosage forms

Answer 9

• tablets (chewable)
• granule packets

Question 10

montelukast dosing for age 0-adult

Answer 10

take at bedtime

Question 11

zafirlukast brand name

Answer 11

Accolate

Question 12

zarfirlukast dosage form

Answer 12

tablets

Question 13

zafirlukast dosing ages

Answer 13

5-11 and adults

Question 14

zileuton brand name

Answer 14

Zyflo CR

Question 15

zileuton dosage froms

Answer 15

• IR tab
• ER tab

Question 16

zileuton dosing ages

Answer 16

adults

Question 17

leukotriene modifier adverse effects

Answer 17

• neuropsychiatric events
• (rare) Churg-Strauss syndrome
• increased hepatic tranaminases (zarfirlukasr and zileuton)

Question 18

leukotriene modifier clinical pearls

Answer 18

• less effective than low dose ICS and ICS/LABA in asthma
• not for COPD

Question 19

montelukast clinical pearls

Answer 19

• minor substrate of CYP2C8/9 and CYP3A4
• not for acute relief of symptoms
• black box warning

Question 20

zafirlukast clinical pearls
* take at least ___ before or ___ after meals
* can increase ___
* major substrate, minor inhibitor id CYP___

Answer 20

• 1h, 2h
• INR
• CYP2C9

Question 21

zileuton clinical pearls
* weak CYP___ inhibitor
* take with __

Answer 21

• CTP1A2
• food

Question 22

theophylline is a…

Answer 22

methylxanthines

Question 23

theophylline brand name

Answer 23

Theochron

Question 24

theophylline dosage forms

Answer 24

• ER 12h tab
• ER 24h tab
• ER 24h cap
• liquid

Question 25

theophylline dosing ages

Answer 25

adult | acute exacerbation AND chronic managment

Question 26

theophylline adverse effects

Answer 26

* insomnia * GI upset * hyperactivity * hypotension * tremor

Question 27

theophylline dose related toxicity

Answer 27

* tachycardia * N/V * headache * seizures * arrhythmias

Question 28

theophylline is a major substrate of CYP___, ___, and ___ * 5 meds that increase theophylline concentration * 4 meds that decrease theophylline concentration | PDE ___ inhibition likely cause for hypotension, tachycardia and nausea

Answer 28

* CYP3A4, 1A2, 2E1 * cimetidine, erythromycin, clarithromycin, ciprofloxacin, ticlopidine * phenobarbital, phenytoin, cabamazepine, rifampin (and smoking) | III

Question 29

how do methylxanthines work?

Answer 29

bronchodilation through inhibition of PDE III and PDE IV

Question 30

roflumilast is a...

Answer 30

PDE-4 inhibitor

Question 31

roflumilast brand name

Answer 31

Daliresp

Question 32

roflumilast dosage form

Answer 32

tablets

Question 33

roflumilast dosing ages

Answer 33

adults | COPD ONLY

Question 34

roflumilast adverse effects

Answer 34

* headache * weight loss * diarrhea * nausea

Question 35

roflumilast monitoring: ___ function test * CYP ___ (major), * CYP___ (minor)

Answer 35

liver * CYP3A4 * CYP1A2

Question 36

how do PDE-4 inhibitors work?

Answer 36

inhibits PDE4 leading to increased cAMP