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Pharm 825 > Long-Term Control Medications in Asthma and COPD > Flashcards

Long-Term Control Medications in Asthma and COPD Flashcards

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1
Q

What are the 11 different classes used at long-term therapy for COPD and asthma?

A 
ICS
LABA
LAMA
LABA/LAMA
ICS/LABA
Leukotriene modifiers
methylxanthines
Anti-IgE
Anti-IL5
Mast cell stabilizers
Phosphodiesterase-4 inhibitors
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2
Q

How do ICS work

A

controlling and preventing inflammation

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3
Q

AE’s of ICS

A

oral thrush, cough, dysphonia

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4
Q

Most common long-term ICS Medications

A 
Belomethasone
Budesonide*
Circlesonide
flunisolide
Fluticasone proprionate*
fluticasone furoate
mometasone
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5
Q

ICS are the most effective LTC treatment for asthma becuase?

A

imporve Quality of Life
INC lung function
reduce risk of exacerbation

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6
Q

What do we want to do in regards to ICS dose?

A

Titrate to lowest effective dose

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7
Q

generic: belmethasone

A

brand: QVAR

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8
Q

dosage form of belmethasone?

A

HFA

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9
Q

Strength of belmethasone HFA inhaler

A

40 or 80 mcg/inhalation

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10
Q

generic: budesonide

A

brand: Pulmicort

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11
Q

available dosage forms of budesonide?

A

Flexhaler or Nebulizer soln

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12
Q

Strength of the budesonide flexhaler

A

90 or 180 mcg/inhalation

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13
Q

Strength of budesonide nebulizer soln

A

(Pulmicort Respules)
0.25mg/2ml
0.5mg/2ml
1mg/2ml

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14
Q

generic: ciclesonide

A

brand: Alvesco

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15
Q

dosage form of ciclesonide and strength

A

HFA

80 or 160 mcg/inhalation

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16
Q

generic: flunisolide

A

brand: Aerospan

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17
Q

dosage form and strength of flunisolide

A

HFA inhaler 80mcg/inhalation

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18
Q

generic: Fluticasone Proprionate

A

Brand: Flovent or Armon Air

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19
Q

available dosage form of fluticasone proprionate

A

HFA
DPI
Respiclick

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20
Q

Strength of HFA Fluticasone Prop

A

44,110, or 220 mcg/inhalation

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21
Q

Strength of DPI Fluticasone Prop

A

50, 100, or 250 mcg/inhalation

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22
Q

Strength of RespiClick Fluticasone Prop

A

55,113,232 mcg/inhalation

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23
Q

generic: fluticasone furoate

A

brand: Arunity Ellipta

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24
Q

dosage form of fluticasone furoate

A

Ellipta inhaler

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25
strength of fluticasone furoate ellipta inhaler
100 and 200 mcg/ inhalation
26
generic: mometasone
brand: Asmanex
27
dosage forms mometasone comes in
HFA and Twistihaler
28
Strength of mometasone HFA
100 and 200 mcg/inhalation
29
strength of mometasone Twistihaler
110 and 220 mcg/ inhalation
30
Which long term ICS is approved for children ages 0-4
budesonide nebulizer soln
31
Counseling tip with pulmincort respules
should use jet nebulizer , do not mix with other nebulizer medications
32
Which ICS has a built in spacer?
Aerospan, which is flunisolide
33
W/ ICS when do we see an increased risk for systemic side effects
at high doses
34
How do LABA's work?
INC cAMP which will cause bronchial SM relaxation & inhibit hypersensitivity mediators from the mast cells ( histamines and leukotrienes)
35
AE's of LABAs
tachycardia, headache, tremor, hypokalemia
36
Boxed warning for LABAs
- INC risk of asthma related death for all monotherapy LABA use; DO NOT use alone for asthma management - Increasing hospitalizations in peeds and adolescents
37
In regards to LABA's, what is clinically observed in intentional overdoses
prolonged QT ( irregular heart rhythm)
38
Counseling points for LABA's
- will not help acute symptoms | - may be helpful for exercise induced spasms
39
When a pt has an inhaler that contains capsules, what should you make sure that they know?
Capsules should not be taken orally
40
Which two LABA's come with capsules
Formoterol and indacaterol
41
What is important to note , in regard to pediatrics on LABA's
most children under the age of 4t/o cannot provide sufficient inspiratory flow for adequate lung delivery with a DPI
42
generic: arformoterol tartrate
brand: Brovana
43
dosage form of arformoterol tartrate
nebulizer solution
44
Strength of arformoterol tartrate
1mcg/ 2ml
45
generic: formoterol
brand: Foradil Aerolizer
46
dosage form of formoterol
aerolizer with capsules
47
strength of formoterol
12mcg/ capsule
48
generic: indacaterol
brand: Arcapta Neohaler
49
dosage form and strength of indacaterol
Neohaler with capsules | 75 mcg/ capsule
50
generic: olodaterol
brand: Striverdi Respimat
51
dosage form that olodaterol comes in
Respimat inhaler
52
strength of olodaterol respimat inhaler
2.5mcg/ inhalation
53
Which LABA comes in a dosage form that utilizes blister packs
salmeterol
54
generic: salmeterol
brand: Serevent
55
dosage and strength of salmeterol
Diskus | 50 mcg/ blister
56
Which LABA's should be used for COPD ONLY
Arformoterol Indacaterol Olodaterol
57
Which LABA's can be used for treatment in asthma
Salmeterol and formoterol;however, remember there is a Boxed warning for LABA use as a monotherapy for asthma
58
How do LAMA's work in long acting treatment of asthma and COPD
block constricting effects of ACh on M3 and M2 receptors
59
AE's of LAMA's
Think antimuscarinic effects: dry mouth, dizziness, blurred vision, UpperRI, paradoxial bronchospasms
60
generic: aclidinium
brand: Tudorza Pressair
61
dosage form of aclidinium
DPI
62
strength of aclimidium
400mcg/ inhalation
63
generic: tiotropium
brand: Spiriva
64
Dosage form(s) that tiotropium comes in
Handihaler and Respimat
65
tiotrpoium handihaler strength
18mcg/ capsules
66
tiotropium respimat strength
2.5mcg/inhalation
67
Which LAMA uses capsules?
Spiriva Handihaler
68
generic: umeclidinium
brand: Incruse Ellipta
69
Available dosage form and strength of umeclidinium
DPI; 62.5 mcg/ inhalation
70
Which LAMA's are used for COPD ONLY
Aclidinium Tiotropium- handihaler Umeclidinium
71
Which LAMA has been approved for asthma therapy, as well is used for COPD
Tiotropium respimat inhaler
72
When would you use tiotropium respimat inhaler in asthmatics?
Use as an add-on option in step 4 or 5 ( this is when there is a history of exacerbation, despite ICS/LABA use)
73
What are the 4 most common ICS/LABA combo products
Fluticasone/salmeterol budesonide/ salmeterol mometasone/ formoterol fluticasone/ vilanterol
74
generic: fluticasone/ salmeterol
brand: Advair
75
What dosage form is fluticasone/ salmeterol available in?
DPI HFA MDI Respiclick ( also a DPI)
76
Available dose/ strength of Advair DPI
100mcg/50mcg 250mcg/50mcg 500mcg/50mcg
77
Available dose strength of fluticasone/ salmeterol HFA in
45mcg/21mcg 115mcg/21mcg 230mcg/21mcg
78
Brand : AirDuo
Generic: fluticasone/salmeterol Respiclick inhaler
79
Dose strength of the AirDuo Respiclick inhaler
55mcg/14mcg 113mcg/14mcg 232 mcg/ 14mcg
80
generic: budesonide/formoterol
brand: Symbicort
81
Dosage form and strength of budesonide/formoterol
HFA MDI 80mcg/4.5mcg 160mcg/4.5 mcg
82
generic: mometasone/formoterol
brand: Dulera
83
dosage form and strength of mometasone/formoterol
MDI 100mcg/5mcg 200mcg/5mcg
84
generi: fluticasone/ vilanterol
brand: Breo Ellipta
85
Dosage form of fluticasone/vilanterol
DPI
86
Dosage strength of Breo Ellipta
100mcg/25mcg | 200mcg/25mcg
87
AE's of ICS/ LABA combo products
adverse effects are the same AE's associated with ea. individual class
88
Why were combination products developed?
To create convenient packaging and to assist with patient adherence
89
Most common LABA/ LAMA products
olodaterol/tiotropium vilanterol/umeclidinium indacaterol/glycopyrronium formoterol/ glycopyrronium
90
Counseling points for LABA/LAMA
not indicated for treatment of acute deterioration
91
Which LABA/LAMA combo products are approved for asthma treatment
none, they are all used only in COPD
92
generic: olodaterol/ tiotropium
brand: Stiloto Respimat
93
dosage form and strength of olodaterol/ tiotropium
respimat inhaler | 2.5mcg/2.5mcg per inhalation
94
generic: vilanterol/ umeclidinium
brand:Anoro Ellipta
95
dosage form and strength of vilanterol/umeclidinium
Ellipta inhaler | 62.5mcg/ 25mcg per inhalation
96
generic: indacanterol/ glycopyrronium
brand:Utibron Neohaler
97
dosage form and strength of indacanterol/ glycopyrronium
neohaler inhaler | 27.5 mcg/15.6mcg capsules
98
generic: formoterol/ glycoprronium
brand: Bevespi Aerosphere
99
formoterol/ glycoprronium dosage form and strength
Aerosphere | 4.8 mcg/9mcg per inhalation
100
Which LABA/LAMA combo product uses capsules
Utibron Neohaler
101
Which LABA/LAMA only requires use once daily?
Stiloto Respimat and Anoro Ellipta
102
Which ICS/ LABA requires only one inhalation once daily
Breo Ellipta
103
most common mast cell stabalizer
cromolyn
104
wht dosage form does cromolyn come in?
nebulizer solution
105
Strength of cromolyn nebulizer soln?
20mg/ampule
106
AE of mast cell stabalizers
unpleasant taste in mouth ( common), rare cardiac arrythmias, coughing, dyspnea,sore throat, N/V/D if absorbed systemically
107
Which is more effective: low dose ICS or mast cell stabalizer
LD ICS
108
Why are mast cells beneficial?
Prevents INC in bronchial hyperactivity seen during allergy season
109
Common lekotriene modifiers
montelukast, zafirlukast, zileuton
110
how do leukotriene modifiers work?
block the production of leukotrienes
111
generic: montelukast
brand: singulair
112
generic: zafirlukast
brand: Accolate
113
generic: Zileuton
brand: Ayflo CR
114
dosage form and strength of montelukast
tablets, chewable 4mg, 5mg, 10mg granule packets-4mg
115
dosage form and strength of zafirlukast
tablets | 10 or 20 mg
116
dosage form and strength of zileuton
600mg tablets
117
AE's of leukotriene modifiers
neuropsych events such as agitation, anxiety, abnormal dreams, hallucinations, depression, suicidal thoughts. Chung-Strauss syndrome, INC hepatic transaminases ( not montelukast)
118
For asthma, which of the following would be least effective: Low dose ICS, ICS/LABA or Leuko modifier
Leukotriene modifier
119
Why would we, or why we would not use lekotrienes in COPD
they have not been adequately trialed
120
Counseling points unique to Zafirlukast
Take at least one hour before or two hours after meals | can increase INR
121
counseling points unique for montelukast
weak inhibitor of CYP2C8 and 2C9 major substrate for CYP2C9 and 3A4 not acute relief of symptoms
122
counseling points unique to Zileuton
moderate CYP 1A2 inhibitor | minor substrate for CYP1A2, 2C9 and 3A4
123
how do methylxanthines work?
dialation thru inhibition of PDE III and PDE IV
124
most common methylxanthines
theophylline
125
What dosage form does theophylline come in
ER tabs, ER capsules, liquid
126
Strength of theophylline ER tabs
100,200,300,400,450,600 mg
127
Strength of theophylline ER capsules
100,200,300,400mg
128
Strength of theophylline Liquid
80mg/15ml
129
what age group can you use mast cell stabalizers?
Any age group
130
Which leukotriene modifier is FDA approved for ages 0-4
montelukast
131
AE of methylxanthines
insomnia, GI upset, hyperactivity, hypotension
132
What kind of injuries do we tend to see with methylxanthines?
dose related injury
133
Methylxanthine dose related injuries include:
tachycardia,N/V, headache, seizures,arrthymias
134
CI of methylxanthines ( contraindications)
perptic ulcer disease, arrythmias, seizure disorders
135
Drug interactions of methylxanthines
major substrate of CYP 3A4 and 1A2,and 2E1
136
Methylxanthines are CYP substrates. What are some drugs that you'll see with INC concentration
cimetidine, erythromycin, clarithromycin, ciprofloxacin,ticlopidine
137
Methylxanthines are CYP substrates. What are some drugs that you'll see with DEC concentration
pheobarbital, phenytoin, carbamzepine,rifampin, smoking
138
normal drug serum concentration
5-15 mcg/mL
139
What is the likely cause of hypotension when taking methylxanthines
PDE III
140
How do Anti-IgE medications work?
htey inhibit IgE binding to receptors on mast cells and basophils, inhibit mediator release and attenuation of early- and late-phase allergic responses
141
Most common Anto-IgE medication(s)
Omalizumab
142
generic: omalizumab
brand: Xolair
143
Dosage form of Xolair
150mg/ 1.2ml after reconstitution with 1.4 mL sterile water for injection
144
AE's of Anti IgE drugs
headache, reactions at injection site, arthralgias, thrombocytopenia, pharyngitis, sinusitis, upper resp tract infections
145
Boxed warning woth omalizumab
anaphylaxis
146
Counseling points with omalizumab
DO NOT admin more than 150 mg/ injection site | monitor for anaphylaxis before and after injection
147
Xolair has been FDA approved for moderate to severe persistent asthma in pt w/ positive skin test OR?
reactivity to a perennial aeroallergen and symptoms that are inadequately controlled with ICS
148
How do Anti IL5's work?
block the binding of IL-5 to the alpha chain of the IL-5 receptor complex, which results in reduced production and survival of eosinophils
149
Most common anti IL-5's?
Mepolizumab | Reslizumab
150
Generic: Mepolizumab
brand: Nucala
151
Generic: reslizumab
brand: Cinqair
152
AE's of anti IL-5's ( specific to mepolizumab)
headache, reaction at injection site, arthalgias, Herpes Zoster injection*
153
Dosage form and strength of Nucala
100 mg/1.2 mL after reconstituted with 1.2 ml sterile water for injection
154
Dosage from and strength of Cinqair
100mg/10ml ( no reconstitution needed)
155
What age population should you use anti IL-5's in?
adults only
156
What age group is it approved to use Anti-IgE's in ?
5-11 y/o and adults
157
AE's specific to the anti IL-5 Reslizumab
reactions at injection site, myalgias, INC creatinine phosphokinase
158
Which anti-IL5 does not have a boxed warning for anaphylaxis?
Nucala- mepolizumab | -only has a precaution warning
159
counseling points of mepolizumab and reslizumab
- monitor for anaphylaxis before and after injection | - indicated for add on maintenance tx of pt w/ severe asthma w/ and eosinophil phenotype
160
Boxed warning on reslizumab
anaphylaxis and malignancies
161
How do phosphodiaesterases-4 inhibitors work?
inhibit PDE4 which leads to inc cAMP
162
Most common PDE -4 inhibitor?
roflumilast
163
generic: roflumilast
brand: Daliresp
164
dosage form and strength of Daliresp
500 mcg tablets
165
what age group is it safe to use roflumilast
adults only
166
Is Dalireso used for asthma, COPD or both
COPD only
167
What you should monitor for while on PDE-4's?
weight and liver function
168
Drug interactions of Daliresp
CYP3A4 (major) CYP1A2 ( minor)
169
Contraindication of roflumilast
Child-Pugh class B or C

Pharm 825 (5 decks)

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