Rescue Medication - Asthma and COPD

Question 1

SABA - Meds

Answer 1

albuterol, levalbuterol

Question 2

SAMA - Meds

Answer 2

ipratropium, ipratropium/albuterol

Question 3

Systemic Corticosteroid - Meds

Answer 3

methylprednisolone, prednisolone, prednisone, dexamethasone, methylprednisolone acetate

Question 4

Systemic/Subcutaneous Beta-2 Agonists - Meds

Answer 4

epinephrine, terbutaline

Question 5

albuterol - Age Group

Answer 5

all ages

Question 6

albuterol - Dosage Forms

Answer 6

HFA: MDI, Aerosol Powder Inhaler
Nebulizer

Question 7

albuterol - Adverse Effects

Answer 7

Tachycardia, tremor, hypokalemia (low potassium), irritability

Question 8

albuterol - Clinical Pearls

Answer 8

• Chronic use (>2x /day) indicates poor asthma control
• May mix nebulizer solution with cromolyn solution, budesonide inhalant suspension, or ipratropium solution
• In mild to moderate exacerbation, MDI plus valved holding chamber is as effective as nebulized therapy w/ appropriate administration technique and coaching by trained personnel

Question 9

albuterol - Brand Name

Answer 9

ProAir, Ventolin, Proventil, ProAir Respiclick, ProAir Digihaler

Question 10

levalbuterol - Brand Name

Answer 10

Xopenex

Question 11

levalbuterol - Age Group

Answer 11

all ages

Question 12

levalbuterol - Dosage Forms

Answer 12

HFA: MDI
Nebulizer

Question 13

levalbuterol - Adverse Effects

Answer 13

tachycardia, tremor, hypokalemia (low potassium), irritability

Question 14

levalbuterol - Clinical Pearls

Answer 14

• Reserved for pts who do not respond to albuterol for quick relief
• Nebulizer solution compatible with budesonide inhalant suspension
• Levalbuterol administered in 1/2 the mg dose of albuterol provides comparable efficacy and safety
• Has not been evaluated by continuous nebulization

Question 15

ipratropium - Brand Name

Answer 15

Atrovent

Question 16

ipratropium - Dosage Forms

Answer 16

HFA: MDI
Nebulizer

Question 17

ipratropium - Age Group

Answer 17

all ages

Question 18

ipratropium - Adverse Effects

Answer 18

Dry mouth, urinary retention, infection, sinusitis, bronchitis

Question 19

ipratropium - Clinical Pearls

Answer 19

• Used in combo w/ albuterol for asthma exacerbation treatment
• May mix in same nebulizer w/ albuterol
• Should NOT be used as first-line therapy; should be added to SABA therapy for severe exacerbations

Question 20

ipratropium/albuterol - Brand Name

Answer 20

Combivent Respimat, DuoNeb

Question 21

ipratropium/albuterol - Dosage Forms

Answer 21

MDI, nebulizer

Question 22

ipratropium/albuterol - Age Group

Answer 22

all ages

Question 23

ipratropium/albuterol (DuoNeb) - Clinical Pearls

Answer 23

May be used for up to 3 hours in initial management of severe exacerbations

Question 24

prednisolone - Dosage Forms

Answer 24

tablets, oral liquid

Question 25

Systemic Corticosteroids - Age Group

Answer 25

all ages

Question 26

prednisone - Dosage Forms

Answer 26

tablets, oral liquid

Question 27

dexamethasone - Dosage Forms

Answer 27

oral liquid, tablets, injection

Question 28

methylprednisolone acetate - Dosage Forms

Answer 28

repository injection

Question 29

Systemic Corticosteroids - Adverse Effects

Answer 29

short-term use - hyperglycemia, increased appetite, fluid retention, demargination of WBCs, psychiatric disturbances

Question 30

Systemic Corticosteroids - Contraindications

Answer 30

systemic fungal infections, administration of live vaccines if immunocompromised

Question 31

Systemic Corticosteroids - Drug Interactions

Answer 31

Warfarin INR (clotting levels) increase, decrease efficacy of inactivated vaccines

Question 32

Systemic Corticosteroids - Clinical Pearls

Answer 32

- May be used w/ ICS if patient is already taking ICS before hospitalization - May also be used for chronic therapy in both asthma (and COPD) only in severe stages - "Bursts" effective for establishing control when initiating therapy or during period of gradual deterioration - Injection may be used in place of "burst" if adherence is an issue or patient is vomiting

Question 33

Systemic/Subcutaneous Beta-2 Agonists - Age Group

Answer 33

all ages

Question 34

Systemic/Subcutaneous Beta-2 Agonists - Comments

Answer 34

No proven advantage of systemic therapy over aerosol epinephrine: indicated in addition to standard therapy for acute asthma associated w/ anaphylaxis and/or angioedema

Question 35

magnesium sulfate - Dosage Forms

Answer 35

IV

Question 36

magnesium sulfate - Age Groups

Answer 36

all ages

Question 37

magnesium sulfate - Adverse Effects

Answer 37

flushing, hypotension, vasodilation

Question 38

magnesium sulfate - Contraindications

Answer 38

Heart block, caution in renal dysfunction

Question 39

magnesium sulfate - Comments

Answer 39

Consider if patient remains in life threatening exacerbation after 1 hour of therapy