Podcast
Questions and Answers
What is the brand name for budesonide/formoterol?
What is the brand name for budesonide/formoterol?
- Symbicort (correct)
- Advair
- Dulera
- Qvar
What is the drug class of budesonide/formoterol?
What is the drug class of budesonide/formoterol?
Inhaled Corticosteroid/Bronchodilator Combination
What are the dosage forms of budesonide/formoterol?
What are the dosage forms of budesonide/formoterol?
MDI 80 mcg/4.5 mcg/inhalation and 160 mcg/4.5 mcg/inhalation
What are the common indications and dosing for budesonide/formoterol?
What are the common indications and dosing for budesonide/formoterol?
What is the mechanism of action (MOA) of budesonide/formoterol?
What is the mechanism of action (MOA) of budesonide/formoterol?
What is the dose adjustment renal for budesonide/formoterol?
What is the dose adjustment renal for budesonide/formoterol?
What are contraindications for budesonide/formoterol?
What are contraindications for budesonide/formoterol?
What are the black box warnings for budesonide/formoterol?
What are the black box warnings for budesonide/formoterol?
What are the drug interactions with budesonide/formoterol?
What are the drug interactions with budesonide/formoterol?
The interaction between budesonide/formoterol and SABAs may potentiate the effect of __________.
The interaction between budesonide/formoterol and SABAs may potentiate the effect of __________.
The interaction between budesonide/formoterol and beta-blockers may decrease the effectiveness of __________.
The interaction between budesonide/formoterol and beta-blockers may decrease the effectiveness of __________.
The interaction between budesonide/formoterol and MAOIs and tricyclic antidepressants may potentiate the effect on the __________ system.
The interaction between budesonide/formoterol and MAOIs and tricyclic antidepressants may potentiate the effect on the __________ system.
The interaction between budesonide/formoterol and azole antifungals may increase __________ concentrations.
The interaction between budesonide/formoterol and azole antifungals may increase __________ concentrations.
CYP3A4/CYP3A5 inducers can increase budesonide metabolism and decrease its effectiveness, thus, __________ should be monitored.
CYP3A4/CYP3A5 inducers can increase budesonide metabolism and decrease its effectiveness, thus, __________ should be monitored.
CYP3A4/CYP3A5 inhibitors can decrease budesonide metabolism and increase the risk of __________.
CYP3A4/CYP3A5 inhibitors can decrease budesonide metabolism and increase the risk of __________.
What are common adverse reactions with budesonide/formoterol?
What are common adverse reactions with budesonide/formoterol?
What are rare but serious adverse reactions with budesonide/formoterol?
What are rare but serious adverse reactions with budesonide/formoterol?
What are the efficacy monitoring parameters for budesonide/formoterol?
What are the efficacy monitoring parameters for budesonide/formoterol?
What are the toxicity monitoring parameters for budesonide/formoterol?
What are the toxicity monitoring parameters for budesonide/formoterol?
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Study Notes
Drug Overview
- Brand name: Symbicort
- Drug class: Inhaled Corticosteroid/Bronchodilator Combination
Dosage Forms
- Metered-Dose Inhaler (MDI)
- Formulations:
- 80 mcg budesonide / 4.5 mcg formoterol per inhalation
- 160 mcg budesonide / 4.5 mcg formoterol per inhalation
Indications and Dosing
- Asthma:
- Recommended dose: 80 mcg/4.5 mcg, 2 puffs twice daily (BID)
- Possible increase to 160 mcg/4.5 mcg, 2 puffs BID
- Chronic Obstructive Pulmonary Disease (COPD):
- Recommended dose: 160 mcg/4.5 mcg, 2 puffs BID
Mechanism of Action
- Budesonide:
- Anti-inflammatory agent with strong glucocorticoid effects and weak mineralocorticoid effects
- Inhibits various cell types and mediators involved in inflammation
- Formoterol:
- Long-acting selective beta-adrenergic agonist, leading to bronchodilation
Renal Dose Adjustment
- No dose adjustment required for renal impairment
Contraindications
- Known hypersensitivity to budesonide or formoterol
- Not to be used as primary treatment for status asthmaticus or acute asthma/COPD episodes
Black Box Warnings
- Risk of asthma-related deaths in pediatric patients
- Increased risk of hospitalizations
Drug Interactions
- May interact with:
- Short-acting beta agonists (SABAs)
- Beta-blockers
- Monoamine oxidase inhibitors (MAOi) and tricyclic antidepressants
- Azole antifungals and macrolides
- CYP3A4/CYP3A5 inducers and inhibitors
Specific Interactions and Recommendations
- SABAs: May enhance formoterol effects; avoid concurrent use
- Beta-blockers: Nonselective beta-blockers can reduce formoterol effectiveness and cause bronchospasms; consider cardioselective options with PFT monitoring
- MAOi and tricyclic antidepressants: May augment cardiovascular effects of formoterol; consider alternative therapies
- Azole antifungals and macrolides: Can increase budesonide concentration; avoid long-term use
- CYP3A4/CYP3A5 inducers: Increase metabolism of budesonide, decreasing effectiveness; monitor and possibly increase budesonide dose
- CYP3A4/CYP3A5 inhibitors: Decrease metabolism leading to toxicity; monitor and possibly decrease budesonide dose
Adverse Reactions
- Common: Upper respiratory tract infections
- Rare but serious:
- Asthma-related deaths
- Bronchospasm
- Hypokalemia
- Arrhythmias
Monitoring Parameters
- Efficacy:
- Pulmonary function tests (PFTs)
- Resolution of asthma symptoms
- Frequency of exacerbations
- Nighttime awakenings
- Need for rescue albuterol
- Toxicity:
- Monitor growth velocity in pediatric patients on long-term therapy
- Seek alternative treatment or emergency care for paradoxical bronchospasms
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