Pharmacology Combo Products Quiz

Questions and Answers

Match each medication with its appropriate class:

Fluticasone furoate = ICS Umeclidinium = LAMA Vilanterol = LABA

Match the Symbicort inhaler medications with their classes:

Budesonide = ICS Formoterol = LABA

Match the Stiolto Respimat inhaler medications with their classes:

Tiotropium = LAMA Olodaterol = LABA

Match the DuoNeb nebulization solution medications with their classes:

Albuterol = SABA Ipratropium = SAMA Signup and view all the answers

What are the two leukotriene receptor antagonists (LTRA)?

Montelukast, Zafirlukast Signup and view all the answers

What are the indications of leukotriene receptor antagonists (LTRA)?

Asthma management, Exercise-induced bronchoconstriction prevention, Allergic rhinitis Signup and view all the answers

What is the MOA of leukotriene receptor antagonists (LTRA)?

Inhibit the actions of leukotrienes, relax smooth muscle, lead to bronchodilation and inhibit inflammatory responses. Signup and view all the answers

What are the ADE and dosing of leukotriene receptor antagonists (LTRA)?

ADE: Headache, Fatigue, neuropsychiatric events. Dosing: Montelukast taken at bedtime. Signup and view all the answers

What are the five Biologic Agents?

Benralizumab, Dupilumab, Mepolizumab, Omalizumab, Reslizumab Signup and view all the answers

What is the MOA, route, ADE, and dosing for Benralizumab?

MOA: IL-5 inhibitor. Route: SQ. ADE: Headache. Dosing: Every 4-8 weeks. Signup and view all the answers

What is the MOA, route, ADE, and dosing for Dupilumab?

MOA: IL-4 inhibitor. Route: SQ. ADE: Injection site reaction. Dosing: Every 2 weeks. Signup and view all the answers

What is the MOA, route, ADE, and dosing for Mepolizumab?

MOA: IL-5 inhibitor. Route: SQ. ADE: Injection site reaction. Dosing: Every 4 weeks. Signup and view all the answers

What is the MOA, route, ADE, and dosing for Omalizumab?

MOA: Inhibits IgE binding. Route: SQ. ADE: Anaphylaxis. Dosing: Every 2-4 weeks. Signup and view all the answers

What is the MOA, route, ADE, and dosing for Reslizumab?

MOA: IL-5 inhibitor. Route: IV. ADE: Anaphylaxis. Dosing: Every 4 weeks. Signup and view all the answers

What is the one PDE-4 inhibitor?

Roflumilast Signup and view all the answers

What is the indication of Roflumilast?

Reduce risk of COPD exacerbations Signup and view all the answers

What is the MOA of Roflumilast?

Inhibits phosphodiesterase-4, increasing cAMP levels to decrease inflammation. Signup and view all the answers

What is the ADE and dosing of Roflumilast?

ADE: Diarrhea, weight loss. Dosing: Oral. Signup and view all the answers

Match the medications that can cause medication-induced pulmonary toxicity:

Methotrexate = Trexall, Otrexup Amiodarone = Cordarone, Pacerone Signup and view all the answers

What is the SABA/SAMA combination product?

Albuterol/atrovent (DuoNeb, Combivent) Signup and view all the answers

What are the LABA/LAMA combination products?

Formoterol/aclidinium (Duaklir Genuair), Formoterol/glycopyrrolate (Bevespi Aerosphere), Olodaterol/tiotropium (Stiolto Respimat), Vilanterol/umeclidinium (Anoro Ellipta) Signup and view all the answers

What are the ICS/LABA combination products?

Budesonide/formoterol (Symbicort), Fluticasone/salmeterol (Advair, Wixhela), Fluticasone/vilanterol (Breo Ellipta), Mometasone/formoterol (Dulera) Signup and view all the answers

What are the ICS/LAMA/LABA combination products?

Budesonide/glycopyrrolate/formoterol (Breztri Aerosphere), Fluticasone/umeclidinium/vilanterol (Trelegy Ellipta) Signup and view all the answers

What are the indications of epinephrine (epi-pen, auvi-Q, etc.)?

Hypersensitivity reactions, type I allergic/anaphylactic; acute relief of bronchospasm in anaphylaxis; decongestant - intranasal product. Signup and view all the answers

What is the MOA of Epinephrine?

Stimulates alpha 1, beta 1 and beta 2 receptors to relax smooth muscle of the bronchial tree. Signup and view all the answers

What are the pharmacokinetics of onset and duration of Epinephrine?

Onset = immediate, 3-5 min; Duration = 60-90 min. Signup and view all the answers

What is the product availability and dosing of Epinephrine?

Intramuscular in thigh, subcutaneous injection, nebulization solution, intranasal; Adult 0.3 mg, Pediatric 0.15 mg. Signup and view all the answers

What medication do you need to be mindful of as a potential cause of dry cough?

Ramipril (Altace) Signup and view all the answers

What are the 3 antitussives/cough suppressants?

Benzonatate (Tessalon), Codeine, Dextromethorphan (Delsym, Robitussin, MANY OTC). Signup and view all the answers

What are the indications of the 3 antitussives/cough suppressants?

Symptomatic relief of non-productive cough; temporary control of cough due to throat and bronchial irritation. Signup and view all the answers

What are the MOA of the 3 antitussives/cough suppressants?

Dextromethorphan = interrupts cough impulse transmission; Benzonatate = suppresses cough by topical anesthetic; Codeine = suppresses cough reflex. Signup and view all the answers

What are the ADE of the 3 antitussives/cough suppressants?

Dextromethorphan: drowsiness, nausea, constipation, stomach discomfort, tachycardia; Benzonatate: oral/pharyngeal numbness, dizziness; Codeine: CNS & respiratory depression, constipation, addictive potential. Signup and view all the answers

What are the clinical pearls of the 3 antitussives/cough suppressants?

Dextromethorphan: misuse risks; Benzonatate: keep away from children; Codeine: potential for addiction. Signup and view all the answers

What is the 1 expectorant/mucolytic?

Guaifenesin (Mucinex, plus MANY OTCs). Signup and view all the answers

What is the indication of the 1 expectorant/mucolytic?

Symptomatic relief of acute, ineffective productive coughs; not indicated for chronic cough. Signup and view all the answers

What is the MOA of the 1 expectorant/mucolytic?

Increases hydration of the respiratory tract and reduces viscosity of mucus. Signup and view all the answers

What are the ADE, patient counseling, and clinical pearl of the expectorant/mucolytic?

ADE: well tolerated, dizziness; counseling: take with a full glass of water; pearl: may be no more effective than increased water intake. Signup and view all the answers

Which of the following cough and cold medications has misuse potential?

Dextromethorphan (Delsym, Robitussin) Signup and view all the answers

Which cough and cold medication can cause pharyngeal numbness?

Benzonatate (Tessalon) Signup and view all the answers

Describe types of inhalation devices used to deliver medications for COPD and asthma.

Nebulizers, metered dose inhalers (MDIs), spacers, dry powder inhalers (DPIs), etc. Signup and view all the answers

Describe general patient counseling techniques for proper inhaler use.

Review inhaler technique, dose counter orientation, and storage in a cool, dry place. Signup and view all the answers

How should metered dose inhalers (MDIs) be administered?

Prime upon first use, take a slow deep breath for 10 seconds. Signup and view all the answers

How should spacers and valve holding chambers (VHCs) be administered?

Use with aerosol inhalers to increase medication delivery to the lungs. Signup and view all the answers

How should dry powder inhalers (DPIs) be administered?

Breath-activated; requires a deep, fast intake through the inhaler. Signup and view all the answers

What are the Beta2-agonists?

All end in 'terol' (exception = terbutaline); SABA: albuterol; LABA: various others. Signup and view all the answers

What are the 4 SABA (short-acting beta2-agonists)?

Albuterol, Levalbuterol, Metaproterenol, Terbutaline. Signup and view all the answers

What are the LABA (long-acting beta2-agonists)?

Arformoterol, Formoterol, Olodaterol, Salmeterol, Vilanterol. Signup and view all the answers

What are the indications of the Beta2-agonists?

Bronchospasm treatment, prevention of exercise-induced bronchospasm; not for acute management. Signup and view all the answers

What is the MOA of the Beta2-agonists?

Stimulates beta2-receptors of bronchial smooth muscle, activating adenyl cyclase, increasing cAMP. Signup and view all the answers

What antihypertensive/cardiovascular medication interacts with agonists?

Beta-blockers, especially non-selective ones. Signup and view all the answers

In what patients would the benefits of concomitant therapy outweigh the risks?

Patients following an MI or heart failure who need beta-blockers even with COPD or asthma. Signup and view all the answers

What are the PK/PD/PGx of Beta2-agonists?

SABA: fast onset ~ 5 min, duration 4-6 hr; LABA: slow onset, every 12 hours dosing. Signup and view all the answers

What are the ADE and drug interactions of Beta2-agonists?

ADE: tachycardia, tremor, headache; interactions: with beta-blockers and diuretics. Signup and view all the answers

What do the SABA products look like?

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What do the LABA products look like?

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What are the clinical pearls of Beta2-agonists?

SABA are rescue medications; LABA should not be used as monotherapy. Signup and view all the answers

What are the Antimuscarinics, aka muscarinic antagonists?

SAMA: Ipratropium; LAMA: Aclidinium, tiotropium, umeclidinium. Signup and view all the answers

What is the SAMA (short-acting muscarinic antagonist)?

Ipratropium (Atrovent). Signup and view all the answers

What are the LAMA (long-acting muscarinic antagonists)?

Aclidinium, glycopyrrolate, revefenacin, tiotropium, umeclidinium. Signup and view all the answers

What are the indications of the Antimuscarinics?

COPD, off-label for asthma; should be used daily. Signup and view all the answers

What are the MOA of the Antimuscarinics?

Block acetylcholine on muscarinic receptors, resulting in bronchodilation. Signup and view all the answers

What are the PK/PD/PGx of muscarinic antagonists?

SAMA: onset 30 min, duration 4-6 hours; LAMA: onset 1 hour, duration 24 hours. Signup and view all the answers

What are the ADE and drug interactions of muscarinic antagonists?

ADE: bronchitis, sinusitis, dry mouth; drug interaction risk with other anticholinergic drugs. Signup and view all the answers

What do the SAMA and LAMA drugs look like?

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What are the clinical pearls of muscarinic antagonists?

Not appropriate for acute episodes; excessive use may lead to tolerance. Signup and view all the answers

What are the ICS (inhaled corticosteroids)?

Beclomethasone, Budesonide, Ciclesonide, Fluticasone, Mometasone. Signup and view all the answers

What are the indications of inhaled corticosteroids (ICS)?

Maintenance/prophylactic treatment of asthma; NOT for acute bronchospasm. Signup and view all the answers

What are the MOA of inhaled corticosteroids (ICS)?

Decrease production of inflammatory substances, reduce airway edema and mucus production. Signup and view all the answers

What are the ADE of inhaled corticosteroids (ICS)?

Oral candidiasis, dry mouth, throat irritation, hoarseness. Signup and view all the answers

What do the ICS products look like?

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What is the clinical pearl of ICS products about their dosing?

Most steroids have low, moderate, and high dosing options; slowly taper when discontinuing. Signup and view all the answers

What is the SABA and ICS preferred in pregnancy?

Albuterol is preferred SABA; Budesonide is the ICS preferred for use in pregnancy. Signup and view all the answers

What are the 4 combo products?

SABA/SAMA, LABA/LAMA, ICS/LABA, ICS/LABA/LAMA. Signup and view all the answers

What do the SABA/SAMA and LABA/LAMA products look like?

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What do the ICS/LABA and ICS/LAMA/LABA products look like?

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Which inhaler is MOST likely to cause oral thrush?

Fluticasone (Flovent) Signup and view all the answers

The Trelegy Ellipta inhaler contains 3 medications.

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Study Notes

Combination Products

SABA/SAMA: Albuterol/Ipratropium (DuoNeb, Combivent)
LABA/LAMA:
- Formoterol/Aclidinium (Duaklir Genuair)
- Formoterol/Glycopyrrolate (Bevespi Aerosphere)
- Olodaterol/Tiotropium (Stiolto Respimat)
- Vilanterol/Umeclidinium (Anoro Ellipta)
ICS/LABA:
- Budesonide/Formoterol (Symbicort)
- Fluticasone/Salmeterol (Advair, Wixhela)
- Fluticasone/Vilanterol (Breo Ellipta)
- Mometasone/Formoterol (Dulera)
ICS/LAMA/LABA:
- Budesonide/Glycopyrrolate/Formoterol (Breztri Aerosphere)
- Fluticasone/Umeclidinium/Vilanterol (Trelegy Ellipta)

Indications and Mechanism of Action (MOA)

Epinephrine (EpiPen, Auvi-Q):
- Indicated for hypersensitivity reactions, acute bronchospasm in anaphylaxis, and as a decongestant.
- MOA: Stimulates alpha 1, beta 1, and beta 2 receptors to relax bronchial smooth muscle.
Antitussives:
- Indicated for symptomatic relief of non-productive cough.
- MOA:
  - Dextromethorphan interrupts cough impulse.
  - Benzonatate acts as a topical anesthetic.
  - Codeine suppresses cough reflex.

Dosage and Administration

Epinephrine:
- Available for intramuscular, subcutaneous, nebulization, and intranasal use.
- Dosing: Pediatric 0.15 mg, Adult 0.3 mg, consider redosing every 5-15 mins if symptoms persist.
Guaifenesin (Expectorant):
- Dosing: Take with water; evidence suggests no significant advantage over increased fluid intake.

Adverse Drug Effects (ADE) and Drug Interactions

Epinephrine: Potential ADE includes tachycardia, hypertension, and nervousness.
Antitussives:
- Benzonatate: Oral numbness if capsules are chewed, sedation, and dizziness.
- Codeine: CNS depression and addictive potential.
Beta2-agonists:
- ADE: Tachycardia, anxiety, headache, hypokalemia.
- Interactions: Non-selective beta-blockers can reduce efficacy.
Muscarinic Antagonists (Antimuscarinics):
- SAMA: Ipratropium; ADE includes bronchitis and nausea.
- LAMA: Aclidinium, Tiotropium; typically well tolerated but may cause dry mouth.

Clinical Pearls

SABA: Albuterol is the primary choice for asthma relief; not for anti-inflammatory action.
LABA: Should be combined with ICS for asthma control, as they are not effective for acute attacks.
ICS: Effective long-term for asthma maintenance; rinse mouth to prevent oral thrush.
Patient Counseling: Confirm proper inhaler technique, emphasize the importance of adherence to controller medications, and the need to store inhalers properly

Biologic Agents

Not defined in the text; further information would be required for specifics.

Leukotriene Receptor Antagonists (LTRA)

Medications: Montelukast (Singulair) and Zafirlukast (Accolate).
Indications: Asthma management, exercise-induced bronchoconstriction (Montelukast), allergic rhinitis.
MOA: Inhibit effects of leukotrienes to promote bronchodilation and reduce inflammatory response.
ADE: Include headache, fatigue, and neuropsychiatric events.

Inhalers and Devices

Various inhaler types: MDIs, DPIs, spacers, nebulizers are utilized for delivering medications for asthma and COPD.
Techniques differ by inhaler type; proper patient education is essential for effective medication delivery.

Key Considerations

Always consider patient history, especially regarding substance misuse with medications like dextromethorphan and pseudoephedrine.
Monitor for potential misuse or abuse of medications, particularly in adolescents and individuals with a history of substance use.

Biologic Agents: Monoclonal Antibodies

Benralizumab (Fasenra), Dupilumab (Dupixent), Mepolizumab (Nucala), Omalizumab (Xolair), and Reslizumab (Cinqair) are monoclonal antibodies, indicated for various allergic and inflammatory conditions.

Benralizumab (Fasenra)

Mechanism of Action (MOA): IL-5 inhibitor, promotes apoptosis of eosinophils and basophils.
Administration Route: Subcutaneous (SQ).
Adverse Drug Events (ADE): Commonly reported headache.
Dosing Schedule: Administered every 4 weeks, then every 8 weeks; can be self-administered at home.

Dupilumab (Dupixent)

Mechanism of Action (MOA): IL-4 inhibitor, targeting pathways involved in asthma and allergic responses.
Administration Route: Subcutaneous (SQ).
Adverse Drug Events (ADE): Injection site reactions and hypereosinophilia are noted.
Dosing Schedule: Every 2 weeks, with home administration option.

Mepolizumab (Nucala)

Mechanism of Action (MOA): IL-5 inhibitor, reduces eosinophil production.
Administration Route: Subcutaneous (SQ).
Adverse Drug Events (ADE): Injection site reactions, headache, and risk of herpes zoster activation.
Dosing Schedule: Administered every 4 weeks; can be taken at home.

Omalizumab (Xolair)

Mechanism of Action (MOA): Inhibits IgE binding on mast cells, reducing allergic responses.
Administration Route: Subcutaneous (SQ).
Adverse Drug Events (ADE): Anaphylaxis (Black Box Warning) and injection site reactions.
Dosing Schedule: Every 2-4 weeks; must be administered in a healthcare setting.

Reslizumab (Cinqair)

Mechanism of Action (MOA): IL-5 inhibitor, reduces eosinophil production.
Administration Route: Intravenous (IV) - unique among the listed biologics.
Adverse Drug Events (ADE): Risk of anaphylaxis (Black Box Warning).
Dosing Schedule: Every 4 weeks; administration must occur in an office.

Roflumilast (Daliresp) - PDE-4 Inhibitor

Indication: Primarily reduces risk of exacerbations in Chronic Obstructive Pulmonary Disease (COPD); not intended for acute bronchospasm or asthma patients.
Mechanism of Action (MOA): Inhibits phosphodiesterase-4, increasing cAMP accumulation, leading to decreased inflammatory activity.
Adverse Drug Events (ADE): Notable for causing diarrhea and weight loss.
Drug Interactions: Caution with strong CYP3A4 inhibitors and inducers.
Dosing Schedule: Administered orally.

Medication-Induced Pulmonary Toxicity

Common Culprits: Methotrexate (Trexall, Otrexup) and Amiodarone (Cordarone, Pacerone) are associated with potential pulmonary toxicity.

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Description

Test your knowledge on various combination products in pharmacology. This quiz covers SABA/SAMA, LABA/LAMA, and ICS/LABA combinations, essential for managing respiratory conditions. Perfect for students in pharmacology courses or healthcare professionals.