Pharmacology Combo Products Quiz
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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:

<p>Albuterol = SABA Ipratropium = SAMA</p> Signup and view all the answers

What are the two leukotriene receptor antagonists (LTRA)?

<p>Montelukast, Zafirlukast</p> Signup and view all the answers

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

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

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

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

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

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

What are the five Biologic Agents?

<p>Benralizumab, Dupilumab, Mepolizumab, Omalizumab, Reslizumab</p> Signup and view all the answers

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

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

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

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

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

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

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

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

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

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

What is the one PDE-4 inhibitor?

<p>Roflumilast</p> Signup and view all the answers

What is the indication of Roflumilast?

<p>Reduce risk of COPD exacerbations</p> Signup and view all the answers

What is the MOA of Roflumilast?

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

What is the ADE and dosing of Roflumilast?

<p>ADE: Diarrhea, weight loss. Dosing: Oral.</p> Signup and view all the answers

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

<p>Methotrexate = Trexall, Otrexup Amiodarone = Cordarone, Pacerone</p> Signup and view all the answers

What is the SABA/SAMA combination product?

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

What are the LABA/LAMA combination products?

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

What are the ICS/LABA combination products?

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

What are the ICS/LAMA/LABA combination products?

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

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

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

What is the MOA of Epinephrine?

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

What are the pharmacokinetics of onset and duration of Epinephrine?

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

What is the product availability and dosing of Epinephrine?

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

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

<p>Ramipril (Altace)</p> Signup and view all the answers

What are the 3 antitussives/cough suppressants?

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

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

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

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

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

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

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

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

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

What is the 1 expectorant/mucolytic?

<p>Guaifenesin (Mucinex, plus MANY OTCs).</p> Signup and view all the answers

What is the indication of the 1 expectorant/mucolytic?

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

What is the MOA of the 1 expectorant/mucolytic?

<p>Increases hydration of the respiratory tract and reduces viscosity of mucus.</p> Signup and view all the answers

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

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

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

<p>Dextromethorphan (Delsym, Robitussin)</p> Signup and view all the answers

Which cough and cold medication can cause pharyngeal numbness?

<p>Benzonatate (Tessalon)</p> Signup and view all the answers

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

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

Describe general patient counseling techniques for proper inhaler use.

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

How should metered dose inhalers (MDIs) be administered?

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

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

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

How should dry powder inhalers (DPIs) be administered?

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

What are the Beta2-agonists?

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

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

<p>Albuterol, Levalbuterol, Metaproterenol, Terbutaline.</p> Signup and view all the answers

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

<p>Arformoterol, Formoterol, Olodaterol, Salmeterol, Vilanterol.</p> Signup and view all the answers

What are the indications of the Beta2-agonists?

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

What is the MOA of the Beta2-agonists?

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

What antihypertensive/cardiovascular medication interacts with agonists?

<p>Beta-blockers, especially non-selective ones.</p> Signup and view all the answers

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

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

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

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

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

<p>ADE: tachycardia, tremor, headache; interactions: with beta-blockers and diuretics.</p> 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?

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

What are the Antimuscarinics, aka muscarinic antagonists?

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

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

<p>Ipratropium (Atrovent).</p> Signup and view all the answers

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

<p>Aclidinium, glycopyrrolate, revefenacin, tiotropium, umeclidinium.</p> Signup and view all the answers

What are the indications of the Antimuscarinics?

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

What are the MOA of the Antimuscarinics?

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

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

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

What are the ADE and drug interactions of muscarinic antagonists?

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

What do the SAMA and LAMA drugs look like?

Signup and view all the answers

What are the clinical pearls of muscarinic antagonists?

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

What are the ICS (inhaled corticosteroids)?

<p>Beclomethasone, Budesonide, Ciclesonide, Fluticasone, Mometasone.</p> Signup and view all the answers

What are the indications of inhaled corticosteroids (ICS)?

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

What are the MOA of inhaled corticosteroids (ICS)?

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

What are the ADE of inhaled corticosteroids (ICS)?

<p>Oral candidiasis, dry mouth, throat irritation, hoarseness.</p> Signup and view all the answers

What do the ICS products look like?

Signup and view all the answers

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

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

What is the SABA and ICS preferred in pregnancy?

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

What are the 4 combo products?

<p>SABA/SAMA, LABA/LAMA, ICS/LABA, ICS/LABA/LAMA.</p> 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?

<p>Fluticasone (Flovent)</p> Signup and view all the answers

The Trelegy Ellipta inhaler contains 3 medications.

Signup and view all the answers

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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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.

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