Asthma/COPD PDF

ASTHMA/COPD ASTHMA *HFA = MDIs* *everything else most likely DPI* SABA - ADRs opposite of BBs – hypokalemia - Albuterol - MDI: Ventolin HFA, Proventil HFA, ProAir HFA - For all MDIs:...

ASTHMA/COPD ASTHMA *HFA = MDIs* *everything else most likely DPI* SABA - ADRs opposite of BBs – hypokalemia - Albuterol - MDI: Ventolin HFA, Proventil HFA, ProAir HFA - For all MDIs: - Shake and prime - Use a spacer - Breathe slowly and deeply - Clean mouthpiece with water - DPI: ProAir Respiclick *all respiclicks are DPI* - Levabuterol (Xopenex) - MDI: Xopenex HFA - Nebulizer Solution → vial used within 2 weeks if pouch is open, use within 1 week if removed from pouch - Terbutaline - PO → for asthma - Injectable → for stopping preterm labor ICS - 1st line therapy for persistent asthma - All BID unless otherwise stated - Beclomethasone (QVAR RediHaler) - Ready to use → no shake/prime/button/spacer - Breath-actuated aerosol - Counseling: - Open white cap and breathe away from inhaler - Inhale deeply - Hold breath 5-10 secs - Rinse mouth - Budesonide (Pulmicort) - Pulmicort Flexhaler - DPI - Pulmicort Respules - nebulizer - Only nebulized steroid - Only steroid for use in 1 yo - Mometasone (Asmanex) - Asmanex HFA - Asmanex Twisthaler - DPI - QPM - Discard 45 days after removing from pouch - Fluticasone :  - Flovent HFA - Flovent Diskus - DPI - Arunity Ellipta - DPI - Once daily - All elliptas = discard 6 wks after opening - Ciclesonide (Alvesco) - MDI – special !! solution = do not shake! - Pro-drug → hydrolyzes in lung = less oral thrush SYSTEMIC STEROIDS - Used for acute treatment with SABAs - Prednisone - 3-10 days - Prednisolone - several formulations, not all interchangeable - Dexamethasone - Methylprednisolone (Medrol Dose Pack) - 6 day course, all 4 mg tabs - Rayos - Delayed-release - Not for asthma, used in RA (Rayos for RA) - Equivalent doses: Cute Hot Pretty Pharmacist Makes Triple Digits Boooom! - Cortisone 25mg - Hydrocortisone 20mg - Prednisolone 5mg - Prednisone 5mg - Methylprednisolone 4mg - Triamcinolone 4mg - Dexamethasone 0.75mg - Betamethasone 0.6-0.75 mg - ADR: PREDNISONE - PUD/Psych - Retention of salt/water - Eye - cataracts, glaucoma - Diabetes - Neurologic - seizure, headache - Immunosuppression - Swelling - Osteoporosis - Nausea - can be used to treat nausea, can also cause nausea if not taken w food - Electrolyte changes - hypokalemia, hypernatremia LABA - Never use alone → add to ICS - Salmeterol - Severent Diskus - DPI - Advair Diskus/HFA (+ fluticasone) - Steroid dose changes in all combos! - Generic = Wixela - AirDuo Respiclick (+ fluticasone) - Formoterol – all MDIs - Symbicort (+ budesonide) - Budesonide = pulmiCORT - Dulera (+ mometasone) - You need a dula for mom ANTI-LEUKOTRIENES :  - All LIVER - Receptor antagonists → lukasts - Pathway antagonists → Zileuton - Montelukast (Singulair) - Chewable, tab, granules - Granules mixed with SOLIDS - QHS - ADR: mood/behavior changes - Zafirlukast (Accolate) - BID Empty Stomach (eat later with Accolate) - 10 mg or 20 mg - Zileuton (Zyflo, Zyflo CR) - CR → BID with food - Monitor frequent blood tests – LFTs! OMALIZUMAB (XOLAIR) - SubQ - Binds IgE → for allergies - Allergic asthma, chronic idiopathic urticaria - BBW: anaphylaxis INTERLEUKIN-5 RECEPTOR ANTAGONISTS - For esophinilic asthma - Reslizumab (Cinqair) - IV - Mix w NS - Mepolizumab (Nucala) - SubQ - Benralizumab (Fasenra) - SubQ INTERLEUKIN-4 RECEPTOR ANTAGOISTS - Dupliumab (Dupixent) SQ THEOPHYLLINES - Never 1st line, usually not used long-term 2/2 ADRs and monitoring levels - MOA: phosphoduesterase inhibitor → acts line caffeine - PO and IV - PO dose = IV dose x 0.8 - Therapeutic Levels - Children 5-10 - Adults 5-15 - DI: CYP1A2 substrate - Can be used for apnea of prematurity - Alternate preferred: caffeine citrate (no level monitoring, less ADRs) MAST-CELL STABILIZER - Cromolyn - Used for asthma and allergies, not really used tho COPD ANTICHOLINERGIC INHALERS - Ipatropium – all QID - Atrovent HFA - MDI solution *no shake* - Combivent Respimat - soft mist :  - + albuterol - All Respimats = soft mist, remember P-TOP - Prime, Twist, Open, Press - Discard 3 months - DuoNeb - + albuterol but nebulizer version - Use within 1 wk when removed from foil - Tiotropium - all QD - Spiriva HandiHaler - capsules DPI - Vibration = doing it right - Spiriva Respimat - soft mist - Umeclidinium (Incruse Ellipta) - DPI QD - Aclidinium (Tudorza Pressair) - DPI BID - Special mechanism: - Remove cap - Press green button, release button - Window changes from red to green - Breathe rapidly and deeply until you hear a click - Glycopyrrolate - BID - Seebri - DPI capsule - Lonhala Magnair - nebulizer LABA - All are “terol” meds - Olodaterol – all respimats - Striverdi Respimat QD - Stiolto Respimat (+ tioptropium) QD, discard after 3 mo - Indacaterol – all neohalers - Arcapta Neohaler – capsule, QD - Utibrion Neohaler (+ glycopyrrolate) BID - Formoterol - Perforomist – nebulizer, BID - Refrigerated - Bevespi Aerosphere (+ umeclidinium) QD - Duaklir Pressair (+ aclidinium) BID DPI - Aformoterol (Brovana) BID nebulizer solution - Refrigerated - Vilanterol – all QD, never alone, always in combination with someone else - Anoro Ellipta (+ umeclidinium) QD - Breo Ellipta (+ fluticasone) QD, DPI - Trelegy Ellipta (+ fluticasone, + umeclidinium) QD, DPI NEWER MEDS - Roflumilast (Daliresp) – LAST line - PO Daily mcg tab - PDE4 inhibitor - ADR: Suicide, Wt Loss - DI: 3A4 Substrate - CI: liver impairment - Breztri Aerosphere (Budesonide / Glycopyrrolate / Formoterol) :  - MDI BID ALLERGIC RHINITIS NASAL CORTICOSTEROIDS - NASE = Nasal steroids - Mometasone (Nasonex) OTC - Triamcinolone (Nasacort) OTC - Budesonide (Rhinocort) OTC - Fluticasone (Flonase) OTC OTHER NASAL SPRAYS - Antihistamines - Olopadatine (Patanase) - Azelastine + Fluticasone (Dymista) - Cromolyn (NasalCrom) - mast cell stabilizer OTC - Ipatropium - Anticholinergic :