Pulmonology Medications Part 4.pdf

PULMONOLOGY MEDICATIONS PART 4 MONOCLONAL ANTIBODIES FOR TREATMENT OF ASTHMA MONOCLONAL ANTIBODIES - AGENTS Omalizumab (Xolair) Mepolizumab (Nucala) Reslizumab (Cinqair) Benralizumab (Fasenra) Dupilumab (Dupixent) Tezepelumab (Tezspire) MONOCLONAL ANTIBODIES Target the following substances to...

PULMONOLOGY MEDICATIONS PART 4 MONOCLONAL ANTIBODIES FOR TREATMENT OF ASTHMA MONOCLONAL ANTIBODIES - AGENTS Omalizumab (Xolair) Mepolizumab (Nucala) Reslizumab (Cinqair) Benralizumab (Fasenra) Dupilumab (Dupixent) Tezepelumab (Tezspire) MONOCLONAL ANTIBODIES Target the following substances to treat asthma • Immunoglobulin E (IgE) - antibody produced during an allergic reaction (higher levels with allergic asthma) • Cytokines -signal molecules that boost the immune response § Type 2 cytokines associated with asthma are interleukins (IL) § Asthma interleukins include IL-4, IL-5, and IL-13 § Interleukins play a major role in producing inflammation leading to asthma symptoms in 50% of asthmatics • Eosinophils (WBC) involved in the production of mucus and fluid that can trigger bronchospasms MONOCLONAL ANTIBODIES • Reduce exacerbation rates, less ER visits • Improve lung function (improved FEV) • Greater asthma control and better quality of life • Less need for inhaled and oral corticosteroids • Used in most severe cases of asthma, without control despite using high doses of ICSs MONOCLONAL ANTIBODIES ž Add on therapy, not replacement ž Useful in patients with severe asthma refractory to combination therapy that includes high dose ICS § Potential for reduction in ICS dose in some ž Have elevated allergic inflammatory biomarkers (serum IgE, blood eosinophil count) MONOCLONAL ANTIBODIES Most common adverse effects • Injection site pain • Fatigue • Headache • Sore throat • Muscle aches ( • Back pain ( MONOCLONAL ANTIBODIES Caution ž Can cause an allergic reaction including anaphylaxis ž Avoid use in patients with severe infection—especially a parasitic infection, because the body typically fights parasites with IgE and eosinophils MONOCLONAL ANTIBODIES These agents target IL-5 and the overproduction of eosinophils • adults and children 12 and older • adults 18 and over with severe asthma • - adults and children 12 and older Targets IL-4 •Dupilumab Targets • OMALIZUMAB • • • • OMALIZUMAB ž o o OMALIZUMAB Dosing ž Initiate in a healthcare setting due to risk of anaphylaxis ž Adult – dose based on body weight and IgE level ž Pediatric -dose based on weight and IgE level ž Renal impairment – no dose adjustment ž Hepatic impairment – no dose adjustment ž Administered subQ every 2 to 4 weeks OMALIZUMAB • § § OMALIZUMAB Adverse Effects • Major side effect is anaphylaxis, uncommon (<0.1%) • Injection site reaction • Urticaria • Headache OMALIZUMAB ž ž ž OMALIZUMAB ž ž ž OMALIZUMAB ž ž OMALIZUMAB • • • ANTITUSSIVES ANTITUSSIVES • § § • § ANTITUSSIVES ž ž ž ž ž ANTITUSSIVES Dextromethorphan (Delsym) Benzonatate (Tessalon Perles) Opiates - Codeine Gabapentin (Neurontin), Pregabalin (Lyrica) DEXTROMETHORPHAN ž ž ž DEXTROMETHORPHAN • § § • § § DEXTROMETHORPHAN ž ž § § DEXTROMETHORPHAN ž ž ž § § BENZONATATE ž ž ž BENZONATATE • • • BENZONATATE ž ž ž ž OPIATES - CODEINE ž § § § OPIATES - CODEINE ž • • GABAPENTIN • § GABAPENTIN ž § GABAPENTIN ž ž ž ž GABAPENTIN ž ž ž ž ž GABAPENTIN ž § MUCOLYTICS MUCOLYTICS ž ž ž ž N-ACETYLCYSTEINE • • •