DKQ - p1 fall drugs

what drugs are common inhaled corticosteroids

beclomethasone

budesonide

fluticasone

mometasone

how do inhaled corticosteroids work

inhibit inflammatory response in airways and increase sensitivity of beta 2 receptors

indications for inhaled steroids

asthma, COPD, allergic rhinitis

beclomethasone brand names

qvar, qnasl

budesonide brand names

pulmicort

fluticasone brand names

flovent, flonase

mometasone brand names

asmanex

inhaled steroid contraindications

status asthmaticus (because does not have immediate affect on airways)

common side effects of inhaled steroids

throat irritation, cough, thrush, headache

serious side effects of inhaled steroids

vertigo, URI, pneumonia, HPA axis suppression, growth retardation in high doses

how to prevent thrush from inhaled steroids

rinse mouth and throat after use

what inhaled steroid should not be used with grapefruit juice

fluticasone

what generic drugs are ICS/LABAs

fluticasone/salmeterol

fluticasone/vilanterol

budesonide/formoterol

mometasone/formoterol

fluticasone/salmeterol brands

advair, wixela

fluticasone/vilanterol brands

breo ellipta

budesonide/formoterol brands

symbicort, breyna

mometasone/formoterol brands

dulera

ICS/LABAs boxed warning

LABAs as monotherapy increase risk of asthma related deaths and hospitalization (esp in peds) — bc don’t work on airways fast enough to be a rescue med

ICS/LABA contraindications

acute bronchospasm, status asthmaticus — bc don’t work on airways fast enough

serious side effects of ICS/LABA

a-fib, hypokalemia

ICS/LABA major drug interaction

beta blockers — BBs are doing opposite of what LABAs are doing

what ICS/LABAs should not be used with grapefruit juice

fluticasone/salmeterol, fluticasone/vilanterol — any combo with fluticasone in it

what LABA can be used as monotherapy for exercise induced bronchospasm

salmeterol

budesonide/glycopyrrolate/formoterol brand

breztri

fluticasone/umeclidinium/vilanterol brand

trelegy

what is a unique indication for trelegy vs breztri

trelegy can be used for asthma maintenance and COPD

breztri is just for COPD

trelegy contraindications

severe hypersensitivity to milk proteins

common side effects of ICS/LABA/LAMA

constipation, diarrhea, arthralgia, muscle spasms

serious side effects of ICS/LABA/LAMA

UTI, sinusitis

ICS/LABA/LAMA drug interactions

beta blockers

anticholinergics

what generic drugs are LABA/LAMA

vilanterol/umeclidinium

formoterol/glycopyrrolate

formoterol/aclidinium

olodaterol/tiotropium

vilatnerol/umeclidiunium brand

anoro ellipta

formoterol/glycopyrrolate brand

bevespi aerosphere

formoterol/aclidinium brand

duaklir pressair

olodaterol/tiotropium brand

stiolto respimat

LABA/LAMA indication

COPD only

common side effects of LABA/LAMAs

anxiety, chest pain, headache, dizziness, xerostomia

serious side effects of LABA/LAMA

toothache, tooth abscess, a-fib

LABA/LAMA drug interactions

beta blockers — doing opposite of what LABA is doing

antimuscarinics — TOO much antimuscarinic activity

what generic drug is a SAMA

ipratropium

ipratropium brand

atrovent

ipratropium indications

COPD

acute asthma — off label

common side effects of SAMA

dry mouth, bitter taste, anticholinergic effects

serious side effects of SAMA

bronchospasm, MI, anaphylaxis

drug interaction with all muscarinic antagonist inhalers

anticholinergic agents

SAMA mechanism

antagonizes M3 receptors → decrease in secretions and causes bronchodilation

what generic drug is a LAMA

tiotropium

tiotropium brand

spiriva

what formulation of tiotropium is indicated for asthma

spiriva respimat

LAMA common side effects

anticholinergic — can’t see, can’t spit, can’t pee, can’t poop

serious side effect of LAMA

closed angle glaucoma

what inhaler contains a capsule that is punctured for inhalation

spiriva handihaler

LAMA mechanism

antagonizes M3 receptor in airway smooth muscle

long acting with affinity on M1-5

what generic drug is a SABA

albuterol

albuterol brand

proair, ventolin, proventil

what is an off-label indication for albuterol

hyperkalemia — bc causes hypokalemia

common side effects of SABA

tachycardia, tremor, nervous

nausea, cough, hypokalemia

serious side effects of SABA

a-fib, HTN, hyperglycemia, bronchospasm, palpitations

SABA drug interaction

non-selective beta blockers

what is the R isomer of albuterol

levalbuterol

SABA mechanism

activates beta 2 receptors → relaxation of smooth muscle and inhibition of mediator release of mast cells

what generic drug is SABA/SAMA

albuterol/ipratropium

albuterol/ipratroprium brand

combivent duoneb

what generic drug is an ICS/SABA

budesonide/albuterol

budesonide/albuterol brand

airsupra

common side effects of ICS/SABA

oral candidiasis, headache, voice disorder, cough

what generic drug is a leukotriene modifier

montelukast

montelukast brand

singulair

montelukast indications

asthma, EIB, allergic rhinitis

montelukast boxed warning

increased risk for neuropsychiatric events

common side effects of montelukast

headache, dizziness, dyspepsia, flu-like symptoms, URI, abdominal pain

serious side effects of montelukast

suicidal thoughts, altered behavior, cholestatic hepatitis

when should montelukast be taken

in the evening

montelukast mechanism

inhibits leukotriene receptors → inhibits airway edema and facilitates bronchodilation

what generic drug is a PDE4 inhibitor

roflumilast

roflumilast brand

daliresp

roflumilast indications

COPD

roflumilast mechanism

inhibits PDE4 → increases cAMP → reduced lung inflammation

roflumilast contraindications

moderate-severe liver impairment (child pugh B or C)

common side effects of roflumilast

weight loss, nausea, vomiting, decrease in appetite, insomnia, backache, headache, flu

serious side effects of roflumilast

diarrhea, suicidal thoughts

roflumilast topical formulation

zorvye — atopic dermatitis, plaque psoriasis, seborrheic dermatitis

dexamethasone brands

dexpak, decadron

hydrocortisone

cortef, solucortef

methylprenisolone brands

medrol

solumedrol

prednisone brands

deltasone

prednisolone brand

milipred

systemic glucocorticoid contraindications

live vaccines

serious systemic infections

acute side effects of systemic glucocorticoids

increased appetite/weight gain, sodium/water retention, hypokalemia, HTN, hyperglycemia, immunosuppression, etc — LOTS of different side effects

chronic side effects of systemic steorids

cushing syndrome, dermal thinning, diabetes, glaucoma, growth retardation, GI bleed, hirsutism, etc — LOTS of different side effects

drug interactions with systemic steroids

CYP3A4 interactions, live vaccines, decreased oral contraceptives

steroid conversion

(current dose/current potency) = (new dose/new potency)

relative steroid potencies

dex - 0.75 (most potent)

methylpred - 4

prednisone/nisolone - 5

hydrocortisone - 20 (least potent)

how to avoid HPA axis suppression on systemic steroids

taper slowly if therapy is over 10-14 days

what generic drug is a xanthine derivative

theophylline

theophylline indications

asthma, COPD

common side effects of theophylline

N/V, insomnia, tremors, restlessness, headache, irritability

serious side effects of theophylline

a-fib, tachyarrhythmia, seizures

theophylline drug interactions

CYP1A2

oral contraceptives

cipro

carbamazepine

phenytoin

how is theophylline dosed

based on ideal body weight