-
Smoking Cessation meds (2)
- 1. bupropion (Zyban)
- 2. varenicline (Chantix)
-
Zyban Rx concerns (1/3)
- 1. Lowers seizure threshold.
- 2. Generally well tolerated
- 3. can offset weight gain
-
Chantix Rx concerns (2/3)
- 1. "black box" -- worsened psych symptoms
- 2. "black box" -- increased cardiac risk with CAD
- 3. Side effects: abnormal dreams, constipation, dry mouth, nausea
-
Beta Agonists
Adverse effects (2 categories, 3 each)
- 1. Cardiac: Tachy, angina, HTN
- 2. CNS: Tremors, insomnia, headache
-
Short Acting Beta Agonists (SABA) (2)
- 1. albuterol (Proventil, Ventolin)
- 2. Levoalbuterol (Xopenex)
-
SABA Rx concerns (2)
- 1. generally for PRN use (though Xopenex more likely to be scheduled
- 2. use more than 2 days/wk = inadequate asthma control
-
Long Acting Beta Agonists (LABA) (3)
- Salmeterol (Serovent)/Formeterol (Foradil)
- Arformeterol (Brovana)
- Indacaterol (Arcapta Neohaler)
-
LABA Rx concerns (3)
- Generally for COPD
- "Black box" warnings for asthma, only use when other tx not working
- Not a monotherapy; use with glucocorticoid then switch to short-acting
-
Anticholinergics (2)
- Ipratropium (Atrovent)
- Tiotropium (Spiriva)
(Also: Combivent -- alb/atrovent)
-
Anticholinergics: Rx concerns (3)
- Decreases bronchial secretions
- Adjunctive tx with SABAs (not 1st line tx)
- SE: dry mouth and cough
-
Corticosteroids, inhaled (5); oral (1)
- Inhaled:
- Beclomethasone (Beclovent, Vanceril) -- HFA, MDI
- Budesonide (Pulmocort) -- DPI (dry powder inhaler), neb
- Flu -- ticasone (Flovent) -- HFA, MDI, DPI
- Ciclesonide (Alvesco) -- MDI
- Oral: Prednisone
-
Corticosteroids Combination Products (3)
(Glucocorticoid and LABA):
- Fluticasone/Salmeterol (Advair)
- Budesonide/Formeterol (Symbicort)
- Mometesone/Formeterol (Dulera)
-
Corticosteroids Rx concerns (4)
- Fixed schedule, not prn
- Can be dose-adjusted for severity
- SE (short term): thrush, hoarseness, cough
- SE (Long term): adrenal suppression, OP, PUD, hyperglycemia, psych symptoms
-
Phosphodiesterase 4 (PDE4) Inhibitor (1)
(Action)
Roflumilast (Daliresp)
Reduces inflammation, NOT a bronchodilator or steroid
-
PDE4 inhibitor Rx concerns:
general use: (2)
SE:
Contra:
- NOT a 1st line agent; best when not responding to other tx
- Works in late copd
- SE: Diarrhea, nausea, psych effects, insomnia
- Drug-drug: (increase effects): cimetidine, emycin, fluconazole
- Contra: hepatic impairment
-
Leukotriene Modifiers (3)
- Zafirlukast (Accolate)
- Zileutin (Zyflo)
- Montelukast (Singulair)
-
Leukotriene Modifiers Rx concerns
General use:
SE: (3)
Adverse rx: (1 major)
- Decrease inflammation in asthma, COPD and allergies
- SE: Headache, dizziness, GI upseet
- Adverse rx: agitation, tremors, dreams, depression, suicidal ideation
-
Prophylaxis Agent (2)
- Cromolyn (Intal)
- Nedocromil (Tilade)
-
Prophylaxis Agents Rx concerns
General use/not for:
SE: (2)
- Mast cell stabilizer
- NOT for acute attack
- SE: cough, unpleasant taste
-
Methylxanthine (1)
Theophylline
-
Methylxanthine Rx concerns
General use: (3)
SE: (3)
Toxicity: (4)
- Bronchodilator, anti-inflammatory, decreases pulmonary edema
- NOT a first-line drug (but making a comeback)
- Narrow therapeutic range
- SE: nervousness, tachycardia, GI upset
- Toxicity: GI, CNS, dysrhythmias, coma
-
Monoclonal Antibody (1)
Omalizulab (Xolair)
-
Monoclonal Antibody Rx concerns
General use: (2)
Black box:
SE: (3)
- Adjunctive for uncontrolled persistant Asthma pts over 12
- NOT 1st line
- "Black box" -- anaphylaxis
- SE: site reactions, HA, viral and upper resp infections
-
Mild intermittent asthma
Symptoms: (4)
- S&S Less than 2x/week
- Nighttime S&S less than 2/mo
- Minimal affect on activity
-
Mild intrmittent asthma TX (3)
- No daily meds
- PRN SABA
- Steroids for exacerbations
-
Mild Persistent Asthma S&S (3)
- S&S more than 2/week, less than 1/day
- Nighttime S&S more than 2/mo
- Normal activity except exacerbation
-
Mild Persistent Asthma TX
Preferred: (3)
Alternatives: (2)
- Preferred: Low-dose inhaled steroid
- PRN SABA
- May need LABA/steroid
- Alternative: cromolyn OR
- Leukotriene modifier
-
Moderate Persistant Asthma S&S (4)
- Requires SABA daily
- Nighttime S&S more than 1/wk
- Exacerbations over 2/wk, may last all day
- Impacts activities
-
Moderate Persistant Asthma TX
Preferred: (3)
Alternative: (3)
- Preferred: Low to med dose inhaled steroids
- LABAs
- PRN SABAs
- Alternatives: Increase inhaled steroid dose
- Leukotriene modifier
- Consider Theophylline
-
Severe Persistent Asthma S&S (3)
- Continual S&S and frequent exacerbations
- Nighttime S&S frequent
- Limited physical activity
-
Severe Persistent Asthma Tx (5)
- High dose inhaled steroids
- LABA
- Systemic steroids (with attempts to decrease & D/C dose)
- PRN SABA
- Consider Theophylline
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