Table of contents
Respirology Medications
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Inhaled Corticosteroids
- Beclomethasone (QVAR)
- Budesonide (Pulmicort) [ white/brown ]
- Fluticasone (Flovent) [ orange/ peach ]
- Ciclesonide (Alvesco)
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Long-Acting Beta-Agnosits
- Do not use as monotherapy in asthma b/c keep airways open, pt expose to allergens, HUGE exacerbation --> death.
- Salmeterol (Serevent) [ teal ]
- + fluticasone (Advair) [ purple discus ] (S/F 250mcg/50mcg one puff bid)
- Formoterol (Oxeze)
- + budesonide (Symbicort) [ red/white ]
- + mometasone (Zenhale)
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Short Acting B-agonist
- Salbutamol (Ventolin) [ light blue ]
- Terbutaline (Bricanyl) [ blue/white ]
- Albuterol (US only)
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Short Acting Anticholinergic
- Ipratropium bromide (Atrovent) [ clear/green ]
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Long Acting Anticholinergics
- Tiotropium bromide (Spireva) 18mcg [ white/turquoise ]
- Salbutamol (Combivent) [ clear/orange ] (rare)
- Tiotropium bromide (Spireva) 18mcg [ white/turquoise ]
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Leukotriene Receptor Angagonists (LTRA)
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Zafirlukast (Accolade)
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Montelukast (Singulair)
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Zileuton (Zyflo, Zyflo CR)
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Anti-IgE
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Anti-IgE Antibody (omalizumab)
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Recombinant DNA derived IgG that binds IgE. Very expensive, SC injection q2w. used in SEVERE allergic asthma.
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Rx Notes
- Acute Exacerbations:
- Atrovent 2cc + Ventolin 5mg nebulized by face mask
Detailed Review
- Inhaled Corticosteroids (ICS)
- Decrease the number and activity of inflammatory cells.
- Decrease symptoms and exacerbations.
- Synergistic with LABA (increase B2 receptors).
- Inhibits the "delayed phase" allergy response in airways.
- Side Effects:
- Local: Hoarseness, Oral Thrush, Cough.
- Recommend adherence to asthma regimen (use spacer and rinse mouth after use).
- Reduce ICS dose to safest lowest amount.
- Use Nystatin mouth wash if needed.
- Systemic: Weight gain, adrenal suppression, osteopenia, glaucoma, skin thinning.
- Risks very low (mostly in elderly).
- Local: Hoarseness, Oral Thrush, Cough.
- Leukotriene Receptor Antagonists (LTRA) (Montelukast [Singulair], Zafirlukast [Accolate], Zileuton [Zyflo])
- Leukotrienes promote asthma (mucous secretion, vasodilation, inflammation).
- Anti-inflammatory and bronchodilator effect.
- Improve symptoms, QOL, prevent exercise-induced sx, but not first line.
- Side/Effect:
- Neuropsychiatric (Anxiety, Agitation, Hallucination, Depression). [uncommon, reported]
- Zileutin can cause hepatotoxicity [monitor].
- Theophylline
- Very narrow therapeutic margin, target drug levels closely.
- In the guidelines, but rarely used.
- Targer 5-12 mcg/mL.
- Many drug interactions (increased level with other drugs such as fluoroquinolones).
- Cousel on side effects: tremor, headache, nausea, palpitations.
- High risk of cardiac arrhythmias and seizure.
- DO NOT use for acute exacerbation, only chronic...
- Anti-IgE Antibody
- Recombinant antibody, blocks Fc portion of IgE.
- Reduces exacerbations, improve symptoms, reduces systemic and ICS dose.
- Only reserved for severe asthma refractory to therapy with evidence of allergies. (IgE level 30-700 IU [normal 0-90]). --> very expensive.
- Requires monitoring with anaphylactoid reactions. (1 in 1000) Observe 2h post-dose x3 doses then x1h thereafter.
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