Pharmacy

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Short-acting Beta-2 Agonists (SABA)
Asthma

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Racepinephrine (Asthmanefrin atomizer)
Albuterol (Ventolin HFA, Proventil HFA, ProAir HFA, AccuNeb, VoSpire ER)
Levalbuterol (Xopenex, Xopenex HFA)
Pirbuterol (Maxair Autohaler)

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Side Effects (SABA)
Asthma

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tremor, shakiness, lightheadedness, cough, palpitations, hypokalemia, tachycardia, hyperglycemia

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(SABA): DOC for
Asthma

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Exercise-induced bronchospasm

Front 4

SABA Therapy for Asthma

Back 4

If using SABA> 2 days/week, then need to increase maintenance therapy
Used PRN as rescue inhaler

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Asthma (SABA) Monitor

Back 5

number of days of use, symptom frequency, peak flow, BP, HR, blood glucose, and K+

Front 6

Albuterol

Back 6

(Ventolin HFA, Proventil HFA, ProAir HFA, AccuNeb, VoSpire ER)
90mcg, 200 sprays
Shake the inhaler well before each spray
DOC for pregnancy

Front 7

levalbuterol

Back 7

Xopenex

Front 8

Pirbuterol

Back 8

Maxair Autohaler

Front 9

Asthma: LABA

Back 9

Salmeterol (Serevent Diskus)
Formoterol (Foradil Aerolizer) I capsule BID

Front 10

Asthma: LABA + Corticosteroid
Salmeterol + Fluticasone

Back 10

(Advair Diskus, Advair HFA)
Diskus: 1 inhalation BID >4yo
HFA: 2 inhalations BID

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Asthma: LABA + Corticosteroid
Formoterol + Budesonide

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(Symbicort) 2 inhalations BID
Throw inhaler when counter = 0 or 3 months after first use
Does not relieve sudden symptoms

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Asthma: LABA + Corticosteroid
Mometasone + Formoterol

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(Dulera)
100, 200 mcg mometasone + 5 mcg formoterol Take 2 inhalations BID >12yo

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Inhaled Corticosteroid

Back 13

Rinse mouth and throat after use
Inhaled steroids are first-line for long term control for all ages with persistent asthma
Systemic steroids have a rapid onset of action and are used as "pulse" therapy for up to 15 days after an asthma attack

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Inhaled Corticosteroid
Generic/Brand

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Beclomethasone (QVAR)
Budesonide (Pulmicort)
Ciclesonide (Alvesco) prodrug
Flunisolide (Aerospan HFA: has built-in spacer)
Fluticasone (Flovent HFA,Diskus)
Momentasone (Asmanex)

Front 15

Beclomethasone

Back 15

QVAR
low dose: 80-240 mcg/d
medium: >240-480 mcg/d
high > 480 mcg/d

Front 16

BUdesonide

Back 16

Pulmicort
low dose: 180-600 mcg/d
medium: >600-1200 mcg/d
high dose >1200 mcg/d
respules: indicated for 1-8 yo

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Ciclesonide

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Alvesco 80-320 mcg BID
do not need to shake before use

Front 18

Flunisolide

Back 18

Aerospan

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Fluticasone

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Flovent
MDI: L : 88-264 mcg/d
M: 264-440 mcg/d
H: >440
Diskus L: 100-300 mcg/d
M: >300-500 mcg/d
H: >500 mcg/d

Front 20

Oral Corticosteroids

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Cortisone
Hydrocortisone (Cortef (PO), Solu-CORTEF (Inj)
Methylprednisolone (A-methapred, depo-medrol, solu-medrol (all inj), Medrol and medrol dosepak (PO)
Prednisone (Prednisone Intensol (soln), Rayos (Delated-release tab)
Prednisolone (Milipred, Orapred (tabs and soln), pediapred, veripred (soln), Prelone (syrup), Flo-Pred (susp), Orapred (ODT)
Triamcinolone (Aristospan, Kenalog, Trivaris (inj))

Front 21

Leukotriene Modifying Agent

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Zafirlukast (Accolate)
Montelukast (Singulair)
Zileuton (Zyflo, Zyflo CR)

Front 22

Leukotriene Modifying Agent
Monitor

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Zileuton need to monitor LFT every month x 3, then every 2-3 months for the rest of the first year of therapy
DO NOT abruptly substitute these agents for inhaled or oral corticosteroids

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Leukotriene Modifying Agent
Contraindications/ Cautions

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Active liver disease esp Zileuton
Caution: Neuropsychiatric event; Notify MD is develop signs of aggressive behavior, hostility, agitation, depression, suicidal thinking

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Leukotriene Modifying Agent
Side-effects

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HA, dizziness, ab pain, increase LFTs, upper respiratory tract infections, pharyngitis, sinusitis, and Churg-Strauss syndrome may feature systemic eosinophilia,

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Zafirlukast

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Accolate
Take on empty stomach
Children 5-11: 10mg BID

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Montelukast

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Singulair
10mg daily every evening
12mos - 5yo: 4mg daily
5-14 yo: 5 mg daily
Use for EIB: 2 hours before exercise
Take it as long as your doctor prescribes
Do NOT take an additional dose of singulair within 24 hours of previous dose
Do not open packet until ready to use
Granules (To not out in any liquid other than baby formula or breast milk)

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Zileuton

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Zyflo: 600 mg QID
Zyflo CR: BID within 1 hour of morning and evening meals
Not recommended on children

Front 28

Theophylline: Dose, Thera level, SE, signs of toxicity, DDI

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IR: Elixophyllin
ER: Theolair, THeo-24, Theochron
200-600mg daily
Therapeutic level 5-15 mcg/ml
SE: Nausea, HA< tachycardia, insomnia, tremor, nervousness
Signs of Toxicity: persistent and repetitive vomiting, vtach, seizure
DDI: caffeine, extremem amount of protein, carbs

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Omalizumab

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Xolair
Dosing based on pretreatment serum IgE levels and body weight
Given SC every 2 or 4 weeks
Always given in MD's office
BBW: anaphylaxis: reaction occurs within 2 hours but can be delayed up to 24 hours

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Asthma Rescuers

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SABA
Systemic (IV) steroids
Anticholinergics

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Controllers

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Inhaled steroids
Leukotriene MOdifying Agents
Theophylline
LABA
Mast cell stabilizers
Omalizumab

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Stepwise approach for Managing Asthma

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