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50 Cards in this Set

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ICS (used for asthma control)
Anti-inflammatory

BRANDS:
Beclomethasone dipropionate (QVAR)
Budesonide (Pulmicort)
Flunisolide (Aerobid, Aerospan)
fluticasone propionate (Flovent)
mometasone furoate (Asmanex Twisthaler)
triamcinolone acetonide (Azmacort)
fluticasone + salmeterol (Advair)
xinafoate (inhaled steroid + LABA) (Advair HFA)
budesonide + formoterol LABA (Symbicort)

SE: Dose dependent. At higher doses, thrush (yeast infection in the mouth) and hoarseness may occur, but are not common. Rinsing the mouth after each use and using a spacer device with MDIs will help prevent these side effects. Brusing, adrenal suppression, dysphonia, bone demineralization, growth suppression is slightly linked.

PT ED: Decreases airway hyper-responsiveness and decrease # asthma exacerbations. Does not enhance child's ability to "grow out" of asthma. Corticosteroids are immune-suppressant, monitor for infxn, varicella, measles, URIs.
Oral Steroid (used for asthma relief)
Anti-inflammatory

BRANDS:
dexamethasone
hydrocortisone (Cortef)
methylprednisone (Medrol)
prednisolone (Prelone)
prednisone (Prednisone Intensol)

SE: Long-term use can cause acne, weight gain, mood or behavior changes, upset stomach, bone loss, eye changes and slowing of growth

PT ED: Hypothalamic-pituitary axis suppression -- monitored by growth, intraocular pressure, corticosteroid levels. Preg Cat C
Mast cell stabilizer (used for asthma control)
Anti-inflammatory

BRANDS:
cromolyn sodium (Intal)
nedocromil sodium (Tilade)

SE: Bad taste with Tilade. Need 3-4 weeks to begin working, and needs to be taken 2 to 4 times a day to control long-term.

Note: Prophylatic use only. Treat more AR, than asthma.
Leukotriene Modifiers
Anti-inflammatory

BRANDS:
montelukast sodium (Singulair)
zafirlukast (Accolate)
zileuton (Zyflo CR)

SE: Headache, nausea, uriticaria, flu-sx, otalgia, leg pain, thirst (stay hydrated!)

PT ED: Considered alternative to steroids, especially with pt who need PO steroid... or could be added on when ICS is not as effective as it should. Preg Cat B. May change how the body responds to other drugs, esp Coumadin and theophylline.
IgE Antagonist
Anti-inflammatory

BRANDS:
omalizumab (Xolair)

SE: Black box warning for anaphylaxis... watch Sub-Q infection, viral infxn, URI, sinusitis, headache, sore throat

Note: Reduces IgE in blood by 95% (only helpful for those with inappropriate IgE response to dander, pollen, etc) -- Remember: IgE causes mast cells to dump histamine which causes vessels to leak/edematous and then causes bronchiolar congestion in asthmatics. Only approved for older kids who test positive for aero-allergen that is unable to control with steroids. ~$10k/yr. Monitor 2 hr after for anaphylaxis. Preg Cat B.
Theophylline (control)
Anti-inflammatory

BRANDS:
theophylline (Uniphyl, Theo-Dur, Slo-Bid, Theo-24)

SE: Nausea, vomiting, diarrhea, stomachache, headache, rapid or irregular heartbeat, muscle cramps, jittery or nervous feelings and hyperactivity. Symptoms may be a sign of too much medication, so check blood levels regularly.

PT ED: Available only in the oral form. Used in difficult-to-control or severe asthma. It must be taken daily and doses cannot be missed. Blood tests are required to monitor therapy. Certain medications--such as antibiotics containing erythromycin, seizure medications and ulcer medications--can interfere with the way theophylline works. Cigarette smoke and viral illnesses can also change how the body responds to theophylline.
Oral Methylxanthines
Bronchodilator

BRAND:
oxytriphylline (Choledyl SA)
theophylline (Elixophyllin, Theo-24, Theochron, Uniphyl)

SE: Stomach upset, Nervousness, Nausea and vomiting, Insomnia (difficulty sleeping), Hyperactivity, irritability, Rapid or irregular heartbeat, Dizziness
Anticholinergics (Relief)
Bronchodilator

BRANDS:
ipratropium bromide (Atrovent, Atrovent HFA)
ipratropium bromide + albuterol sulfate Combivent, Duoneb

SE: dry mouth, may increase wheeze for some. Less seen in kids (COPD, chronic bronchitis); use for pt who are not responding
SABA: Inhaled Short-Acting Beta-2 Agonists (Relief)
Bronchodilator

BRANDS:
Albuterol sulfate (Accuneb, Proventil HFA, ProAir HFA, Ventolin)
isoetharine hydrochloride (Beta-2)
isoproterenol hydrochloride (Isuprel)
levalbuterol hydrochloride (Xopenex/HFA)
metaproterenol sulfate (Alupent)
pirbuterol acetate (Maxair Autohaler)
terbutaline sulfate

SE: Anxiety, racing heart, headache, insomnia, nervousness, tremors, restlessness >1 canister/mo, pt needs more control. We worry about increased tolerance, SE profile (esp CV, CNS excitability, DM worry). Preg category C. Drug interactions of note: cough/cold meds (raise BP, HR), MAOI/TCA (additive), Digoxin, any child with heart meds (hypokalemia)
LABA: Long-acting Beta-2 Agonist (Control)
Bronchodilator

BRANDS:
Formoterol fumarate (Foradil Aerolizer)
Salmeterol xinafoate (Serevent Diskus)
Ipratropium bromide + albuterol sulfate (Combivent, Duoneb)
Fluticasone propionate + salmeterol xinafoate (inhaled steroid + LABA) (Advair Diskus)
Budesonide and formoterol fumarate (inhaled steroid + LABA) (Symbicort)

SE: Nervous or shaky feelings, over-excitement or hyperactivity, increased heart rate, and (rarely) upset stomach or trouble sleeping.

PT ED: Always monitor for black box warning issues of asthma-related deaths and exacerbation (long-duration, but takes long time to work!). If pt has "air hunger," it cannot reverse in time; doesn't tx acute episodes. Same CV worries as SABA. No spacer needed. Preg category C.
MDI = Metered dose INH

*List pros, cons, pt ed.
pro: delivers directly into lungs

con: 10% drug dose to lungs only (80% oropharynx), require good hand-lung coordination, mechanics, and adherence (spacers can help!)

Always have pt demo back use!
Dry-powder INH

* List pros, cons, pt ed.
pro: breath-activated (don't have to rely on hand to compress), more environmentally friendly

con: 20% drug dose to lungs only
Nebulizers

*List pros, cons, pt ed
pro: mist inhaled with face mask/mouthpiece

con: make take several minutes (up to 30 min) to deliver tx
formoterol fumarate

(Foradil Aerolizer)
LABA: Long-acting Beta-2 Agonist (Control) >>> Bronchodilator

SE: Nervous or shaky feelings, over-excitement or hyperactivity, increased heart rate, and (rarely) upset stomach or trouble sleeping.

Pt ed: Always monitor for black box warning issues of asthma-related deaths and exacerbation (long-duration, but takes long time to work!). If pt has "air hunger," it cannot reverse in time; doesn't tx acute episodes. Same CV worries as SABA. No spacer needed. Preg category C.
salmeterol xinafoate

(Serevent Diskus)
LABA: Long-acting Beta-2 Agonist (Control) >>> Bronchodilator

SE: Nervous or shaky feelings, over-excitement or hyperactivity, increased heart rate, and (rarely) upset stomach or trouble sleeping.

Pt ed: Always monitor for black box warning issues of asthma-related deaths and exacerbation (long-duration, but takes long time to work!). If pt has "air hunger," it cannot reverse in time; doesn't tx acute episodes. Same CV worries as SABA. No spacer needed. Preg category C.
ipratropium bromide + albuterol sulfate

(Combivent, Duoneb)
LABA: Long-acting Beta-2 Agonist (Control) >>> Bronchodilator

SE: Nervous or shaky feelings, over-excitement or hyperactivity, increased heart rate, and (rarely) upset stomach or trouble sleeping.

Pt ed: Always monitor for black box warning issues of asthma-related deaths and exacerbation (long-duration, but takes long time to work!). If pt has "air hunger," it cannot reverse in time; doesn't tx acute episodes. Same CV worries as SABA. No spacer needed. Preg category C.
fluticasone propionate + salmeterol xinafoate

(Advair Diskus)
LABA: Long-acting Beta-2 Agonist (Control) >>> Bronchodilator

SE: Nervous or shaky feelings, over-excitement or hyperactivity, increased heart rate, and (rarely) upset stomach or trouble sleeping.

Pt ed: Always monitor for black box warning issues of asthma-related deaths and exacerbation (long-duration, but takes long time to work!). If pt has "air hunger," it cannot reverse in time; doesn't tx acute episodes. Same CV worries as SABA. No spacer needed. Preg category C.
budesonide and formoterol fumarate

(Symbicort)
LABA: Long-acting Beta-2 Agonist (Control) >>> Bronchodilator

SE: Nervous or shaky feelings, over-excitement or hyperactivity, increased heart rate, and (rarely) upset stomach or trouble sleeping.

Pt ed: Always monitor for black box warning issues of asthma-related deaths and exacerbation (long-duration, but takes long time to work!). If pt has "air hunger," it cannot reverse in time; doesn't tx acute episodes. Same CV worries as SABA. No spacer needed. Preg category C.
albuterol sulfate

(Accuneb, Proventil HFA, ProAir HFA, Ventolin)
SABA: Inhaled Short-Acting Beta-2 Agonists (Relief) >>> Bronchodilator

SE: Anxiety, racing heart, headache, insomnia, nervousness, tremors, restlessness

PT ED: >1 canister/mo, pt needs more control. We worry about increased tolerance, SE profile (esp CV, CNS excitability, DM worry). Preg category C. Drug interactions of note: cough/cold meds (raise BP, HR), MAOI/TCA (additive), Digoxin, any child with heart meds (hypokalemia)
isoetharine hydrochloride

(Beta-2)
SABA: Inhaled Short-Acting Beta-2 Agonists (Relief) >>> Bronchodilator

SE: Anxiety, racing heart, headache, insomnia, nervousness, tremors, restlessness

PT ED: >1 canister/mo, pt needs more control. We worry about increased tolerance, SE profile (esp CV, CNS excitability, DM worry). Preg category C. Drug interactions of note: cough/cold meds (raise BP, HR), MAOI/TCA (additive), Digoxin, any child with heart meds (hypokalemia)
isoproterenol hydrochloride

(Isuprel)
SABA: Inhaled Short-Acting Beta-2 Agonists (Relief) >>> Bronchodilator

SE: Anxiety, racing heart, headache, insomnia, nervousness, tremors, restlessness

PT ED: >1 canister/mo, pt needs more control. We worry about increased tolerance, SE profile (esp CV, CNS excitability, DM worry). Preg category C. Drug interactions of note: cough/cold meds (raise BP, HR), MAOI/TCA (additive), Digoxin, any child with heart meds (hypokalemia)
levalbuterol hydrochloride

(Xopenex/HFA)
SABA: Inhaled Short-Acting Beta-2 Agonists (Relief) >>> Bronchodilator

SE: Anxiety, racing heart, headache, insomnia, nervousness, tremors, restlessness

PT ED: >1 canister/mo, pt needs more control. We worry about increased tolerance, SE profile (esp CV, CNS excitability, DM worry). Preg category C. Drug interactions of note: cough/cold meds (raise BP, HR), MAOI/TCA (additive), Digoxin, any child with heart meds (hypokalemia)
metaproterenol sulfate

(Alupent)
SABA: Inhaled Short-Acting Beta-2 Agonists (Relief) >>> Bronchodilator

SE: Anxiety, racing heart, headache, insomnia, nervousness, tremors, restlessness

PT ED: >1 canister/mo, pt needs more control. We worry about increased tolerance, SE profile (esp CV, CNS excitability, DM worry). Preg category C. Drug interactions of note: cough/cold meds (raise BP, HR), MAOI/TCA (additive), Digoxin, any child with heart meds (hypokalemia)
pirbuterol acetate

(Maxair Autohaler)
SABA: Inhaled Short-Acting Beta-2 Agonists (Relief) >>> Bronchodilator

SE: Anxiety, racing heart, headache, insomnia, nervousness, tremors, restlessness

PT ED: >1 canister/mo, pt needs more control. We worry about increased tolerance, SE profile (esp CV, CNS excitability, DM worry). Preg category C. Drug interactions of note: cough/cold meds (raise BP, HR), MAOI/TCA (additive), Digoxin, any child with heart meds (hypokalemia)
terbutaline sulfate
SABA: Inhaled Short-Acting Beta-2 Agonists (Relief) >>> Bronchodilator

SE: Anxiety, racing heart, headache, insomnia, nervousness, tremors, restlessness

PT ED: >1 canister/mo, pt needs more control. We worry about increased tolerance, SE profile (esp CV, CNS excitability, DM worry). Preg category C. Drug interactions of note: cough/cold meds (raise BP, HR), MAOI/TCA (additive), Digoxin, any child with heart meds (hypokalemia)
ipratropium bromide

(Atrovent, Atrovent HFA)
Anticholinergics (Relief) >>> Bronchodilator

SE: dry mouth, may increase wheeze for some

Less seen in kids (COPD, chronic bronchitis); use for pt who are not responding
ipratropium bromide + albuterol sulfate

(Combivent, Duoneb)
Anticholinergics (Relief) >>> Bronchodilator

SE: dry mouth, may increase wheeze for some

Less seen in kids (COPD, chronic bronchitis); use for pt who are not responding
oxytriphylline

(Choledyl SA)
Oral Methylxanthines >>> Bronchodilator

SE: Stomach upset, Nervousness, Nausea and vomiting, Insomnia (difficulty sleeping), Hyperactivity, irritability, Rapid or irregular heartbeat, Dizziness
theophylline

(Elixophyllin, Theo-24, Theochron, Uniphyl)
Oral Methylxanthines >>> Bronchodilator

SE: Stomach upset, Nervousness, Nausea and vomiting, Insomnia (difficulty sleeping), Hyperactivity, irritability, Rapid or irregular heartbeat, Dizziness
Theophylline

(Uniphyl)
For asthma control

SE: Nausea, vomiting, diarrhea, stomachache, headache, rapid or irregular heartbeat, muscle cramps, jittery or nervous feelings and hyperactivity. Symptoms may be a sign of too much medication, so check blood levels regularly.

PT ED: Available only in the oral form. Used in difficult-to-control or severe asthma. It must be taken daily and doses cannot be missed. Blood tests are required to monitor therapy. Certain medications--such as antibiotics containing erythromycin, seizure medications and ulcer medications--can interfere with the way theophylline works. Cigarette smoke and viral illnesses can also change how the body responds to theophylline.
Omalizumab (SQ injection)

(Xolair)
IgE Antagonist >>> Anti-inflammatory

Black box warning for anaphylaxis... watch Sub-Q infection, viral infxn, URI, sinusitis, headache, sore throat

Reduces IgE in blood by 95% (only helpful for those with inappropriate IgE response to dander, pollen, etc) --
Remember: IgE causes mast cells to dump histamine which causes vessels to leak/edematous and then causes bronchiolar congestion in asthmatics.

Only approved for older kids who test positive for aero-allergen that is unable to control with steroids. ~$10k/yr. Monitor 2 hr after for anaphylaxis. Preg Cat B.
montelukast sodium

(Singulair)
Leukotriene Modifiers >>> Anti-inflammatory

SE: Headache, nausea, uriticaria, flu-sx, otalgia, leg pain, thirst (stay hydrated!)

Considered alternative to steroids, especially with pt who need PO steroid... or could be added on when ICS is not as effective as it should. Preg Cat B. May change how the body responds to other drugs, esp Coumadin and theophylline.
zafirlukast

(Accolate)
Leukotriene Modifiers >>> Anti-inflammatory

SE: Headache, nausea, uriticaria, flu-sx, otalgia, leg pain, thirst (stay hydrated!)

Considered alternative to steroids, especially with pt who need PO steroid... or could be added on when ICS is not as effective as it should. Preg Cat B. May change how the body responds to other drugs, esp Coumadin and theophylline.
zileuton

(Zyflo CR)
Leukotriene Modifiers >>> Anti-inflammatory

SE: Headache, nausea, uriticaria, flu-sx, otalgia, leg pain, thirst (stay hydrated!)

Considered alternative to steroids, especially with pt who need PO steroid... or could be added on when ICS is not as effective as it should. Preg Cat B. May change how the body responds to other drugs, esp Coumadin and theophylline.
cromolyn sodium

(Intal)
Mast cell stabilizer (Control) >>> Anti-inflammatory

SE: Bad taste with Tilade. Need 3-4 weeks to begin working, and needs to be taken 2 to 4 times a day to control long-term.

Prophylatic use only. Treat more AR, than asthma.
nedocromil sodium

(Tilade)
Mast cell stabilizer (Control) >>> Anti-inflammatory

SE: Bad taste with Tilade. Need 3-4 weeks to begin working, and needs to be taken 2 to 4 times a day to control long-term.

Prophylatic use only. Treat more AR, than asthma.
dexamethasone
Oral Steroid (Relief) >>> Anti-inflammatory

SE: Long-term use can cause acne, weight gain, mood or behavior changes, upset stomach, bone loss, eye changes and slowing of growth

Hypothalamic-pituitary axis suppression -- monitored by growth, intraocular pressure, corticosteroid levels. Preg Cat C
hydrocortisone

(Cortef)
Oral Steroid (Relief) >>> Anti-inflammatory

SE: Long-term use can cause acne, weight gain, mood or behavior changes, upset stomach, bone loss, eye changes and slowing of growth

Hypothalamic-pituitary axis suppression -- monitored by growth, intraocular pressure, corticosteroid levels. Preg Cat C
methylprednisone

(Medrol)
Oral Steroid (Relief) >>> Anti-inflammatory

SE: Long-term use can cause acne, weight gain, mood or behavior changes, upset stomach, bone loss, eye changes and slowing of growth

Hypothalamic-pituitary axis suppression -- monitored by growth, intraocular pressure, corticosteroid levels. Preg Cat C
prednisolone

(Prelone)
Oral Steroid (Relief) >>> Anti-inflammatory

SE: Long-term use can cause acne, weight gain, mood or behavior changes, upset stomach, bone loss, eye changes and slowing of growth

Hypothalamic-pituitary axis suppression -- monitored by growth, intraocular pressure, corticosteroid levels. Preg Cat C
prednisone

(Prednisone Intensol)
Oral Steroid (Relief) >>> Anti-inflammatory

SE: Long-term use can cause acne, weight gain, mood or behavior changes, upset stomach, bone loss, eye changes and slowing of growth

Hypothalamic-pituitary axis suppression -- monitored by growth, intraocular pressure, corticosteroid levels. Preg Cat C
beclomethasone dipropionate

(QVAR)
ICS (Control) >>> Anti-inflammatory

SE: Dose dependent. At higher doses, thrush (yeast infection in the mouth) and hoarseness may occur, but are not common. Rinsing the mouth after each use and using a spacer device with MDIs will help prevent these side effects. Brusing, adrenal suppression, dysphonia, bone demineralization, growth suppression is slightly linked.

Decreases airway hyper-responsiveness and decrease # asthma exacerbations. Does not enhance child's ability to "grow out" of asthma. Corticosteroids are immune-suppressant, monitor for infxn, varicella, measles, URIs.
budesonide

(Pulmicort)
ICS (Control) >>> Anti-inflammatory

SE: Dose dependent. At higher doses, thrush (yeast infection in the mouth) and hoarseness may occur, but are not common. Rinsing the mouth after each use and using a spacer device with MDIs will help prevent these side effects. Brusing, adrenal suppression, dysphonia, bone demineralization, growth suppression is slightly linked.

Decreases airway hyper-responsiveness and decrease # asthma exacerbations. Does not enhance child's ability to "grow out" of asthma. Corticosteroids are immune-suppressant, monitor for infxn, varicella, measles, URIs.
flunisolide

(Aerobid, Aerospan)
ICS (Control) >>> Anti-inflammatory

SE: Dose dependent. At higher doses, thrush (yeast infection in the mouth) and hoarseness may occur, but are not common. Rinsing the mouth after each use and using a spacer device with MDIs will help prevent these side effects. Brusing, adrenal suppression, dysphonia, bone demineralization, growth suppression is slightly linked.

Decreases airway hyper-responsiveness and decrease # asthma exacerbations. Does not enhance child's ability to "grow out" of asthma. Corticosteroids are immune-suppressant, monitor for infxn, varicella, measles, URIs.
fluticasone propionate

(Flovent)
ICS (Control) >>> Anti-inflammatory

SE: Dose dependent. At higher doses, thrush (yeast infection in the mouth) and hoarseness may occur, but are not common. Rinsing the mouth after each use and using a spacer device with MDIs will help prevent these side effects. Brusing, adrenal suppression, dysphonia, bone demineralization, growth suppression is slightly linked.

Decreases airway hyper-responsiveness and decrease # asthma exacerbations. Does not enhance child's ability to "grow out" of asthma. Corticosteroids are immune-suppressant, monitor for infxn, varicella, measles, URIs.
mometasone furoate

(Asmanex Twisthaler)
ICS (Control) >>> Anti-inflammatory

SE: Dose dependent. At higher doses, thrush (yeast infection in the mouth) and hoarseness may occur, but are not common. Rinsing the mouth after each use and using a spacer device with MDIs will help prevent these side effects. Brusing, adrenal suppression, dysphonia, bone demineralization, growth suppression is slightly linked.

Decreases airway hyper-responsiveness and decrease # asthma exacerbations. Does not enhance child's ability to "grow out" of asthma. Corticosteroids are immune-suppressant, monitor for infxn, varicella, measles, URIs.
triamcinolone acetonide

(Azmacort)
ICS (Control) >>> Anti-inflammatory

SE: Dose dependent. At higher doses, thrush (yeast infection in the mouth) and hoarseness may occur, but are not common. Rinsing the mouth after each use and using a spacer device with MDIs will help prevent these side effects. Brusing, adrenal suppression, dysphonia, bone demineralization, growth suppression is slightly linked.

Decreases airway hyper-responsiveness and decrease # asthma exacerbations. Does not enhance child's ability to "grow out" of asthma. Corticosteroids are immune-suppressant, monitor for infxn, varicella, measles, URIs.
fluticasone + salmeterol

(Advair)
ICS (Control) >>> Anti-inflammatory

SE: Dose dependent. At higher doses, thrush (yeast infection in the mouth) and hoarseness may occur, but are not common. Rinsing the mouth after each use and using a spacer device with MDIs will help prevent these side effects. Brusing, adrenal suppression, dysphonia, bone demineralization, growth suppression is slightly linked.

Decreases airway hyper-responsiveness and decrease # asthma exacerbations. Does not enhance child's ability to "grow out" of asthma. Corticosteroids are immune-suppressant, monitor for infxn, varicella, measles, URIs.
xinafoate

(Advair HFA)
ICS (Control) >>> Anti-inflammatory
(inhaled steroid + LABA)

SE: Dose dependent. At higher doses, thrush (yeast infection in the mouth) and hoarseness may occur, but are not common. Rinsing the mouth after each use and using a spacer device with MDIs will help prevent these side effects. Brusing, adrenal suppression, dysphonia, bone demineralization, growth suppression is slightly linked.

Decreases airway hyper-responsiveness and decrease # asthma exacerbations. Does not enhance child's ability to "grow out" of asthma. Corticosteroids are immune-suppressant, monitor for infxn, varicella, measles, URIs.
budesonide + formoterol

(Symbicort)
ICS (Control) >>> Anti-inflammatory
LABA

SE: Dose dependent. At higher doses, thrush (yeast infection in the mouth) and hoarseness may occur, but are not common. Rinsing the mouth after each use and using a spacer device with MDIs will help prevent these side effects. Brusing, adrenal suppression, dysphonia, bone demineralization, growth suppression is slightly linked.

Decreases airway hyper-responsiveness and decrease # asthma exacerbations. Does not enhance child's ability to "grow out" of asthma. Corticosteroids are immune-suppressant, monitor for infxn, varicella, measles, URIs.