Asthma/COPD

  • Short-Acting Beta 2 Agonists (SABAs)
  • Salbutamol (Albuterol)
    • Can cause hypokalemia with muscle weakness, arrhythmias, and tremors
    • EKG changes, palpitations, and HA may occur
    • Albuterol
    • Nebulizer: 2.5-5mg q20mins for 4 doses, then 2.5-10mg q1-4hrs
    • MDI (Ventolin HFA, Proventil HFA, ProAir HFA): 4-8 puffs q30mins up to 4hrs, then every 1-4hrs PRN
  • Levalbterol MDI (Xopenex, Xopenex HFA)
  • Pirbuterol MDI (MaxAir autohaler)
  • Terbutaline
  • SEs: Tremor (7%), tachycardia, anxiety
    • Hypokalemia, angina, tachyarrhythmia

  • Long-Acting Beta 2 Agonists (LABAs)

    • Not recommended without ICS in asthma due to increased mortality
    • Salmeterol DPI (Serevent Diskus, Aeromax)
    • Formoterol DPI (Foradil Aerolizer)
    • Oxis
    • Serovent
    • Onbrex
    • SE: Headache (17%), Tremor (8%)
    • Hypertension, Rash, dizziness, hyperglycemia
    • Inhaled Corticosteroid (ICSs)
    • Beclomethasone MDI (QVAR)
    • Budesonide DPI (Pulmicort Flexhaler)
    • Flunisolide MDI (Aerospan)
    • Fluticasone Propionate MDI (Flovent HFA)
    • Fluticasone Furoate DPI (Arnuity Ellipta)
    • Mometasone DPI (Asmanex Twisthaler)
    • Triamcinolone
    • Oral Corticosteroid
    • Methylprednisolone
    • Asthma: 32-64 mg/day PO in 1-2 doses
    • 40-80 mg/day IV in 1-2 doses
    • Reserve IV for NPO or severe in the ICU
    • Depo-Medrol 160mg IM at discharge equal to 8 days PO taper
    • Prednisolone
    • Prednisone
    • Asthma: 40-80 mg/day PO in 1-2 doses
    • Give until PEF is 70% predicted
    • 7–10-day courses do not need to be tapered
    • SE: Elevated Uric Acid, Increase or decrease INR w/Warfarin
    • Antimuscarinics (SAMA/LAMA)
    • Short-Acting Anticholinergics (SAMAs)
    • Ipratropium Bromide
    • Nebulizer: Must use with albuterol
    • MDI (Atrovent HFA): 4-8 puffs PRN every 2-4hrs
    • Better tolerated than LAMAs
    • SE: Bitter taste (20%), Xerostomia
    • Urinary retention, mydriasis
    • Long-Acting Anticholinergics (LAMAs)
    • Tiotropium Bromide (Spiriva Handihaler)
    • SE: Xerostomia (16%), Constipation
      • Rash, myalgia, dysphonia
    • Bretaris
    • SEEbri
    • Incruse Ellipta
    • Combos
    • SAMA/SABA
    • Ipratropium + Albuterol (Combivent Respimat)
    • LAMA/LABA
    • Vilanterol/umeclidinium (Anoro)
    • LABA/ICS
    • Budesonide/Formoterol MDI (Symbicort)
    • Fluticasone Furoate/Umeclidinium Bromide/Vilanterol (Trelegy Ellipta)
    • Fluticasone/Salmeterol MDI (Advair HFA)
    • Fluticasone/Salmeterol DPO (Advair Diskus)
    • Fluticasone Furoate/Vilanterol (Breo Ellipta)
    • Ipratropium Bromide/Salbutamol (Combivent)
    • Mometasone/formoterol (Durela hfa)
    • LAMA/LABA/ICS
    • Fluticasone/Umeclidinium/Vilanterol (Trelegy Ellipta)
    • Other
    • Methylxanthines
    • Theophylline
    • SE: Caffeine-like, MAT
      • Toxicity: vomiting, hypokalemia, hyperglycemia, seizures, tachycardia, ventricular arrhythmias
    • Eicosanoid Inhibition
    • Leukotriene Antagonists
    • Montelukast (Singulair): 10 mg QD tablet
    • Arachidonate 5-lipoxygenase Inhibitors
    • Zileuton (Zyflo CR): 1200mg BID tablet
    • Thromboxane Receptor Antagonists
    • Non-xanthine PDE4 Inhibitors
    • Zafirlukast (Accolate): 20mg BID tablet
    • AST/ALT ≥3x normal in 3%, monitor monthly for 3 months when initiating
    • Mast Cell Stabilizers
    • Cromolyn Sodium Nebulizer solution
    • IgE Inhibitor
    • Omalizumab (Xolair): 150mg injection
    • PDE-4 Inhibitors
    • Roflumilast (Daliresp): 500 ug tablet QD