Children under age 12 years 1 or 2 puffs every 6 hours Ipratropium albuterol

Children under age 12 years 1 or 2 puffs every 6

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Children under age 12 years: 1 or 2 puffs every 6 hours Ipratropium-albuterol combination (Combivent) is a second-line quick relief medication in the treatment of asthma Not indicated Education Overuse may increase bronchospasm & decrease pul function; Spiriva needs HandiHaler Leukotriene Modifiers MOA contribute to the inflammatory process, including smooth muscle contractility; neutrophil aggregation, degranulation, and chemotaxis; vascular permeability; and on lymphocytes Leukotriene-Receptor Agonists (LTRAs) 5-Lipoxygenase Pathway Inhibitors zafirlukast (Accolate) montelukast (Singulair) zileuton (Zyflo) Pharmac o- kinetics Rapidly absorbed via oral; metabolized by liver (CYP 450) Excreted in feces Bile urine Contra- indicatio n Hypersensitivity; abrupt substitute for inhaled or oral steroids Chewable formula in phenylketonuria Active liver disease Black box warning: Neuropsychiatric events in adult to children such as agitation, aggression, anxiousness, dream abnormality, hallucination, depression, insomnia, irritability, restlessness, SI Pregnancy B C Safety in children > 5y/o Infant < 12 m/o for chronic asthma Children 12 u/o ADRs HA, URI when taking w/ steroids (age 55 yr and older) Dyspepsia; hepatic injuries Clinical Use & dosing Chronic asthma 20 mg bid in children 12 y/o or older; 10 mg bid in children 5-11 y/o w/ empty stomach Persistent asthma & EIB for children 15 yr & older ; daily dose taken in the evening; w/o foods Persistent asthma: 600mg qid or extended-release bid taken 1 hr after meals Educatio n Even if Sx is free, pt has to take med; monitor drug interactions Corticosteroids Inhalants anti-inflammatory effects lead to reduction in the severity of asthma symptoms, increased peak flow readings, and decreased airway
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hyperresponsiveness; safe and well tolerated in all ages Inhaler beclomethasone dipropionate (QVAR), triamcinolone acetonide (Azmacort), budesonide (Pulmicort), flunisolide (AeroBid), mometasone furoate (Asmanex Twisthaler), fluticasone (Flovent), and ciclesonide (Alvesco). Intranasal beclomethasone (Beconase), triamcinolone (Nasacort AQ), budesonide (Rhinocort Aqua), flunisolide (Nasalide, Nasarel), mometasone (Nasonex), fluticasone (Flonase), and ciclesonide (Omnaris) Precautio n & contra- indicatio n All steroid inhaler in acute status asthmaticus or intensive, acute therapy is warranted; not used for relief of acute bronchospasm; no substitute for oral corticosteroids death resulting from adrenal insufficiency Cushing’s syndrome, caution in use w/ ocular HSV, TB, oral or nasal trauma, healing nasal septal ulcer, untreated URIs; Pregnancy C ADRs All corticosteroids: Xerostomia, hoarseness, tongue & mouth irritation, flushing, and dysgeusia, local immunosuppression (oral candidiasis), cataracts, bronchospasm, concurrent use w/ oral & inhaler causing HPA suppression; Pulmonary infiltrates with eosinophilia flunisolide, beclomethasone, and fluticasone: rash, urticaria; inhaled fluticasone & mometasone: dysmenorrhea; Intranasal corticosteroid: nasal irritation, itching, sneezing, and nasal dryness, bloody nasal mucus or epistaxis Drug interacti ons Known: Ritonavir & Ketoconazole significantly increases (fluticasone), budesonide serum
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  • Spring '14
  • Henrikson,J

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