What is the BLACK BOX warning for Omalizumab? - ✔✔Bronchospasm, ↓BP, syncope,
angioedema
Management: Provide medication guide to patient
Administer in health care setting and observe patient
Personnel, medications and equipment for treatment of life threatening anaphylaxis
What is allergic asthma ? - ✔✔Associated with family history of allergic disease
Generally responds well to ICS
what is non-allergic asthma? - ✔✔Not associated with allergy
Less responsive to ICS
what is late-onset asthma? - ✔✔Present with asthma as an adult
Require higher doses of ICS or refractory to ICS
what is asthma with fixed airflow limitation? - ✔✔Airway remodeling
what is asthma with obesity? - ✔✔Prominent respiratory symptoms and little eosinophilic
airway inflammation
what is immunotherapy MOA? - ✔✔decrease IgE production, inflammation mediator release
from sensitized cells, tissue responsiveness
,what is the goal of immunotherapy? - ✔✔increase tolerance when natural allergen exposure
occurs
what are the disadvantages of immunotherapy? - ✔✔cost, risk to patient, time commitment
what are some adverse effects of immunotherapy? - ✔✔Local irritation, urticartia,
anaphylaxis (life threatening)
what would the choice be made to do immunotherapy? - ✔✔For those who have failed
avoidance and pharmacotherapy
What is Oralair (Greer Labs) used for ? - ✔✔"allergic Rhinitis" and allergies to the 5 grass
species (perennial rye, kentucky blue, timothy, orchard and sweet vernal)
Ages: 10-65, starting 4 months prior to the season
prescribe and epi pen
what is Grastek (merck) used for ? - ✔✔"allergic rhinitis" and single extract of timothy grass,
which is cross reactive to multiple species
Ages: 5 to 65, starting 12 weeks prior to the season and can be taken for 3 years
prescribe an epi pen
what is Ragwitek (Merck) ? - ✔✔"allergic rhinitis" and extract of short ragweed
Ages: 18 to 65, and start 12 weeks prior to the season
,IL-5 Agent: Mepolizumab (Nucala) - ✔✔add on for severe eospinophilic asthma for greater
than or equal too 12 yo
IL-5 Agent: Reslizumab (Cinqair) - ✔✔add on maintenance for severe eosinophilic asthma of
an 18 year old or greater
Adverse Reactions:
Anaphylaxis
↑ CK/myalgias
Ab development
Oropharyngeal pain
Malignancy
IL-5 Agent: Benralizumab (Fasernra) - ✔✔Add-on for severe asthma with an eosinophilic
phenotype
studied in moderate to very severe COPD with exacerbations and for steroid sparing effect
on patients 12 yo or greater
, Adverse Reactions:
Ab development
Headache
Pharyngitis
Anaphylaxis, angioedema
Urticaria, rash
Injection site rxn
Is ipratropium or less or more receptive for the M3 receptor? - ✔✔Less
What are the main benefits of tiotropium? - ✔✔Improves lung function, dyspnea, and
health-related quality of life
Decreases exacerbations and related hospitalizations
Are there more or fewer studies for aclindinium - ✔✔Fewer studies than its counterparts
What are the benefits of aclindinium? - ✔✔Improves lung function, dyspnea, and health-
related quality of life
Strength of ________________ approved by FDA is lower than shown to have the same
effectiveness as tiotropium (62.5mcg vs 125mcg) - ✔✔Umeclidinium
What are the benefits of umeclidinium? - ✔✔Improves FEV1 and QoL, use of rescue
medication and extends time to first exacerbation
Does glycopyrrolate have faster or slower action than tiotropium and aclindinium? -
✔✔faster (in in vitro studies)
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