COP D: (acute)

Question 1

If pt becomes tachycardic while on albuterol, what do you do

Answer 1

Switch to levalbuterol

Question 2

Treatment for COPD exacerbation while inpt

Answer 2

• SABA+/- SAMA
• Continue long acting brochodilator (or start on discharge if not on prior)
• Systemic glucocorticoid: 40mg prednisone 5D
• O2 therpay if pt O2 sat <90%
• ABX if pt has increased sputum purulence and one of the following
  - increased dyspnea
  - increased sputum volume

Question 3

SABA/SAMA use in acute COPD inpt

Answer 3

• formulation (neb vs. inhaler device) does NOT matter
• give 1 dose Q1H for 2-3 doses then Q2-4H PRN

Question 4

Benefit of systemic glucocorticoid in acute COPD

Answer 4

• improve oxygenation
• recovery time shorten hospitalzaion
• reduce risk of relapse

Question 5

Target O2 sat in acute COPD

Answer 5

88-92%
If no improvement while on supplemental O2, pt will need mechanicla ventilation

Question 6

What to monitor for when pt is on supplemental O2

Answer 6

• ABG - donn’t want hypercapnia
• For resp acidosis
  
  • pH <7.3
  • PaCO2 >45 mmHG

Question 7

What ABX to use in an acute COPD pt with the following characteristics:

• Uncomplicated exacerbation
• <4 exacerbations / year
• No commorbidites

Answer 7

• zithro
• clarithromycin
• 2nd or 3rd gen cephalosporin
• doxy

Question 8

What ABX to use in an acute COPD pt with the following characteristics:

• Complicated exacerbation
• > 4 exacerbations / year
• Age 65+
• Commorbidites

Answer 8

• augmentin
• levofloxacin
• gemifloxacin
• moxifloxacin

Question 9

What ABX to use in an acute COPD pt with the following characteristics:

• High risk for MDR
• Chronic cortocosteroid therapy
• Hospitlazation in past 90 days
• ABX use in past 90 days
• LTC resident

Answer 9

• levofloxacin
• IV options: 3rd or 4th gen cephalosporin (cefepime, ceftazidime)

Question 10

ABX to NEVER use in COPD exacerbation

Answer 10

• Erythromycin - doesn’t cover H. influenzae
• Bactrim - d/t resistance
• Amoxicillin ad first gen cephalosporins (keflex) d/t beta lactamase susceptibility

Question 11

ABX monitoring in COPD exacerbation

Answer 11

• WBC
• O2 requirements
• temp
• physical exam
• renal function (SCr, BUN)
• hypersensitivity
• c.diff infection

Question 12

Pt monitoring in acute COPD exacerbation

Answer 12

• Temp, HR RR TID
• WBC, SCr, electrolytes
• S/Sx QD