copd 2

Question 1

A change is the patient’s natural course of the disease characterized by a change in baseline dyspnea, cough, and/or sputum beyond day to day vulnerability.

Answer 1

COPD exacerbation

Question 2

medications used in the treatment of COPD exacerbation?

Answer 2

SABA (albuterol ie: proventil)and/or SAMA (ipratropium bromide)
Systemic corticosteroids - (40-60mg x5 days)
ABX if absolutely necessary

Question 3

First-line therapy for GOLD stage 1 or 2

A (low exacerbation risk less sx)

Answer 3

SABA (albuterol ie: proventil) PRN
OR
SAMA (ipratropium bromide) PRN

Question 4

First-line therapy for GOLD stage 1 or 2

B (low exacerbation risk more symptoms)

Answer 4

SABA (albuterol ie: proventil) Scheduled
OR
SAMA (ipratropium bromide Atrovent) Scheduled

Question 5

First-line therapy for GOLD stage 3 or 4

C (high exacerbation risk less symptoms)

Answer 5

LAMA (long-acting muscarinic antagonist tiotropium -Spiriva) SCHEDULED

Question 6

First-line therapy for GOLD stage 3 or 4

D (high exacerbation risk more symptoms)

Answer 6

option 1:
LAMA (long-acting muscarinic antagonist tiotropium -Spiriva) SCHEDULED plus LABA (Long-acting beta 2 agonist salmeterol (Serevent)
option 2:
ICS (fluticasone (flovent) budesonide (pulmicort) plus LABA (Long acting beta 2 agonist salmeterol (serevent)
Option 3:
ICS/LABA/LAMA combination
ALL SCHEDULED

Question 7

If abx are prescribed for a mild to moderate exacerbation, list the 4 recommended drugs

Answer 7

1. Amoxicillin
2. TMP/SMX
3. • best Doxycycline
4. Cephalosporin

Question 8

Drawback to Amoxicillin

Answer 8

poor beta-lactamase coverage

Question 9

Drawback to TMP/SMX

Answer 9

should avoid in patients taking an ace or ARB due to risk of hyperkalemia

Question 10

Drawback to doxycycline

Answer 10

this is the best choice for ABX therapy in mild to moderate COPD exacerbation

Question 11

Drawback to Cephalosporin

Answer 11

3rd generations are a good choice just need to take more frequently (Cefdinirr, cefpodoxime)

Question 12

If abx are prescribed for a severe exacerbation, list the 5 recommended drugs

Answer 12

Beta-lactam
1. Amox-clav (really tough on belly)
* Best 2. Cephalosporin (Cefdinirr, cefpodoxime)
Macrolide
3. Azithromycin (prolongs QT)
4. Clarithrmycin (CYP450 inhibitor and QT prolongation)
Respiratory Fluroquinolones
5. Moxi or levofloxacin older adults taking are more likely for tendon rupture

Question 13

How many hours a day should O2 be worn?

Answer 13

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