Asthma/COPD

Question 1

S&S of asthma

Answer 1

-resp distress at rest -*difficulty speaking in sentences -*hyperresonance (=air trapping) *pulsus paradoxus >12mmHg -use of accessory muscles -tachypnea (>28) -tachycardia (>110) -cough -chest tightness

Question 2

When is hospitalization recommended in asthma?

Answer 2

-if initial FEV1 is <30% predicted or does not increase to at least 40% predicted after 1 hr of vigorous therapy -if peak flow is <60L/min initially or does not improve to >50% predicted after 1 hr of tx

Question 3

What would initial ABG of asthmatic patient demonstrate?

Answer 3

respiratory alkalosis w/mild hypoxemia

Question 4

Outpatient management of asthma

Answer 4

1. SABA- for sxs relief or before exercise
2. LCS for daily maintenance
3. if sxs persist despite above, increase LCS or add LABA (salmeterol)
4. inhaled anticholinergics may be added if necessary (i.e lots of secretions)–> Ipratropium

Question 5

What class of medications is useful in the maintenance of chronic asthma?

Answer 5

antileukotrienes (Montelukast- Singulair)

Question 6

Management of inpatient asthma

Answer 6

• supplemental O2 (2-3L/min)
• severe attacks–> ABG
• hydration (IVF)
• Inhaled sympathomimetics: Albuterol , Metaproterenol

*Corticosteroids in those who do not respond to sympathomimetics

-Anticholinergics

Question 7

Dose of albuterol (Proventil, Ventolin) in treating asthma exacerbation

Answer 7

0.3cc in 3ml NSS q30-60min

Question 8

Dose of metaproterenol (alupent)

Answer 8

0.3 cc in 2.2ml NSS q30-60min

Question 9

Dose of methylprednisolone in asthma exacerbation

Answer 9

60-125mg IV x 1 then 20mg IV q4-6hrs until attack broken

Question 10

Dose of atrovent in asthma exacerbation

Answer 10

MDI 2-6 puffs q4-6hr

Question 11

Dose of steroids in status asthmaticus

Answer 11

Methylprednisolone 60-125mg or hydrocortisone 300mg IV

Question 12

definition of chronic bronchitis

Answer 12

excessive secretion of bronchial mucus; manifested by productive cough x 3 mon or more in at least 2 consecutive years

Question 13

S&S of chronic bronchitis

Answer 13

BLUE BLOATER (obese) -intermittent mild-mod dyspnea -onset of sxs after age 35 -*copious sputum production (purulent) -*chest AP normal -*percussion normal -hyperinflation, bulla, blebs + flattened diaphragm on CXR -Hct inc -hypercapnea, hypoxemia on ABG

Question 14

S&S if Emphysema

Answer 14

PINK PUFFER (thin, wasted) -progressive, constant dyspnea -onset of sxs after age 50 -mild sputum (clear) -Chest AP increased -percussion hyperresonant -HCT normal -TLC inc -flattened diaphragm on CXR

Question 15

Which COPD exacerbation patients should receive ABX?

Answer 15

those w/purulent sputum

Question 16

ABX for treatment of COPD exacerbation

Answer 16

Ampicillin or Amoxicillin 500mg QID

OR Doxycycline 100mg BID

OR Bactrim DS 1 tab daily

Question 17

In patient management of COPD exacerbation

Answer 17

O2 1-2L

pharmacologic progression as for in patient asthma exac

ABX for those w/purulent sputum