COPD Exacerbations

Question 1

Asthma Excerbation

Answer 1

• SOB, coughing, wheezing, chest tightness (PFT)
• Decrease in Expiratory Airflow (PEF)
• Mild, Mod, Sev, Life Threatening

Question 2

Attack Goals

Answer 2

• Correct Hypoxia
• Rapid Reversal of Airway Obstruction-Early admin of Cortiscosteroids
• Repetitive admin of SABA
• reeval in a few days

Question 3

Treat Attack

Answer 3

• admin Albuterol alone or w/ Ipratropium
• reassess, repeat
• admin po cortiscosteroids, and adjuvent meds, if needed
• assess for infection before giving Cortiscosteroids

Question 4

Quick Relief Medications: Anticholinergics

Answer 4

• Ipratropium bromide (Atrovent)
• Administer in multiple doses along with SABA in mod/severe exacerbation (3 doses)
• Caution if glaucoma or urinary outflow problems
• Side effects: dry mouth, constipation, blurred vision, hoarseness, flushing

Question 5

Short-Acting Beta2-Agonists

Answer 5

• First line for acute s/s and prevention of EIB
• Albuterol (Proair, Ventolin, Proventil)
• Levalbuterol (Xopenex)
• Pirbuterol (Maxair)
• Relax smooth muscle and increase airflow
• Regular use is not recommended
• Active portion is R-enantiomer

Question 6

Albuterol Dosing: Inhaled

Answer 6

• Weight Based
• 0.15 mg/kg/dose
• Cardiac no more than 1 ml max

Question 7

Albuterol Dosing: Oral

Answer 7

• Used Less Frequently

- More SE

Question 8

Albuterol: Safety

Answer 8

• Pregnancy category C
• Lactation category 1- compatible
• Greater Harm in Not Administering
• No renal or hepatic dosing needed
• Cardiac

Question 9

Levabuterol

Answer 9

• R-isomer of racemic albuterol
• Side effects = tachycardia, palpitations, tremor, insomnia, nervousness, nausea, headache
• As effective as albuterol with fewer cardiac side effects
• Dosing not equivalent

Question 10

Systemic Corticosteroids

Answer 10

• Should be used in All Moderate to Severe Exacerbations
• Risk of adverse effects related to dose and length of treatment hence the term “steroid burst” (5-7 days), taper off
• Memorize
• Prednisone/prednisolone 1–2 mg/kg/day, max 40–80 mg/day outpatient
• COPD 40 mg/day
• Asthma 60 mg/day

Question 11

Exacerbation

Answer 11

-change in pt baseline

Question 12

COPD

Answer 12

• increase in: dyspnea, sputum volume, sputum purulence

- Upper Resp Infection in last 5 days

Question 13

COPD

Answer 13

• From: infection, environmental cause, CHF, PE

- Eval:chest xray, pulse ox

Question 14

Outpatient Excerbations

Answer 14

• bronchodilators
• oral steroids
• o2 prn
• abx (purulent sputum)

Question 15

Asthma & Vaccines

Answer 15

• Never give active!

- Dangerous!

Question 16

ABX Treatment

Answer 16

• Group A: mild, no risk factors (beta-lactam tetracycline, macrolide)
• Group B: moderate with risk factors (beta-lactam lactamase inhibitor, augmentin)
• Group C and D: severe with risk factors for P. aeruginosa (Fluoroquinolone)

Question 17

Albuterol

Answer 17

• max 5/ day
• cardiac max 1 ml po
• 3 doses, 20 minutes apart

Question 18

Albuteral vs Levbuteral

Answer 18

-Lev less SE (Cardiac)

Question 19

Albuteral

Answer 19

• 2.5 Start nebulizer to 5
• reassessafter each dose
• home w/ po prednisone (1-3 days)

Question 20

Beta Agonists not working

Answer 20

-Long acting Anticholinergic (will dry secretions)

Question 21

Steroids

Answer 21

-weight gain short term

Question 22

Artovent MDI

Answer 22

-do not use with peanut allergy

Question 23

Preg

Answer 23

• treat w/albuteral
• amoxacillin
• zofran

Question 24

02

Answer 24

88%

Question 25

Basic Peds Nebulizer

Answer 25

0.15mg/kg/dose

Question 26

Prednisone

Answer 26

1-2 mg/kg/day

Question 27

COPD Stages

Answer 27

- Stage 1: 80% Predicted - Stage 2: 50%-80% - Stage 3: 30%-50% - Stage 4: Less than 30% (avoid O2)

Question 28

COPD Illness in last 90 days or Abx

Answer 28

-Quinlones

Question 29

COPD Acute

Answer 29

- bronchodilators | - oral steroids

Question 30

Bronchodilators

Answer 30

- decrease airway resistence - improve air trapping - decrease O2 demand

Question 31

Long Acting Anticholinergics

Answer 31

-severe acute

Question 32

Cornerstone COPD

Answer 32

Bronchodilator

Question 33

Cornerstone Asthma

Answer 33

ICS

Question 34

COPD

Answer 34

- obstruction - not always infection - notalways inflammation - steroids 10-14 days

Question 35

Max dose prednisone

Answer 35

60

Question 36

ICS

Answer 36

- Asthma: Gold Standard treatment, can prevent function loss | - COPD: no monotherpay, cant prevent loss of funtion

Question 37

Antiflammatory Drugs

Answer 37

ICS

Question 38

Broncholdilator Drugs

Answer 38

LABAs, Theophylline/Methylxanthines

Question 39

Neutraophil predominent inflamation

Answer 39

smokers, blacks,

Question 40

Steroids

Answer 40

Monitor bone fracture, glaucoma

Question 41

Xolair

Answer 41

- long term adjunct (only way) | - allegic and severe treated best in combo with ICS (osteoperosis lomg term)

Question 42

Singulair

Answer 42

- young adults, mood suicide | - lfts

Question 43

Long Acting Beta Agonists

Answer 43

- SAD - montherapy in COPD, NOT Asthma - long duration

Question 44

Combo Meds-SAD-Symbicort, Advair, Dulera

Answer 44

- same black box warning | - not as dangerous

Question 45

GI Ulcer

Answer 45

-do not give roflumalist