Exam 1 - Chronic Obstructive Pulmonary Disease (acute)

Question 1

What are risk factors for an acute COPD exacerbation? (4)

Answer 1

respiratory viral illness, bacterial infections, environmental factors, short-term exposure to particulate matter

Question 2

What is required for a mild COPD exacerbation classification? (5)

Answer 2

dypsnea, RR < 24, HR < 95, resting O2 > 92%, CRP < 10

Question 3

What is required for a moderate COPD exacerbation classification? (5)

Answer 3

dypsnea, RR > 24, HR > 95, resting O2 < 92%, CRP > 10 (NEED 3 OF 5)

Question 4

What is required for a severe COPD exacerbation classification? (2)

Answer 4

same as moderate, ABG showing hypercapnia and acidosis

Question 5

In what conditions should noninvasive pressure ventilation be avoided? (4)

Answer 5

AMS, acidosis, respiratory arrest, cardiovascular instability

Question 6

When are scheduled nebulizers no longer preferred inpatient-wise?

Answer 6

after initial three doses

Question 7

What are AEs for albuterol? (2)

Answer 7

tachycardia and DDI with non-selective beta-blockers

Question 8

How should short-acting bronchodilators be given for COPD exacerbation treatment?

Answer 8

2-3 doses then PRN

Question 9

How should systemic glucocorticoids be given for COPD exacerbation treatment?

Answer 9

40 mg prednisone for 5 days

Question 10

What are AEs of systemic glucocorticoids? (2)

Answer 10

leukocytosis, hyperglycemia

Question 11

What is required for antimicrobial therapy initiation in COPD exacerbations?

Answer 11

increased dyspnea, sputum volume, or sputum purulence (need all three or two with one being purulence)

Question 12

Which patients qualify for antimicrobial therapy regardless of cardinal symptoms?

Answer 12

mechanically ventilated

Question 13

Which patients are considered for uncomplicated exacerbation antibiotics? (2)

Answer 13

< 4 exacerbations per year, no comorbidities

Question 14

Which patients are considered for complicated exacerbation antibiotics? (3)

Answer 14

age > 65, > 4 exacerbations per year, comorbidities

Question 15

Which patients are considered high risk for antimicrobial therapy? (3)

Answer 15

chronic corticosteroid therapy, recent hospitalization, recent antibiotics

Question 16

Which antibiotics are used for uncomplicated COPD exacerbations? (3)

Answer 16

macrolides (NOT ERYTHROMYCIN), 2nd/3rd gen cephalosporins, doxycycline

Question 17

Which antibiotics are used for complicated COPD exacerbations? (2)

Answer 17

amoxicillin/clavulanate, fluoroquinolones

Question 18

Which antibiotics are used for high risk COPD exacerbations? (2)

Answer 18

fluoroquinolones, 3rd/4th gen cephalosporins

Question 19

How long should antimicrobial therapy be for COPD exacerbations?

Answer 19

5-7 days

Question 20

What are AEs of antibiotics? (3)

Answer 20

nephrotoxicity, immune reactions, clostridium difficile infection

Question 21

Which patients qualify for oxygen therapy?

Answer 21

< 90% saturation