COP D: (acute) Flashcards

1
Q

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

A

Switch to levalbuterol

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2
Q

Treatment for COPD exacerbation while inpt

A
  • 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
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3
Q

SABA/SAMA use in acute COPD inpt

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

Benefit of systemic glucocorticoid in acute COPD

A
  • improve oxygenation
  • recovery time shorten hospitalzaion
  • reduce risk of relapse
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5
Q

Target O2 sat in acute COPD

A

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

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6
Q

What to monitor for when pt is on supplemental O2

A
  • ABG - donn’t want hypercapnia
  • For resp acidosis
    • pH <7.3
    • PaCO2 >45 mmHG
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7
Q

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

  • Uncomplicated exacerbation
  • <4 exacerbations / year
  • No commorbidites
A
  • zithro
  • clarithromycin
  • 2nd or 3rd gen cephalosporin
  • doxy
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8
Q

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

  • Complicated exacerbation
  • > 4 exacerbations / year
  • Age 65+
  • Commorbidites
A
  • augmentin
  • levofloxacin
  • gemifloxacin
  • moxifloxacin
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9
Q

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
A
  • levofloxacin
  • IV options: 3rd or 4th gen cephalosporin (cefepime, ceftazidime)
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10
Q

ABX to NEVER use in COPD exacerbation

A
  • Erythromycin - doesn’t cover H. influenzae
  • Bactrim - d/t resistance
  • Amoxicillin ad first gen cephalosporins (keflex) d/t beta lactamase susceptibility
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11
Q

ABX monitoring in COPD exacerbation

A
  • WBC
  • O2 requirements
  • temp
  • physical exam
  • renal function (SCr, BUN)
  • hypersensitivity
  • c.diff infection
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12
Q

Pt monitoring in acute COPD exacerbation

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