COPD Exacerbations Flashcards
1
Q
Asthma Excerbation
A
- SOB, coughing, wheezing, chest tightness (PFT)
- Decrease in Expiratory Airflow (PEF)
- Mild, Mod, Sev, Life Threatening
2
Q
Attack Goals
A
- Correct Hypoxia
- Rapid Reversal of Airway Obstruction-Early admin of Cortiscosteroids
- Repetitive admin of SABA
- reeval in a few days
3
Q
Treat Attack
A
- admin Albuterol alone or w/ Ipratropium
- reassess, repeat
- admin po cortiscosteroids, and adjuvent meds, if needed
- assess for infection before giving Cortiscosteroids
4
Q
Quick Relief Medications: Anticholinergics
A
- 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
5
Q
Short-Acting Beta2-Agonists
A
- 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
6
Q
Albuterol Dosing: Inhaled
A
- Weight Based
- 0.15 mg/kg/dose
- Cardiac no more than 1 ml max
7
Q
Albuterol Dosing: Oral
A
- Used Less Frequently
- More SE
8
Q
Albuterol: Safety
A
- Pregnancy category C
- Lactation category 1- compatible
- Greater Harm in Not Administering
- No renal or hepatic dosing needed
- Cardiac
9
Q
Levabuterol
A
- 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
10
Q
Systemic Corticosteroids
A
- 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
11
Q
Exacerbation
A
-change in pt baseline
12
Q
COPD
A
- increase in: dyspnea, sputum volume, sputum purulence
- Upper Resp Infection in last 5 days
13
Q
COPD
A
- From: infection, environmental cause, CHF, PE
- Eval:chest xray, pulse ox
14
Q
Outpatient Excerbations
A
- bronchodilators
- oral steroids
- o2 prn
- abx (purulent sputum)
15
Q
Asthma & Vaccines
A
- Never give active!
- Dangerous!
16
Q
ABX Treatment
A
- 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)
17
Q
Albuterol
A
- max 5/ day
- cardiac max 1 ml po
- 3 doses, 20 minutes apart
18
Q
Albuteral vs Levbuteral
A
-Lev less SE (Cardiac)
