Pharm - COPD

Question 1

Outline the therapy for outpatient treatment of a COPD exacerbation

Answer 1

a. SABA via MDI or nebulizer with or without SAMA
b. Corticosteroids: prednisone→dose is dependent on patient’s history of responding to steroids
c. Antibiotics: for those with severe exacerbation requiring mechanical ventilation OR an exacerbation with increased sputum purulence PLUS either increased dyspnea or increased sputum volume
d. Antivirals: if exacerbation is triggered by influenza virus

Question 2

cardinal symptoms of COPD

Answer 2

a. Cough increases in frequency and severity
b. Sputum production increased in volume and/or changes in character
c. Dyspnea increases

Question 3

Identify the risk factors for an infection due to Pseudomonas

Answer 3

a. Frequent exacerbations requiring antibiotics (4+ a year)
b. Pseudomonas cultured during previous hospitalization
c. Severe airflow limitation (FEV1 <50%)
d. Recent hospitalization (2+ days in last 90 days)

Question 4

Identify the most common bacterial causes of an exacerbation

Answer 4

a. H. influenza
b. M. catarrhalis
c. Strep pneumoniae

Question 5

Select the antibiotic of choice in COPD if no RFs for pseudomonas

Answer 5

• ceftriaxone (3rd gen)
• cefotaxime (3rd gen)
• levofloxacin
• moxifloxacin

Question 6

Select the antibiotic of choice in COPD if RFs for pseudomonas

Answer 6

• levofloxacin
• piperacillin-tazobactam
• cefepime (4th gen)
• ceftazidime (3rd gen)

Question 7

goals of therapy in COPD

Answer 7

a. Minimize the impact of the current exacerbation

b. Prevent development of subsequent exacerbations

Question 8

Given a patient who is hospitalized for a COPD exacerbation, select the appropriate use of SABA

Answer 8

drug of choice via nebulizer or MDI. Usually give β-2 agonist every hour and anticholinergics (ipratropium) every 4 hours

Question 9

Given a patient who is hospitalized for a COPD exacerbation, select the appropriate use of steroids

Answer 9

shorten recovery time, improve FEV1 and improve arterial oxygen levels. Reduce risk of early relapse, treatment failure and length of hospital stay

Question 10

Given a patient who is hospitalized for a COPD exacerbation, select the appropriate use of antibiotics

Answer 10

• indicated if:
  i. These 3 sx: increase in dyspnea, sputum volume or sputum purulence OR
  ii. Has 2 sx as long as one is sputum purulence OR
  iii. Require mechanical ventilation

Question 11

appropriate antibiotic prophylaxis to prevent COPD exacerbations

Answer 11

Azithromycin 250mg daily or 250mg 3x/week→for those with frequent exacerbations who are on optimal therapy with bronchodilators and steroids

Question 12

appropriate immunizations to prevent COPD exacerbations

Answer 12

i. Annual influenza to decrease rate/severity of symptoms
ii. Pneumococcal polysaccharide once before 65 y/o and follow up booster 5 years later
iii. Prevnar 13 for those >50 y/o