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24 Cards in this Set
- Front
- Back
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What are the hospital treatment goals for COPD? |
1. Rapid resolution 2. Prevention of tx failure 3. Prevention of future exacerbations 4. Cost-containment |
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What causes an exacerbation in COPD? |
1. IL-8 2. TNF-a 3. MMP-9 All cause mucosal breakdown, allowing colonizing flora to invade |
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What % of COPD exacerbations are viral? |
1. Roughly 50%-- rhinovirus 2. IL-6 |
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Why treat viral COPD with abx? |
1. Suppresses inflammation 2. Suppresses colonizing flora |
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What bacteria should you worry about in COPD? |
1. H. flu 2. Strep P 3. M. catarrhalis**** |
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What PMNs increase in the pathophysiology of COPD? |
1. Neutrophils 2. Lymphocytes 3. Eosinophils |
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What are the characteristics of LABA use? |
1. Reduce frequency of SABA administration 2. Don't speed resolution 3. Improve patient/DO symptom perception |
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What are the LABA/LAMA drugs? |
1. Formoterol, arformoterol, vilanterol 2. Tiotropium, aclidinium |
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What are the etiologic agents behind atypical COPD? |
1. M. pneumoniae 2. C. pneumoniae |
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What is the tx for COPD admission? |
1. Lovenox 2. Doxycycline 3. Humibid LA 4. Prednisone if respiratory failure 5. Solumedrol if no respiratory failure |
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How soon should abx be administered in pneumonia? |
1. 6 hours |
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When should abx be given to COPD patients? |
One of the following
1. Those w/: increased dyspnea, increased sputum volume, increased sputum purulence 2. Increased sputum purulence and one other cardinal symptom 3. Those who require mechanical ventilation |
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Which abx should be used in AECOPD? |
1. Macrolides 2. Quinolones 3. Tetracyclines NO CURRENT GUIDELINES |
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How long should steroids be given in COPD? |
1. Less than 2 weeks 2. 10 days better than 3 in severe exacerbation 3. But 5 days is better than 14 days |
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What are the steroid options to tx COPD? |
1. Prednisone 2. Methylpredisolone 3. Inhaled budesonide 4. Inhaled fluticasone |
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What is the optimum dose of prednisone? |
1. 20-80 mg 2. Keep doses down, oral when possible |
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What do patients on a ventilatory need? |
1. **Steroids 2. **Abx |
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What should the dosage of corticosteroids be for COPD? |
1. 1 mg/kg methylprednisolone/day |
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Who needs non-invasive ventilation? |
1. **Moderate to severe dyspnea with accessory muscle ventilation 2. **Moderate to severe acidosis (<7.35) and/or hypercapnia 3. **Respiratory frequency>25 bpm |
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Who should NOT get NIV? |
1. Respiratory arrest 2. CV instability 3. Change in mental status 4. High aspiration risk 5. Viscous or copious secretions 6. Recent facial or gastroesophageal surgery 7. Craniofacial trauma 8. Fixed nasopharygeal abnormalities 9. Burns 10. Extreme obesity |
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1.Can positive pressure NIV reduce mortality in COPD patients in the hospital? |
**YES** Especially in acidotic patients |
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When can you discharge a COPD patient and expect success? |
1. B2 puffer less than every 4 hours 2. Ambulatory 3. Sleep, eat, talk 4. Clinically stable, ABGs 5. Understands med |
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What is the single best way to prevent hospital readmission in COPD? |
1. **Pulmonary rehab** |
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Can you use OMM to tx COPD? |
ABSOLUTELY NOT |
