24 Chronic Obstructive Pulmonary Disease
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Maintenance Treatment:
-Salmeterol (Serevent) 2 puffs bid; not effective for acute asthma because of
delayed onset of action.
-Pirbuterol (Maxair) MDI 2 puffs q4-6h prn.
-Bitolterol (Tornalate) MDI 2-3 puffs q1-3min, then 2-3 puffs q4-8h prn.
-Fenoterol (Berotec) MDI 3 puffs, then 2 bid-qid.
-Ipratropium (Atrovent) MDI 2-3 puffs tid-qid.
Prevention and Prophylaxis:
-Cromolyn (Intal) 2-4 puffs tid-qid.
-Nedocromil (Tilade) 2-4 puffs bid-qid.
-Montelukast (Singulair) 10 mg PO qd.
-Zafirlukast (Accolate) 20 mg PO bid.
-Zileuton (Zyflo) 600 mg PO qid.
Acute Bronchitis
-Ampicillin/sulbactam (Unasyn) 1.5 gm IV q6h OR
-Ampicillin 0.5-1 gm IV q6h or 250-500 mg PO qid OR
-Cefuroxime (Zinacef) 750 mg IV q8h OR
-Cefuroxime axetil (Ceftin) 250-500 mg PO bid OR
-Trimethoprim/Sulfamethoxazole (Bactrim DS), 1 tab PO bid OR
-Levofloxacin (Levaquin) 500 mg PO/IV PO qd [250, 500 mg].
10. Symptomatic Medications:
-Docusate sodium (Colace) 100 mg PO qhs.
-Ranitidine (Zantac) 50 mg IV q8h or 150 mg PO bid.
11. Extras: Portable CXR, ECG, pulmonary function tests before and after
bronchodilators; pulmonary rehabilitation.
12. Labs: ABG, CBC with eosinophil count, SMA7. Theophylline level stat and
after 24h of infusion. Sputum Gram stain, C&S.
Chronic Obstructive Pulmonary Disease
1. Admit to:
2. Diagnosis: Exacerbation of COPD
3. Condition:
4. Vital signs: q4h. Call physician if P >130; R >30, <10; T >38.5
C; O
2
Sat
<90%.
5. Activity: Up as tolerated; bedside commode.
6. Nursing: Pulse oximeter. Measure peak flow with portable peak flow meter
bid and chart with vital signs. No sedatives.
7. Diet: No added salt, no caffeine. Push fluids.
8. IV Fluids: D5 1 NS with 20 mEq KCL/L at 125 cc/h.
9. Special Medications:
-Oxygen 1-2 L/min by NC or 24-35% by Venturi mask, keep O
2
saturation 90-
91%.
Beta-Agonists, Acute Treatment:
-Albuterol (Ventolin) 0.5 mg and ipratropium (Atrovent) 0.5 mg in 2.5 mL NS
q1-2h until peak flow meter
200-250 L/min, then q4h OR
