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  #1  
Old 08-21-2012
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Default COPD with exacerbation..antibiotic of choice and why ?

A 65-year-old man with chronic obstructive pulmonary disease is evaluated in the emergency
department for a 4-day history of worsening dyspnea, cough, and increased production of
purulent sputum. His albuterol inhaler has been ineffective in relieving his symptoms.
On physical examination, the patient is in respiratory distress using pursed-lip breathing.
Temperature is 36.7C (98.0F), blood pressure is 145/84 mm Hg, pulse rate is 102/min, and
respiration rate is 20/min. He has audible polyphonic wheezes but no crackles. Heart sounds
are distant but otherwise normal. The remainder of his physical examination is normal.
Arterial blood gases performed on 2 L/min nasal cannula: pH, 7.31; PCO2, 50 mm Hg (6.7
kPa); PO2, 65 mm Hg (8.6 kPa). Chest radiograph displays hyperinflation but no infiltrates.
Intravenous corticosteroids and inhaled albuterol are begun.
Which of the following treatments should also be initiated?
(A) Amoxicillin
(B) Inhaled corticosteroids
(C) Levofloxacin
(D) Theophylline
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  #2  
Old 08-21-2012
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and C ........ levofloxacin is the best for community acquired pneumonia and penicillin resistant pneumoncoccus and it also covers pseudomonas so will work way better than amoxicillin
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Old 08-21-2012
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and C ........ levofloxacin is the best for community acquired pneumonia and penicillin resistant pneumoncoccus and it also covers pseudomonas so will work way better than amoxicillin
why you say this patient has pneumonia btw ?
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Old 08-21-2012
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Quote:
Originally Posted by tyagee View Post
A 65-year-old man with chronic obstructive pulmonary disease is evaluated in the emergency
department for a 4-day history of worsening dyspnea, cough, and increased production of
purulent sputum. His albuterol inhaler has been ineffective in relieving his symptoms.
On physical examination, the patient is in respiratory distress using pursed-lip breathing.
Temperature is 36.7C (98.0F), blood pressure is 145/84 mm Hg, pulse rate is 102/min, and
respiration rate is 20/min. He has audible polyphonic wheezes but no crackles. Heart sounds
are distant but otherwise normal. The remainder of his physical examination is normal.
Arterial blood gases performed on 2 L/min nasal cannula: pH, 7.31; PCO2, 50 mm Hg (6.7
kPa); PO2, 65 mm Hg (8.6 kPa). Chest radiograph displays hyperinflation but no infiltrates.
Intravenous corticosteroids and inhaled albuterol are begun.
Which of the following treatments should also be initiated?
(A) Amoxicillin
(B) Inhaled corticosteroids
(C) Levofloxacin
(D) Theophylline
Answer is C, Levofloxacin, can be used as inpatient or outpatient Monotherapy of pneumonia.

A- Amoxicilin is for URI

B.Inhaled Corticosteroids hav NO role in the Mx of COPD. IV or Oral corticosteroids are used

D. Theophylline i presume is last resortT/M, only incases not responding to the standard therapy. Know theophylline for its toxic effects. and if pt is on theophyline, check theophylline levels in every Clinic visit!
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Old 08-21-2012
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Quote:
Originally Posted by tyagee View Post
A 65-year-old man with chronic obstructive pulmonary disease is evaluated in the emergency
department for a 4-day history of worsening dyspnea, cough, and increased production of
purulent sputum. His albuterol inhaler has been ineffective in relieving his symptoms.
On physical examination, the patient is in respiratory distress using pursed-lip breathing.
Temperature is 36.7C (98.0F), blood pressure is 145/84 mm Hg, pulse rate is 102/min, and
respiration rate is 20/min. He has audible polyphonic wheezes but no crackles. Heart sounds
are distant but otherwise normal. The remainder of his physical examination is normal.
Arterial blood gases performed on 2 L/min nasal cannula: pH, 7.31; PCO2, 50 mm Hg (6.7
kPa); PO2, 65 mm Hg (8.6 kPa). Chest radiograph displays hyperinflation but no infiltrates.
Intravenous corticosteroids and inhaled albuterol are begun.
Which of the following treatments should also be initiated?
(A) Amoxicillin
(B) Inhaled corticosteroids
(C) Levofloxacin
(D) Theophylline
I would say C, as it provides a good coverage for the common respiratory pathogens in additions to Pseudomonas, But i'm confused with the daignosis of pneumonia, as the pt. afebrile, no crackles and no chest infiltrate in X ray
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Old 08-21-2012
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Quote:
Originally Posted by Anders View Post
I would say C, as it provides a good coverage for the common respiratory pathogens in additions to Pseudomonas, But i'm confused with the daignosis of pneumonia, as the pt. afebrile, no crackles and no chest infiltrate in X ray
Antibiotics are a part of treatment of exacerbation of COPD. pt doesnt need to have pneumonia to get em. also these exacerbations are mainly caused by infections!
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  #7  
Old 08-21-2012
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Quote:
Originally Posted by shyangel18 View Post
Antibiotics are a part of treatment of exacerbation of COPD. pt doesnt need to have pneumonia to get em. also these exacerbations are mainly caused by infections!
I do agree, as the use of antibiotic is warrant in the case of COPD excerbation.
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