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-Mucous gland
-diminished lung
enlargement and -macrophage and
function
goblet cell -inc. inflammatory neutrophil
hyperplasia response to dust recruitment
-impairs ciliary action and smoke -inflammatory
-allergies cytokines activation
BMI: 17
PE CHEST: prominent Inflammation
Cachexia SPUTUM G/S:
rib cage with Oxidative stress
Gram – bacilli
decreased AP
SPUTUM C/S:
diameter
H. influenza
Fibrosis and thickening CXR: Hyperinflated
of alveolar walls lungs, pneumonic
infiltrates at right mid
Wheezing lung area
Spirometry: Obstruction of airways in both
FEV 1 lung fields
FEV1/FVC
Air trapping
Tachypnea
Ventilation:Perfusion
Alveolar hypoxia
PNEUMOTHORAX mismatch
Hypercarbia Hypoxemia
PE CHEST:
CXR: Positive
Hyperresonant on
Pneumothorax, right
percussion
chest, 30%
Decreased vocal Respiratory Increase RBC
ECG: Tachycardic, small
and tactile acidosis production to
QRS complex, prominent
fremitus compensate for
P waves, Right axis
deviation dec. Oxygen
ABG: pH 7.20
PCO2 88 mmHg
PO2 50 mmHg CBC: Hgb 17 g/dL
HCO3 28 mEq/L HCT 51%
GLUCOCORTICOID
Hydrocortisone Hydrocortisone is a corticosteroid Side effects: Sodium and fluid Among patients admitted to the
used for its anti-inflammatory and retention. Potassium and calcium hospital d/t COPD, the use of
immunosuppressive effects. Its depletion. Muscle wasting, flucocorticoids has been
anti-inflammatory action is due to weakness, osteoporosis. demonstrated to reduce the length
the suppression of migration of of stay, hasten recovery, and
polymorphonuclear leukocytes and Contraindications: Viral/fungal reduce the chance of subsequent
reversal of increased capillary infections, tubercular or syphilitic relapse for a period of up to 6
permeability. It may also be used lesions, bacterial infections unless months.
as replacement therapy in used in conjunction with appropriate
adrenocortical insufficiency. chemotherapy.
ANTIBACTERIAL
Cefuroxime Cefuroxime inhibits bacterial cell Side effects: rash, fever, pruritus, To treat respiratory infections/
wall synthesis by binding to one 1 erythema, urticaria, Stevens-Johnson pneumonia.
or more of the penicillin-binding syndrome, erythema multiforme
proteins (PBPs) which in turn
inhibit the final transpeptidation Contraindications: Hypersensitivity
step of peptidoglycan synthesis in to cefuroxime or to other
bacterial cell walls, thus inhibiting cephalosporins.
cell wall biosynthesis and arresting
cell wall assembly resulting in
bacterial cell death.
LONG-ACTING B2 AGONIST/INHALED CORTICOSTEROID (LABA/ICS)
Salmeterol + Salmeterol, a long acting β2- Side effects: Mouth and throat For management of Asthma and
Fluticasone agonist which acts locally in the candidiasis, throat irritation, COPD.
lung to mediate bronchodilation. hoarseness/dysphonia,
Fluticasone, a corticosteroid with nasopharyngitis, lower respiratory
mainly glucocorticoid activity, tract infections (e.g. pneumonia and
reduce symptoms and bronchitis), hypokalaemia, headache,
exacerbations of asthma. tremors, palpitation, muscle cramps.
Prolonged high dose use may cause
Cushing's syndrome, Cushingoid
features, adrenal suppression,
retardation of growth in children and
adolescents, bone mineral density
decrease, cataract and glaucoma.
THEOPHYLLINE
Aminophylline Theophylline competitively blocks Side effects: Nausea, vomiting, To relieve acute bronchospasm.
phosphodiesterase which increases epigastric pain, abdominal cramps,
cyclic adenine monophosphate anorexia, diarrhoea, haematemesis;
(cAMP) tissue concentrations headache, irritability, restlessness,
causing bronchodilatation, diuresis, nervousness, insomnia, dizziness,
CNS and cardiac stimulation, and reflex hyperexcitability, seizures;
gastric acid secretion. palpitations, sinus tachycardia,
extrasystoles, increased pulse rate,
flushing, circulatory failure,
hypotension, ventricular
arrhythmias; transient increase in
urinary frequency, dehydration,
twitching of fingers and hands,
tachypnoea, elevated serum AST
concentrations.
Contraindications: Hypersensitivity
to theophylline and other xanthine
derivatives. Porphyria
ANTIPYRETIC
Tramadol Tramadol exhibits analgesic action Side effects: Thrombocytopenia, To manage fever (38C).
by peripheral blockage of pain leucopenia, pancytopenia,
impulse generation. It produces neutropenia, agranulocytosis, pain
antipyresis by inhibiting the and burning sensation at inj site.
hypothalamic heat-regulating Rarely, hypotension and tachycardia.
center. Its weak anti-inflammatory
activity is related to inhibition of
prostaglandin synthesis in the CNS.
MUCOLYTIC
Ambroxol Ambroxol is a metabolite of Side effects: Mild GI effects and To lyse mucous in productive
bromhexine and is used similarly as allergic reactions. cough.
a mucolytic.
Carmel Mae Catacutan, M.D. Carmel Mae Catacutan, M.D. Carmel Mae Catacutan, M.D.
Silliman University Medical Center Silliman University Medical Center Silliman University Medical Center
Dumaguete City Dumaguete City Dumaguete City
(035) 225-0330 (035) 225-0330 (035) 225-0330
Rx Rx Rx
Salbutamol (Ventolin) #15 nebules Tiotroprium bromide (Spiriva) #1 Hydrocortisone (Hydrovex) #2 vials
Sig: 2.5 mg via inhalation, q 30 mins Sig: 1 cap (18 mcg) via inhaler device, Sig: 100 mg IV, q 6 hrs
OD
Carmel Mae Catacutan, M.D. Carmel Mae Catacutan, M.D. Carmel Mae Catacutan, M.D.
Silliman University Medical Center Silliman University Medical Center Silliman University Medical Center
Dumaguete City Dumaguete City Dumaguete City
(035) 225-0330 (035) 225-0330 (035) 225-0330
Rx Rx Rx
Cefuroxime (Axetine) #1 pack Salmeterol + Fluticasone Aminophylline (Aminosol) #7
(Combiwave SF125) # 1 inhaler
Sig: 750 mg IVTT ANST, q 8 hrs Sig: 400 mg/day, PO
Sig: 50/125 mcg MDI puff, BID
Carmel Mae Catacutan, M.D. Carmel Mae Catacutan, M.D. Carmel Mae Catacutan, M.D.
Lic.No 083093 Lic.No 083093 Lic.No 083093
Rx Rx
Paracetamol (Biogesic) #5 tabs Ambroxol (Mucosolvan) # 1 syrup