Beta Agonists Acute Treatment

Asthma Free Forever

Asthma Free Forever By Jerry Ericson

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-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

-Albuterol (Ventolin) MDI 2-4 puffs q4-6h. -Albuterol/Ipratropium (Combivent) 2-4 puffs qid.

Corticosteroids and Anticholinergics:

-Methylprednisolone (Solu-Medrol) 60-125 mg IV q6h or 30-60 mg PO qd.

Followed by: -Prednisone 20-60 mg PO qd.

-Triamcinolone (Azmacort) MDI 2 puffs qid or 4 puffs bid. -Beclomethasone (Beclovent) MDI 4-8 puffs bid with spacer, followed by gargling with water OR -Flunisolide (AeroBid) MDI 2-4 puffs bid OR -Ipratropium (Atrovent) MDI 2 puffs tid-qid OR -Fluticasone (Flovent) 2-4 puffs bid (44 or 110 mcg/puff.

Aminophylline and Theophylline (second line therapy):

-Aminophylline loading dose, 5.6 mg/kg total body weight over 20 min (if not already on theophylline); then 0.5-0.6 mg/kg ideal body weight/hr (500 mg in 250 mL of D5W); reduce if elderly, or heart or liver disease (0.2-0.4 mg/kg/hr). Reduce loading to 50-75% if already taking theophylline (1 mg/kg of aminophylline will raise levels by 2 mcg/mL) OR -Theophylline IV solution loading dose, 4.5 mg/kg total body weight, then 0.40.5 mg/kg ideal body weight/hr. -Theophylline long acting (Theo-Dur) 100-400 mg PO bid-tid (3 mg/kg q8h); 80% of daily IV aminophylline in 2-3 doses.

Acute Bronchitis

-Ampicillin 1 gm IV q6h or 500 mg PO qid OR

-Trimethoprim/sulfamethoxazole (Septra DS) 160/800 mg PO bid or 160/800

mg IV q12h (10-15 mL in 100 cc D5W tid) OR -Cefuroxime (Zinacef) 750 mg IV q8h OR -Ampicillin/sulbactam (Unasyn) 1.5 gm IV q6h OR -Doxycycline (Vibra-tabs) 100 mg PO/IV bid

-Azithromycin (Zithromax) 500 mg x 1, then 250 mg PO qd x 4 or 500 mg IV q24h OR

-Clarithromycin (Biaxin) 250-500 mg PO bid OR -Levofloxacin (Levaquin) 500 mg PO/IV qd [250, 500 mg] OR -Sparfloxacin (Zagam) 400 mg PO x 1, then 200 mg PO qd [200 mg].

10. Symptomatic Medications: -Docusate sodium (Colace) 100 mg PO qhs. -Ranitidine (Zantac)150 mg PO bid or 50 mg IV q8h.

11. Extras: Portable CXR, PFT's with bronchodilators, ECG.

12. Labs: ABG, CBC, SMA7, UA. Theophylline level stat and after 12-24h of infusion. Sputum Gram stain and C&S, alpha 1 antitrypsin level.

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