Delta Flashcards
Buproprion - contraindication
bipolar disorder
but okay in mild depression
Varenicline - contraindications
suicidal ideation
NRT - contraindications
unstable IHD
Smoking cessation: best inverventions
combination NRT (short and long acting) + begavioural intervention
Omalizumab target
IgE
Mepolizumab targget
IL-5
Benralizumab target
IL-5 receptor
DUpilimab target
IL4 and IL 13
Tezepelumab target
thymic stromal lymphopoietin (TSLP)
Severe asthma definition and red flags
requires maximum controller therapy or despite maximal therapy remains uncontrolled
Red flags: poor symptom control, frequent / severe / sudden exacerbations, female, obesity, smoking, elevated peripheral eosinophils
How is asthma categorised?
Why does this matter?
High T2 (Allergic / eosinophilic) and low T2 (non-eosinophilic)
Predicts response to MABs to IgE / IL-5 / IL-4/13
ILD
- work up
clinical data
HRCT
Pathology / autoimmune screen
BAL / biopsy
UIP typical HRCT features
honeycombing
traction bronchiectasis
reticular opacities - peripheral and lower lobe predominant
No atypical features
Indications for lung transplant
risk of death >50% within 2 years
likelihood of surviving >90 post TP is >80%
No life-limiting comorbidity in 5 years post
satisfactory supports / psychosocial
contraindications for lung transplant
age >65
smoking, alcohol / drug dependence
malignancy
chronic infection
obesity or malnutrition
osteoporosis - severe symptomatic
When to refer IPF patient for transplant
DLCO <40% predicted
FVC <80% predicted
Dyspnoe or functional limitation
Decrease in SpO2 to 88% (including on exertion)
Antifibrotic therapy for IPF
nintedanib and pirfenidone
nintedanib MOA
inhibits multiple tyrosine kinase
slows decline of FVC
pirfenidone MOA
inhibits TGF-beta and fibroblast proliferation
slows decline of FVC
Nonspecific interstitial pneumonitis imaging features
ground glass opacity
reticular opacity
traction bronchiectasis
diffuse but can have subpleural sparing
NSIP - associations
connective dissue disease
HIV
Drugs (amiodarone, MTX, flecainide, nitrofurantoin)
hypersensitivity pneumonitis
NSIP - treatment
glucocorticoids
mycophenolate / Azathioprine (second line)
cyclophoxphamide / ?rituximab (third line)
Lung transplantation
Precipitins
- role
little use
Sarcoidosis pathogenesis
Th1 inflammation
Granuloma formatiuon
Sarcoidosis radiological findings on HRCT
bilateral hilar and mediastinal lymphadenopathy
nodular opacities in lung fields
Sarcoidosis who requires treatment
usually not required (70%)
treat if:
- progressive pulmonary disease
cardiac or neurologic disease
eye disease not responding to topical therapy
symptomatic hypercalcaemia
Sarcoidosis treatment
ICS / oral corticosteroids
Steroid sparing agents:
aza, MMF, ritux, cyclophosphamide
Organising pneumonia
idiopathic
connective tissue disease (RA, scleroderma)
medications, radiation, post infective
Covid-19
Usually steroid responsive