Dunedin-Resp Flashcards
Define Apnoea
An APNOEA is the cessation of flow for a minimum period of 10s
Define hypopnea
A reduction in airflow of at least 30%, with 3% desaturation, and lasts at least 10s
What is a RERA?
respiratory event related arousals
What is the impact of CPAP on cardiovascular events in people with OSA?
Doesnt prevent cardiovascular events
What are some of the effects of CPAP?
small improvements in BP
decreased erectile dysfunction
reduced risk of MVA
improved QoL scores
What is Tirzepatide?
it is a carbonic anhydrase that has been shown to reduce AHI by 47%
How to tell the difference between OSA and CSA?
Respiratory effort - will be trying in OSA
What is obesity hypoventilation syndrome?
OHS requires an elevated pCO2 (during or immediately after sleep) PLUS BMI>35 AND no other reason for hypercarbia (e.g. COPD, neuromuscular)
What is the treatment for central sleep apnoea?
adaptive servo ventilation (ASV) - not used frequently
What deficiency is most commonly related to restless legs?
iron deficiency
List some conditions associated with restless legs
- Coeliac
- COPD
- Depression, panic
- Fibromyalgia
- Medications- SSRIs, neuroleptics, lithium,
beta blockade, dopamine antagonists - Migraine, multiple sclerosis, Parkinson’s
disease, shift work, PAH, neuropathies etc
List some medications for restless leg syndrome
PRN Levodopa if rare occurence; otherwise gabapentin, ropinirole, clonazepam, tramadol, oxycodone, morphine, methadone
What is the difference between Type 1 and Type 2 narcolepsy?
Type 1 has cataplexy
What is the deficiency in narcolepsy?
orexin
How is narcolepsy diagnosed?
Sleep latency <10 min
REM sleep latency <20 min
MSLT <8 min
AND
Two or more sleep-onset REM (SOREM) events
Describe the treatment for narcolepsy
Modafinil –> doesn’t treat cataplexy
Methylphenidate, gamma hydroxybutyrate and dexamphetamine –> narcolepsy+ cataplexy
Anti-cataplectics: venlafaxine, clomipramine
Sodium oxybate
How to treat REM behavioural disorder
clonazepam +/- melatonin
What is Klein-Levin syndrome?
Periodic hypersomnia, eating disorder (excessive cravings), hypersexuality (often males) and depression (often females)
What is the criteria for lung transplant?
high (>50%) risk of death due to lung disease within 2 years
high (>80%) likelihood of surviving at least 90 days after transplant
high (>80%) likelihood of 5 year post transplant survival
What are absolute contraindications for lung transplant?
- recent malignancy with a high risk of recurrence of death
- major organ dysfunction (GFR <40, liver cirrhosis or synthetic dysfunction, ACS or CVA within 30 days)
- extra pulmonary or disseminated infection or active TB or HIV infection
- progressive cognitive impairment
- repeated non-adherence without evidence of improvement
- severely limited functional status with poor rehabilitation potential
- active substance use or dependent
What are some infections that increase the risk of lung transplant?
M abscessus
Lomentospora prolificans
Burkholderia cenocepacia or gladiolii
When can you do single vs bilateral lung transplant:
Single: COPD, ILD, older patients
Bilateral: CF, bronchiectasis, PAH
What are the immunosuppression regimens post lung transplant?
Calcineurin inhibitors –> tacrolimus or cyclosporine
Cell cycle inhibitors –> azathioprine or MMF
Prednisone
What prophylaxis do you do for lung transplant?
CMV, EBV, PCP, azithromycin
What is CLAD?
Chronic lung allograft dysfunction
- BOS- bronchiolitis obliterates syndrome
- RAS - restrictive allograft syndrome
Resp Flow
What pulmonary artery pressure classifies as pulmonary artery hypertension?
Mean PAP >20 mmHg
What pulmonary capillary wedge pressure is needed to decide if its due to left heart failure?
> 15 mmHg
Describe the classification of Pulmonary HTN
Describe the vasodilator/vasoreactivity challenge in pulmonary HTN
mPAP reduce by 10mmHg to <40mmHg and stable or increased CO2
Describe how we use right heart Cath findings to classify pulmonary artery HTN
What is the female:Male ratio for group 1 pulmonary artery hypertension?
3:1
Which calcium channel blockers can we give to CCB responsive pulmonary artery hypertension?
Amlodipine 20mg
nifedipine 120-240mg
diltiazem 240-720mg
remember to repeat right heart Cath after 3 to 6 months and then annually
Describe the genetics of familial pulmonary artery HTN
autosomal dominant, variable penetrance
mostly BMPR2 mutation carriers
first degree relatives are offered annual echo
HHT (ACVRL1 gene) and PVOD (EIF2AK4 gene)
When to suspect pulmonary veno-occlusive disease?
hypoxia
low DLCO
CT abnormalities
poorly responsie to therapies
Describe the pathophysiology of CTEPH
- Mechanical obstruction of pulmonary arteries by thrombus which does not resolve
- fibrotic transformation of thrombus
- downstream remodelling of smaller vessels
Describe the management of CTEPH
- lifelong anticoagulation
- consider pulmonary thromboedarterectomy
- consider balloon pump angioplasty
What are risk factors for CTEPH?
-pro-coagulant states (antithrombin deficiency, protein C and S deficiency)
- lupus anticoagulant and APS (VKA)
- blood groups A , B and AB (non-blood group O associated with increased risk of VTE)
- splenectomy
General treatment measures of pulmonary artery HTN
correction of anaemia and iron deficiency (even if not anaemic)
pulmonary rehab
immunisation against COVID, influenza, and S.pneumoniae
Describe management of PAH
1) CCB
2) PDE5i or ERA or combination
3) prostaglandin agonist as third line therapy
