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Aisha > Dunedin-Resp > Flashcards

Dunedin-Resp Flashcards

1
Q

Define Apnoea

A

An APNOEA is the cessation of flow for a minimum period of 10s

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2
Q

Define hypopnea

A

A reduction in airflow of at least 30%, with 3% desaturation, and lasts at least 10s

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3
Q

What is a RERA?

A

respiratory event related arousals

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4
Q

What is the impact of CPAP on cardiovascular events in people with OSA?

A

Doesnt prevent cardiovascular events

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5
Q

What are some of the effects of CPAP?

A

small improvements in BP
decreased erectile dysfunction
reduced risk of MVA
improved QoL scores

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6
Q

What is Tirzepatide?

A

it is a carbonic anhydrase that has been shown to reduce AHI by 47%

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7
Q

How to tell the difference between OSA and CSA?

A

Respiratory effort - will be trying in OSA

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8
Q

What is obesity hypoventilation syndrome?

A

OHS requires an elevated pCO2 (during or immediately after sleep) PLUS BMI>35 AND no other reason for hypercarbia (e.g. COPD, neuromuscular)

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9
Q

What is the treatment for central sleep apnoea?

A

adaptive servo ventilation (ASV) - not used frequently

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10
Q

What deficiency is most commonly related to restless legs?

A

iron deficiency

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11
Q

List some conditions associated with restless legs

A
  • Coeliac
  • COPD
  • Depression, panic
  • Fibromyalgia
  • Medications- SSRIs, neuroleptics, lithium,
    beta blockade, dopamine antagonists
  • Migraine, multiple sclerosis, Parkinson’s
    disease, shift work, PAH, neuropathies etc
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12
Q

List some medications for restless leg syndrome

A

PRN Levodopa if rare occurence; otherwise gabapentin, ropinirole, clonazepam, tramadol, oxycodone, morphine, methadone

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13
Q

What is the difference between Type 1 and Type 2 narcolepsy?

A

Type 1 has cataplexy

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14
Q

What is the deficiency in narcolepsy?

A

orexin

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15
Q

How is narcolepsy diagnosed?

A

Sleep latency <10 min
REM sleep latency <20 min
MSLT <8 min

AND

Two or more sleep-onset REM (SOREM) events

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16
Q

Describe the treatment for narcolepsy

A

Modafinil –> doesn’t treat cataplexy

Methylphenidate, gamma hydroxybutyrate and dexamphetamine –> narcolepsy+ cataplexy

Anti-cataplectics: venlafaxine, clomipramine

Sodium oxybate

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17
Q

How to treat REM behavioural disorder

A

clonazepam +/- melatonin

18
Q

What is Klein-Levin syndrome?

A

Periodic hypersomnia, eating disorder (excessive cravings), hypersexuality (often males) and depression (often females)

19
Q

What is the criteria for lung transplant?

A

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

20
Q

What are absolute contraindications for lung transplant?

A
  • 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
21
Q

What are some infections that increase the risk of lung transplant?

A

M abscessus
Lomentospora prolificans
Burkholderia cenocepacia or gladiolii

22
Q

When can you do single vs bilateral lung transplant:

A

Single: COPD, ILD, older patients
Bilateral: CF, bronchiectasis, PAH

23
Q

What are the immunosuppression regimens post lung transplant?

A

Calcineurin inhibitors –> tacrolimus or cyclosporine

Cell cycle inhibitors –> azathioprine or MMF

Prednisone

24
Q

What prophylaxis do you do for lung transplant?

A

CMV, EBV, PCP, azithromycin

25
Q

What is CLAD?

A

Chronic lung allograft dysfunction
- BOS- bronchiolitis obliterates syndrome
- RAS - restrictive allograft syndrome

26
Q

Resp Flow

A
27
Q

What pulmonary artery pressure classifies as pulmonary artery hypertension?

A

Mean PAP >20 mmHg

28
Q

What pulmonary capillary wedge pressure is needed to decide if its due to left heart failure?

A

> 15 mmHg

29
Q

Describe the classification of Pulmonary HTN

A
30
Q

Describe the vasodilator/vasoreactivity challenge in pulmonary HTN

A

mPAP reduce by 10mmHg to <40mmHg and stable or increased CO2

31
Q

Describe how we use right heart Cath findings to classify pulmonary artery HTN

A
32
Q

What is the female:Male ratio for group 1 pulmonary artery hypertension?

A

3:1

33
Q

Which calcium channel blockers can we give to CCB responsive pulmonary artery hypertension?

A

Amlodipine 20mg
nifedipine 120-240mg
diltiazem 240-720mg

remember to repeat right heart Cath after 3 to 6 months and then annually

34
Q

Describe the genetics of familial pulmonary artery HTN

A

autosomal dominant, variable penetrance
mostly BMPR2 mutation carriers
first degree relatives are offered annual echo
HHT (ACVRL1 gene) and PVOD (EIF2AK4 gene)

35
Q

When to suspect pulmonary veno-occlusive disease?

A

hypoxia
low DLCO
CT abnormalities
poorly responsie to therapies

36
Q

Describe the pathophysiology of CTEPH

A
  • Mechanical obstruction of pulmonary arteries by thrombus which does not resolve
  • fibrotic transformation of thrombus
  • downstream remodelling of smaller vessels
37
Q

Describe the management of CTEPH

A
  • lifelong anticoagulation
  • consider pulmonary thromboedarterectomy
  • consider balloon pump angioplasty
38
Q

What are risk factors for CTEPH?

A

-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

39
Q

General treatment measures of pulmonary artery HTN

A

correction of anaemia and iron deficiency (even if not anaemic)
pulmonary rehab
immunisation against COVID, influenza, and S.pneumoniae

40
Q

Describe management of PAH

A

1) CCB
2) PDE5i or ERA or combination
3) prostaglandin agonist as third line therapy

Aisha (47 decks)

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