Pulmonology Flashcards
What are the best tests during an asthma exacerbation?
Peak expiratory flow
ABG - inc PCO2
Severity can be quantified by the decrease in PEF compared to baseline and the A-a gradient
Normal or high CO2 means patient is not compensating/not hyperventilating which indicates impending respiratory failure
Indications for O2 in COPD
PaO2 < 55 or sat < 88%
IF R heart failure or PV or pulmonary HTN … then PaO2 < 60 or sat < 90%
What medication delays progression of COPD?
Nothing
When would you use theophylline or roflumilast?
last resort to avoid having to use oral steroids when patient is not controlled w/ SABA + LABA + LAMA and inhaled steroid
ABPA Findings and Tx
- brown flecked sputum
- transient infiltrates on CXR
- eosinophilia in serum, IgE
TX = oral steroids not inhaled if severe, itraconazole if recurrent episodes
Sweat Test Pos for CF
If > 60 mEq/ L
4 Common Microbes on Sputum Cx in CF
1 - non-typable H flu
2- staph aureus
3- pseudomonas
4- burkholderia
Inpatient v. Outpatient Tx of CAP
Outpatient - azithromycin OR doxy
Outpatient if co-morbidities or abx in last 3 mo - levofloxacin or moxifloxicin
Inpatient - levofloxacin/moxi OR cetriaxone + azithromycin
CURB65
Reason for Admission in Pneumonia (if 2+)
- confusion
- uremia
- resp distress
- BP (hypotension)
- > 65 yo
Tx HAP
Def - after 48 hrs in hospital or if discharged < 90 days ago
Cover E coli and Pseudo
- piperacillin tazo
- imipenem or meropenem
- cefepime or ceftazidime
Tx of VAP
Purulent secretions + fever/WBC on vent
3 DRUG COMBO
1 (anti-pseudo) - cefepime. pip-tazo, imipenem
2- (anti-pseudo) - gentamicin/amikacin OR cipro/levo
3- (MRSA) - vanco or linezolid
Pneumonia Vaccination
Normally in 65 + yo (13 then 23 6-12 months later)
If given before age 65 because underlying lung, liver, kidney disease then give second dose 5 yrs after first
PCP (findings, tx, ppx, allergy options)
Findings - Inc LDH, patchy bilateral infiltrates, cx BAL
Tx - bactrim + steroids if A-a gradient > 35 or PO2 < 70
Other Tx Options (allergies) -
- clindamycin and primaquine
- Pentamidine
PPX - bactrim once CD4 < 200 (can stop if increases above 200 again)
- can use atovaquone or dapsone if allergy
**dapsone and primaquine also cause hemolysis in G6PD
Tb Testing
IGRA = PPD (sensitivity)
IGRA - one visit; no cross reaction w/ vaccine
If either is positive … get CXR
Pos PPD
- 5 cm if HIV, steroid use, close contact w/ active tb, organ transplant, calcification on CXR
- 10 cm if immigrant, prisoner, healthcare worker, close contact w/ latent tb, heme malignancy, CM, alcoholic
- 15 cm no risk factors
Tb Tx Considerations
RIPE 2 mo, RI 4 mo if active (pos CXR)
9 mo isoniazid or 12 wks isoniazid + rifampetine if inactive (neg CXR)
All cause hepatotoxicity (stop if LFTs 3-5X ULN)
Give pyridoxine w/ isoniazid
How do you treat MAC?
Azithromycin (same as PPX)
+ rifampin and ethambutol
Drugs that can cause pulmonary fibrosis (7)
bleomycin
busulifan
amiodarone
methysergide
nitrofurantoin
cyclophosphamide
methotrexate
What 2 meds can dec rate of progression in idiopathic pulmonary fibrosis?
Pirfenidone - anti fibrotic, inhibits collagen synthesis
Nintedanib - tyrosine kinase inhibitor, blocks growth factors and fibroblasts
What is the most common CXR finding in PE? What is the most common EKG finding in PE?
CXR - atelectasis
EKG - sinus tachycardia, non-specific ST changes
How do you treat PE?
Enoxaparin (LMW heparin) –> bridge to warfarin
or NOAC if hemodynamically stable (rivaroxaban, apixaban, edoxaban, dabigatran)
Indications for IVC Filter
Contraindication to anti-coagulation (CNS bleed)
Recurrent emboli while therapeutic A/C
RV dysfunction so bad that next embolus no matter how small would be fatal
NOAC Reversal Agents
Andexanet alfa - for rivaroxaban, apixaban, edoxaban
Idarucizumab - for dabigatran
Warfarin Reversal Agent
Prothrombin complex concentrate
When do you thrombolytics for PE?
If unstable (systolic < 90 and tachycardia)
