Day 2- Sleep Apnea, Pulmonary Hypertension, Inhaler technique Flashcards
What is the difference between central sleep apnea and obstructive sleep apnea?
What are your risk factors for CSA?
What are your risk factors for OSA?
Obstructive is caused by large tonsils, large tongue, obesity, etc. Central is when the brains area that controls your breathing does not function correctly during sleep.
Sex, age, underlying autonomic nervous lesions, neurologic diseases or brain injuries,heart failure, stroke, high altitudes, agents that cause respiratory depression.
Age, sex, race, abnormalities, acromegaly and amyloidosis and hypothyroidism, neurological disorders,obesity(40-60% of cases), smoking.
What is your ESS score cut off?
What are your RDI classifications?
What are your types of PAP?
> 10 or equal. Good for prescreen and determine success.
Mild 5-14, Moderate 15-30, Severe >30. Need score of 15 to diagnose or 5 if symptomatic.
Automatic, Bpap, CPAP(preferred).
What are your behavioral strategies?
What is pharmacological treatment for OSA?
When do you wake promoting meds?
Weight loss Goal BMI < or equal to 25, exercise, positional therapy, sleep in non supine position, avoid alcohol and sedatives before bedtime.
Avoid CNS depressants, no specific treatment.
Modafinil(Provigil), Armodafinil(Nuvigil).
What is the definition of Pulmonary Hypertension?
What is the definition of PAH?
What is group 1-5 of PH?
Eveltation of PAP > or equal to 25. Elevated ET-1 and thromboxane A2, decreased prostacyclin and Nitric oxide.
mPAP > or equal to 25. PVR >3 wood units. PCWP/ PAWP < or equal to 15.
PAH is group 1, group 2 is left sided heart failure, group 3 is lung and oxygen problems, group 4 is thrombo problems, group 5 is unclear multifactorial.
What are your pulmonary HTN risk factors?
What are drugs or toxins that can cause HTN risk factors?
What factors imbalance in pulmonary HTN?
Genetics, Obesity and OSA, Female, Pregnancy, High altitutdes, other diseases(heart, lung, liver, connective tissue), drugs and toxins.
Anorexigens, Stimulants, Chemotherapy, Rapeseed oil.
Lower prostacyclin and nitric oxide but high endothelin 1 and 5-ht.
What is the gold standard for diagnosis of pulmonary HTN?
How do you differentiate group 1 with PAH?
How do you treat with positive response to vasoreactivity testing?
Right heart catheterization.
Reduced PCWP, mPAP high, rule out LVH.
Use CCB(Amlodipine, Nifedipine, Diltiazem), Negative is do not use.
What are your non pharm treatments for pulmonary HTN?
What is your conventional(primary) therapy options?
How do you treat group 1?
Cardio pulmonary rehab(exercise, counseling), no pregnancy, immunizations(influenza and pneumococcal), low sodium diet. Oxygen if applicable, surgery.
CCB, Warfarin, Diuretics, Oxygen, Digoxin.
Conventional treatment, warfarin, FDA approved tareted meds for PAH.
How do you treat group 2?
How do you treat group 3?
How do you treat group 4 and what about group 5?
underlying cause, conventional treatment.
underlying cause, supplemental oxygen for hypoxemic patients.
underlying cause, warfarin, thromboendarectomy, gualanate cyvlase stimulant(targeted). Treat underlying cause.
Which CCB’s do you normally give and when?
When is warfarin recommended?
What is your diuretic of choice?
Amlodipine, Nifedipine or diltiazem if tachycardia present. Only give with positive vasoreactivity testing.
Group 1 and 4. 5 mg(2.5 in elderly) titrate to 1.5-2.5.
Furosemide(lasix)
When is digoxin recommended?
What are your prostanoids and what do they do?
What are prostanoid ADR’s?
PAH with right sided heart failure.
cause vasodilation, inhibits platelet aggregation, cytoprotective and antiproliferative properties. Epoprostenol(IV), Treprostinil(IV,SC,PO,inhale), Iloprost(inhale), Selexipag(po).
Flushing,headache, hypotension, nausea, pain, diarrhea, abdominal cramping. Increase effect of antihypertensives, diuretics, and digoxin.
What are your ERA’s and how do they work?
What are the ERA’s ADR’s?
What to know about your PDE-5’s?
Bosentan,Ambrisentan, Macitentan(all REMS and all oral). Cause vasodilation and proliferation.
BBW of hepatoxicity(monthly), teratogenic(monthly), peripheral edema, nasal congestion, anemia, flushing, and palpitations. Cyp2c9, 3a4, bosentan has more.
Sildenafil(revatio), Tadalafil(adcirca).Sildenafil is 5-20 TID, Tadalafil is 40 mg qday. Sildenafil more likely to cause visual disturbances.
What is your Guanylate cyclase stimulator?
How do you treat refractory PAH?
When do you do targeted therapies?
Riociguat. Approved for WHO groups 1 and 4.
Combination therapy: 2 different MOA’s(prostanoids, ERA’s, PDE-5’s OR guanalate cyclase). Surgical options.
PAH and Functional class 2-4.
What 2 drugs have shown morbidity and mortality benefit?
What is the different in haler?
What clotting factors does warfarin block?
Macitetan, Epoprostenol.
MDI, clean with soap and water, inhale slowly.
2,7,9,10.
