exam 6 lecture 4 Flashcards

1
Q

Where is pulmonary arterial HTN focused

A

It is focused on the pulmonary artery that is bringing de oxygenated blood away from the heart.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Difference between PH and PAH

A

PH is mean pulmonary pressure (mPAP) > or = 20 mmHG at rest and is more common

PAH is a form of PH

PAH is rare

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

causes of PAH

A

Unknown, genetic, drug and toxin exposure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

A majority of pts who have elevated PH is due to

A

HFrEF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

PAH epidemiology

A

4 X more common in women
mean 50 years old
15% mortality in 1 year
median survival 6 yrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

signs and symptoms of PAH

A

86% SOB
27% fatugue
light headedness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

how to diagnose PAH

A

Right heart catheterization (gold standrad)
Echocardiogram
exercise testing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

which side of the heart has difficulty pumping against high pulmonary pressure

A

right

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

WHO functional classes of PAH

A

Class I
Class II
Class III
Class IV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Define class I in PAH

A

Symptom free when physically active or resting. No symptom

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Define Class II in PAH

A

Slight limitation of physical activity
comfortable at rest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Define class III in PAH

A

Marked limitation in physical activity
less than ordinary activities cause symptoms
comfortable at rest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Define Class IV in PAH

A

Significant sx at rest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What medication to use if negative vasoreactivity test?

A

no CCB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What medication to use if positive vasoreactivity test

A

CCB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How to treat treatment naive FC I pts

A

Monitor progression
no drugs

17
Q

How to treat treatment naive FC II pts

A

If willing/able to tolerate combo therapy, ambiserten and tadalafil

if no- Monotherapy with bosentan, macisentan, ambisertan, sildenafil

18
Q

How to treat PAH patient with class III without rapid disease progression or poor prognisis

A

If pt is willing/able to tolerate Combo therapy- combo ambisentan and tadalafil

If no- Monotherapy with bosentan, macisentan, ambrisentan, riociguat, sildenafil or tadalafil

19
Q

How to treat PAH pts class III with evidence of rapid disease progression or poor prognosis

A

If patient is willling and able to manage parenteral prostanoids-

IV epoprostenol
IV treprostinil
SC treprostinil

If no- consider addition of inhaled or oral prostinoid combined with ERA and PDE-5

20
Q

How to treat PAH pts class IV

A

If patient is willling and able to manage parenteral prostanoids-

IV epoprostenol
IV treprostinil
SC treprostinil

If no- consider addition of inhaled or oral prostinoid combined with ERA and PDE-5

21
Q

IMPORTANT positive responders to acute vasoreactivity testing should be treated with

22
Q

When should we not use CCB for pAH

A

-ve testing to acute vasoreactivtiy
RV failure or CCB CI

23
Q

IMPORTANT Recommended CCB drugs

A

Nifedipine
Diltiazem
Amlodipine

NO VERAPAMIL

24
Q

summary of tx of PAH and different classes

A

Class 1- just monitor
Class 2- if tolerate combo therapy- Ambisentan + tadalafil

If no- Monotherapy ERA, PDE 5 I, Riociguat

Class 3 without rapid progression or poor prognosis- if tolerate combo therapy- Ambisentan + tadalafil

If no- Monotherapy ERA, PDE 5 I, Riociguat
(same as class II)

Class III with rapid progression- If candidate for parenteral prostanoids- SC treprostinil (preferred)
IV treprostinil
IV epoprostenol

If not Consider
inhaled or oral
prostanoid
(likely in combo
w/ERA + PDE-
5i)

Class IV same as III with poor prognosis

25
Endothelin receptor antagonist drugs
Bosentan Ambisentan Macisentan
26
prostacyclin pathway drugs
Epoprostenol iloprost Treprostenol
27
How do PDE 5 drugs work
reduce conversion of cGMP to GMP. Causing vasodilation.
28
IMPORTANT. PDE5 drug names and doses
SIldenafil (TID) Tadalafil (QD)
29
ADR for PDE5 drugs
Flushing, hypotension, headache
30
Endothelin receptor MOA and drug name
Patients with PAH overexpress endothelin (vasoconstricor) Blocks endothelin causing less vasoconstriction Ambisentan for ETa bisentan/macisentan mixed
31
ADR of Endothelin receptors, monitoring and CI?
Bosentan has highest risk of hepatic dysfunction Ambrisentan has the most edema monitor LFT monthly for bosentan CI in pregnancy
32
what is a soluble guanylate cyclase stimulator drug and what to know about it
Riociguat CAN NOT be combined with tadalafil and sildenafil due to hypotension risk.
33
IMPORTANT THING TO KNOW ABOUT prostacyclins
Have an effect on the aggregation of platelets
34
IMPOTANT THING to know about treprostinil IV/SQ
IV infusion requires stable access, do not COINFUSE with anything else. same with epoprostenol