Exam 6 - PAH Israel Flashcards
which is the gold standard for diagnosis of PAH?
a. echocardiogram
b. right heart catheterization
c. exercise testing
d. biomarkers
b. right heart catheterization
what is the treatment for pt who is a positive responder to an acute vasoreactivity test?
CCB
what two agents are used in an acute vasoreactivity test?
-inhaled nitric oxide
-IV epoprostenol
what is the recommended combo treatment for WHO class II or class III pts?
ambrisentan + tadalafil
what are the 3 preferred agents for monotherapy for WHO class II or class III pts without rapid progression?
-ERA (endothelin receptor antag)
-riociguat
-PDE-5 inhibitor
how do PDE-5 inhibitors work for PAH?
they dec conversion of cGMP to GMP; inc levels of cGMP lead to pulmonary vasodilation
true or false: PDE-5 inhibitors are considered first line in pts with FC II, FC III without rapid progression
true
which is taken TID for PAH?
a. sildenafil (Revatio)
b. tadalafil (Adcirca)
a. sildenafil (Revatio)
(tadalafil is once daily)
which ERA is given BID?
a. bosentan
b. ambrisentan
c. macitentan
a. bosentan
which ERA is most likely to cause peripheral edema?
a. bosentan
b. ambrisentan
c. macitentan
b. ambrisentan
which ERA causes the most LFT abnormalities?
a. bosentan
b. ambrisentan
c. macitentan
a. bosentan
true or false: do not initiate ERA’s if LFT > 3 x ULN
true
how long to see improvement after starting using an endothelin receptor antagonist? (range)
8-10 weeks
what are the 3 preferred agents for WHO FC III (with rapid progression or poor prognosis) and WHO FC IV who are candidates for parenteral prostanoids?
-SC treprostinil
-IV treprostinil
-IV epoprostenol
prostacyclin analogs inhibits __________ __________
platelet aggregation
what are the 2 oral prostacyclin analogs?
-treprostinil (Orenitram)
-selexipag (Uptravi)
which drug requires re-titration if therapy is interrupted for 3 days or more?
a. treprostinil (Orenitram)
b. selexipag (Uptravi)
c. tadalafil (Adcirca)
d. iloprost (Ventavis)
b. selexipag (Uptravi)
two inhaled prostacyclin analogs
-iloprost (Ventavis)
-treprostinil (Tyvaso)
what are the preferred agents for WHO FC III (with rapid progression or poor prognosis) and WHO FC IV who are NOT candidates for parenteral prostanoids?
inhaled or oral prostanoid (likely in combo w/ERA + PDE-5i)
what drug class is standard for severe PH with right ventricular failure?
parenteral prostacyclins
(subQ treprostinil most common)
half life of IV/subQ treprostinil
4 hours
why do we prefer subQ prostacyclin vs IV?
IV has risk of central line infections
ERAs and riociguat should be avoided in what pt population?
pregnancy
which agents would be acceptable for initial monotherapy in a pt with WHO FC II PAH with significant comorbidities? (3 of them)
ERA, PDE-5, or riociguat
