Lesson 4: Vasodilators and Diuretics Flashcards
What are the two types of pulmonary vasodilators?
Inhaled Nitric Oxide
Synthetic Prostacyclins
What are the two FDA approved synthetic prostacyclins?
Illoprost (Ventavis)
Treprostinil (Tyvaso)
What synthetic prostacyclin is not FDA approved for pulmonary hypertension
Epoprostenol (Flovan)
What is the normal pulmonary artery pressure
10-15 mmHg
What pressure level is considered pulmonary hypertension
> 20 mmHg
What is nitric oxide and natural product of?
Endothelial cells because they cause vasodilation
What disease states is nitric oxide used in ?
Persistant Pulmonary Hypertension of the Newborn(PPHN)
ARDS
What is nitric oxide approved to be used for in regards to neonates?
Hypoxic respiratory failure
What is the recommended dosage of INO?
20 ppm
What does INO stimulate
cGMP production, which decreases intracellular Ca++
What does cGMP production result in
smooth muscle relaxation
What is the therapeutic benefit of INO
Improved blood flow to ventilated alveoli resulting in improved V/Q mismatch
Nitric Oxide is quickly oxidized into what?
NO2, which is more toxic
What level of NO2 is toxic, what is a safe level
10 ppm, 5 ppm is safe
Methemoglobin is a byproduct of INO binding to what?
Hemoglobin
What is the normal methemoglobin level?
0-2%
At what level do you treat high methemoglobin and what do you use to treat it
levels >30% and methylene blue
Oxidation index formula (OI)
Mean airway pressure cmH20 x (FiO2/PaO2)
What is a good OI
Closer to 0 the better
Iloprost (Ventavis) and Treprostinil (Tyvaso) both treat what? And are not approved for who?
Treat pulmonary hypertension and are not studied in asthmatics or peoples with COPD