PAH Flashcards

1
Q

PH defined by:

A

mPAP > 20 at rest via rest heart catheterization

PVR > 2 wood units

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2
Q

Acute Vasodilator Testing

A

-Responder if mPAP decreases by 10, to value of < 40 without decrease in CO
-Indicates CCB

*Not performed in right HF or instability

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3
Q

CCB

A

-Must be responder to vasodilator testing

Agents: nifedipine, diltiazem, amlodipine
-Avoid verapamil

AE: edema, ging hyperplasia, HR

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4
Q

ERAs
-Bosentan, Ambrisentan, Macitentan
(TANS)

A

Warnings
-Teratogenic
-REMs (monitor pregnancy)

Bosentan
-Also monitor LFTs
Ambri
-Edema
Maciten
-Congestion, UTI

BL AE CUM

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5
Q

Require REMS

A

-ERAs
-Riociguat

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6
Q

PDE5i (Sildenafil, Tadalafil)

A

Warnings
-Hypotension
-PDE5is are CI with nitrates or guanylate cyclase

Sildenafil = 20 mg TID
-AE: HA, flush, dysp, nose bleed, visual impairment (FDB HIV)

Tadalafil = 20-40 QD

DDI: CYPs

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7
Q

Riociguat (sGC)

A

0.5-1 mg TID
-Increase by 0.5 every 2 weeks TID
-Target 2.5 mg TID

AE: dyspepsia, gastritis, hypotension

CI: nitrates, PDE5is

DDI: CYP

No smoking

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8
Q

Prostacyclins (Epoprostenol, Treprostinil, Iloprost, Selexipag)

A

Warnings
-Serious AEs
-Central line infections
-Risk of abrupt d/c

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9
Q

Epoprostenol

A

GOLD standard for high risk pts

2 ng/kg/min titrate to 25-45

AE: JIMI FRND
-HA, ND, rash, flushing
-Jaw pain, musco pain
-Infections
-Interrupt infusion = life threatening

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10
Q

Treprostinil

A

Similar AE to epo
-HA, NVD
-Infusion site pain or reaction

Oral
0.125 mg TID or 0.25 BID
(max 120 mg TID)

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11
Q

Inhaled Prostacyclins

A

Iloprost
6-9x per day

Treprostinil neb
3-9 breaths 4x per day

Treprostinil dry power
1 breath 4x per day

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12
Q

Selexipag

A

Avoid in severe hepatic failure
(moderate = 200 mcg starting)

With or without food, do not crush or chew

AE: HA, ND, MJ pain

DONT GIVE WITH CLOPIDOGREL

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13
Q

Guideline Algorithm

A

WITH cardiopulmonary comorbidities
-1. PDE5i or ERA

WITHOUT
-1. Low/Int risk = ERA + PDE5i
-2. High (20%+) = ERA + PDE5i + IV/SC PCA
-3. Add PRA or switch from PDE5i to RIO (If high risk, add IV/SC PCA or eval for lung transplant)

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14
Q

Supportive Tx

A

-Diet, less sodium
-Exercise
-Vaccinations
-Anticoag if not CI
-Oxygen
-Caution in high altitude
-Diuretics

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15
Q

Drugs that induce PAH

A

Dasatinib, pheny/pheno, methamphetamine

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