PAH Flashcards
What is the brand name of Epoprostenol (IV)?
Flolan
Veletri
What is the half-life of Flolan?
VERY SHORT!
3-5 minutes
What is the brand name of Treprostinil (IV/ SC)?
Remodulin
What is the brand name of Treprostinil (INH)?
Tyvaso
What is the brand name of Treprostinil (PO)?
Orenitram
What is the brand name of Iloprost (INH)?
Ventavis
What are ADRs of the Synthetic Prostacyclin and Prostacyclin Analogs?
Flushing Jaw Pain Headache Skeletal Pain Diarrhea
What ADRs can be seen specifically with the the parental formulations of the synthetic prostacyclin and prostacyclin analogs?
Hypotenstion Thrombocytopenia Catheter-related infection pump malfunction infusion site pain (especially SC) thrombosis
What ADRs can be seen specifically with the INH formulations?
Cough
throat irritation may occur with the inhaled formulation
Which PAH agent is shown to decrease mortality in WHO functional class IV patients?
Epoprostenol
Who are the parenteral prostacyclins analogs indicated for?
functional class III and IV
What is the MOA of the Synthetic Prostacyclin and Prostacylin Analogs? (2)
- Direct vasodilator of systemic and pulmonary vascular beds
- also inhibit platelet
What is the MOA of Endothelin Receptor Antagonists (ERAs)?
antagonism of endothelin receptors, leading to vasodilation
What is the brand name of Bosentan?
Tracleer
What is the brand name of ambrisentan?
Letairis
What is the brand name of Macitentan?
Opsumit
How are the endothelin receptor antagonists metabolized?
hepatic metabolism
What are the ADRs of endothelin receptor antagonists?
Headache flushing Increase Liver Function Tests ( more likely w/ bosentan) edema ( especially if >65 yo) decrease hemoglobin/ hematocrit
What drug category (A, B, C, D, X) are the ERAs?
Teratogenic ( Category X)
What drug has a black box warning for liver injury?
Bosentan
True or False
All ERAs Drugs are Oral Agents
True
What drug class are only available through access programs due to teratogenicity? (REMS)
ERAs
What functional classes can one use ERAs?
Functional Classes II through IV
What is the MOA of Phosphodiesterase-5 inhibitors?
increase cellular concentration of cGMP, leading to vasorelaxation and antiproliferative effects on vascular smooth muscle cells
what is the brand name of sildenafil?
Revatio
What is the brand name of Tadafil?
Adcirca
how are the PDE-5 inhibitors metabolized?
hepatic metabolism
What are some ADRs of PDE-5 inhibitors?
Headache Flushing Dyspepsia Epistaxis Rash Vision Changes
What functional classes can you use PDE-5 inhibitors?
Functional Class II through IV
What is the MOA of Soluble Guanylate Cyclase Stimulator?
Senstizes soluble guanylate cyclase to endogenous Nitric Oxide and stimulates NO and soluble soluble guanylate cyclase binding;
increases cGMP leading to vasodilation
What is the brand name Riociguat?
Adempas
How are guanylate cyclase stimulator metabolized?
hepatic metabolism
What are the ADRs of guanylate cyclase stimulator metabolized?
hypotension dizziness headache bleeding edema dyspepsia
What drug category (A, B, C, D, X) are the guanylate cyclase stimulator ?
Category X
What drugs are contraindicated with guanylate cyclase stimulators?
PDE-5 inhibitors
What functional classes can I give guanylate cyclase stimulators to?
functional classes II and III
True or False
Soluble Guanylate Cyclase Stimulator is available through REMs program due to teratogenicity
True
What is the MOA of the selective prostacyclin IP agonists?
activation of the IP receptor leads to smooth muscle cell vasodilation through increased cAMP as well as inhibition of proliferation and platelet aggregation
What is the brand name of selexipag?
uptravi
How is selexipag metabolized?
hepatic metabolism
What are the common ADRs of selexipag?
flushing headache diarrhea nausea vomitting
what are the less common ADRs of selexipag?
hyperthyroidism
decrease hemoglobin
What functional class are selective prostacyclin IP agonist?
studied in functional class II and III
What tests can be monitored while on prostacyclin IP agonists?
thyroid function tests
What is the MOA of CCB?
blocks influx of extracellular calcium leading to vasodilation
What is the brand name of nifedipine?
procardia
What is the brand name of diltiazem?
cardizem
What is the brand name of amlodipine?
norvasc
What is the half-life of amlodipine?
LONG
35hrs
How are CCB metabolized?
hepatic metabolism
What are the ADRs of CCBs?
peripheral edema headache dizziness constipation flushing
Which calcium channel blocker is a negative inotrope?
diltiazem
True or False
Use is independent upon positive response in vasodilator testing
False
its use is DEPENDENT
