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2020 CPR II Pulm Exam 2 > PHARM Pulmonary HTN (Wolff) > Flashcards

PHARM Pulmonary HTN (Wolff) Flashcards

1
Q

Who is the common demographic for pulmonary arterial HTN?

A

young women

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2
Q

What is the definition of pulmonary arterial HTN?

A

sustained elevation of mean pulmonary arterial pressure >25mmHg at rest

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3
Q

What are the common s/s of pHTN?

A

DOE, fatigue, chest pain, tachycardia,

syncope/near-syncope, edema, cyanosis

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4
Q

What is the first gene linked to pHTN?

A

BMPR2

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5
Q

What common drug causes weight loss and pHTN?

A

fen/phen

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6
Q

What is the vasopressor test?

A

short acting vasodilator is administered

test is positive if PAP falls >10

MPAP <40

CO is unchanged or increased

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7
Q

Some positive responders to the vasopressore test will achieve sustained functional improvement and prolonged suvival with what drug?

A

CCB

but will be deleterious in non-responders

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8
Q

What drugs do not help pHTN?

A

anticoagulants

diuretics

O2 therapy

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9
Q

What is the MOA of prostanoids?

A

promotes vascular relaxation

increases cAMP

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10
Q

What are the effects of prostanoids?

A

lowers pulmonary arterial resistance

decreases pulmonary arerial pressure

increases exercise tolerance

improves survival

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11
Q

Epoprostenol has a (short or long) half life?

A

short half life

must be given by IV continuously and kept cold

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12
Q

What are some serious adverse effects of epoprostenol?

A

sepsis

life-threatening if pump problems ensue

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13
Q

What are the pharmokokinetics of treprostinil?

A

given SUBQ but caused too much pain, so given with IV pump

longer half life, no refrigeration

can do QID inhalation

extended release oral form avaialble

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14
Q

What are the adverse effects for Treprostinil?

A

sepsis

jaw pain

cough/throat irritation

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15
Q

How is iloprost administered?

What are some adverse effects?

A

inhalation 6-9x per day

fainting from hyptension, jaw pain

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16
Q

Selexipag is a prostanoid that can be administered (oral or IV)?

common adverse effect?

A

Orally, BID

is VERY expensive

Jaw pain

17
Q

Bosentan is an endothelin antagonist that blocks what?

A

blocks nonspecifically ETa and ETb receptors

18
Q

What are some toxicities of bosentan?

A

hepatotoxicity

teratogenesis

accelerates warfarin metabolism and oral contraception

19
Q

Ambrisentan is an endothelin antagonist that blocks what?

What are the main adverse reactions?

A

Eta selectively

teratogenesis, no liver damage, does not interfere with warfarin, but still must use 2 forms of birth control (due to teratogenesis)

20
Q

Macitentan is an endothelin antagonist that has what benefit?

A

18hr half life allowing for once/day dosing

21
Q

Silidenafil blocks what?

what can it cause if combined with a-blockers or nitrates?

A

selectively blocks PDE 5

can cuase significant hypotension

22
Q

What is the MOA of Riociguat?

A

sensistizes sGC to endogenous NO by stabilizing the NO-sGC

increases cGMP to increase vasodilation

23
Q

If a pt with confirmed pHTN and has a positive vasoreactivty test, treat with what?

A

CCB

24
Q

In patient with naive PHTN with WHO FC II and patient is able to tolerate combination therapy, treat with what?

If they are unable to tolerate combo therapy, treat with what?

A

Ambristentan and tadalafil

Macitentan, ambisentan, riocguat, sildenafil, or tadalafil

25
Q

In pt with naive PAH with WHO FC III w/o evidence of rapid dz progression who is able to take combo theraoy, treat with what?

If unable to take combo therapy?

A

Abrisentan an Tadalfil

Monotherapy with macitentan, ambisentan, riociguat, sildenafil, or tadalafil

26
Q

In pt with naive PHTN with WHO FC III with evidence of rapid dz progression and able to take parenteral prostanoids, treat with

IF unable to take parental prostanoids, take

A

IV epoprosteonol, IV treprostinil, or SC treprostinil

inhlaed or oral prostanoid

27
Q

In pt with pHTN with WHO FC IV and able to take parenteral prostanoids, treat with waht?

If unable to take parentarel prostenoids, tx with

A

IV epoprostenol, IV treprostinil, or SC treprostinil

inhaled prostanoid + oral PDE5 inhibitor and oral ET antagonist

28
Q

What is the most common pHTN drug combo?

A

Tadalafil + Ambrisentan

29
Q

What are the prostanoids?

A

Epoprostenol

treprostinil

iloprost

selexipag

30
Q

What are the PDE5 inhibitors

A

sildenafil

tadalafil

31
Q

what are the endothelin antagonists?

A

bosentan

ambrisentan

macicentan

32
Q

What is the guanylate cyclase sensitizer

A

riociguat

2020 CPR II Pulm Exam 2 (28 decks)

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