Pharm--Restrictive/PAH Flashcards
Some drugs that commonly cause ARDS?
Aspirin, cocaine, antidepressants
NRDS treatment options
Beractant
Beractant MOA/components
Proteins B, C, lipids
**DPCC - main component of surfactant
Sarcoidosis treatment options?
Glucocorticoids
MTX (immunosuppression)
Name some pro-inflammatory cytokines that glucocorticoids downregulate
IL-1
TNF
What about anti-inflammatory cytokines that steroids upregulate?
IL-10
MTX has additional actions that lead to immunosupression via this mediator
Adenosine
MTX AEs
Cat X
Malignant lymphoma
Infection risk
Dermatologic reactions-severe
IPF drugs
None really help; some use corticosteroids to dx - if there is response, it is probs not IPF
Wegener’s granulomatosis drugs
Rituximab, azathioprine, cyclophosphamide, steroids
Rituximab MOA Wegener’s
Binds CD20 and depletes B cells
Azathioprine MOA Wegener’s
DNA/RNA synthesis inhibitor that also causes immunosupperssion of T cells (apoptosis)
Azathioprine AEs
Thrombocytopenia, 2ndary maligs
Cyclophosphamide MOA Wegener’s
Alkylating agent - B and T depletion - also selective B suppression
What systemic HTN drugs are also used for PAH? Why not others?
Ca2+ channel blockers; different mechanism
The four causes of PAH
1) Imbalance between constriction/dilation
2) Smooth muscle/endothelial proliferation
3) Thrombosis
4) Fibrosis
Role of prostacyclin in PAH
Prostacyclin inhibits platelet activation and smooth muscle growth
Role of endothelin in PAH
Induces smooth muscle proliferation
Epoprostenol MOA
prostanoid that induces:
vasodilation
smooth muscle growth retardation
Platelet de-aggregation
Iloprost
prostanoid that induces:
vasodilation
smooth muscle growth retardation
Platelet de-aggregation
Treprostinil
prostanoid that induces:
vasodilation
smooth muscle growth retardation
Platelet de-aggregation
Compare the half lives of the prostanoids
Iloprost 25 min!
Epoprostenol 3-5 min!
Treprostinil 4 hrs
Epoprostenol AEs
Dose-limiting hypotension Myalgia HA Flushing Monitor for bleeding
Iloprost AEs
Hemoptysis
Cough, flushing, HA