Pharmocology PE/Thromboemolism And HTN - Dr. Izsard

Question 1

Tumors that can cause PE

Answer 1

Mucin-secreting adenocarcinomas, HCC, renal cell carcinoma

Question 2

Acute vs chronic PE

Answer 2

Acute: centrally in vasculature, + occlusion,

Chronic : 50% or more occlusion , recanalization and arterial webbing so blood can pass

Question 3

Locations of PE

Answer 3

Saddle—> Lobar —> segmental —> subsegmental

Question 4

PE from air tx

Answer 4

1. Lay pt lateral decubitus head down or Trenderlenburg (tilt bad so feet are up and head down)
2. O2 and ventilation if needed
3. IV vasopressors

Question 5

PE from fat tx

Answer 5

No real tx, O2 given, (dont give heparin or corticosteroids)

Question 6

Pulmonary HTN 4 drug classes

Answer 6

1. Prostanoids (epoprostenol, treprostinil, iloprost, selexipag)
2. Endothelin Antagonist (-sentan, -cantan) = Bosentan, Ambrisentan
3. PDE 5 inhibitors (sildenafil, tadalafil)
4. Guanylate cyclase sensitizer (Riociguat)

Question 7

+ vasopressor test in Pulmonary HTN hat can you use

Answer 7

CCB = Nifedipine

Question 8

Pulmonary HTN definition

Answer 8

MPAP > 25mmHg

Question 9

Pulmonary HTN does what to lungs

Answer 9

Remodeling, inflammation , thickening of wall , narrowing of BVs, thrombosis, intimal fibrosis

Question 10

Pulmonary HTN histology gold finding

Answer 10

PLEXIFORM lesion (froliferation or endothelial and SM cells)

Question 11

Pulmonary HTN TX

Answer 11

No treatment to cure it only management drugs

Question 12

Prostacyclin - Epoprostenol clinical use and MOA and side effects

Answer 12

1. PAH
2. Mimics prostacyclin
3. If pump line is clogged - serious (IV administration)

Question 13

Prostacyclin - Treprostinil Clinical use, pharm, administration

Answer 13

1. PAH (longer H-L 4hr)*
2. No refrigeration needed, can be inhaled or oral
3. Initially was SubQ

Question 14

Prostacyclin -Iloprost clinical use, administration, side effects

Answer 14

1. PAH
2. Inhalation 6-9 x a day
3. Fainting (from hypotension)

Question 15

Prostacyclin -selexipag clinical use, administration, side effects

Answer 15

1. PAH
2. Orally , very expensive
3. Headache
   (Good for children who dont want to do the IV)

Question 16

Endothelin Antagonist - Bosentan clinical use, administration, side effects

Answer 16

1. PAH
2. Oral
3. Hepatotoxic*, drug interactions (oral contraceptives, warfarin), NOT FOR PREGNANCY **

Question 17

Endothelin Antagonist - Abrisentan clinical use, administration, side effects

Answer 17

1. PAH * better
2. Oral
3. NOT IF PREGNANT**, some drug interactions

Question 18

Sildenafil clinical use, administration, side effects

Answer 18

——I Phosphodiesterase type 4 
1. PAH
2. Oral 
3. Well tolorated
(Tadalafil  = longer H-L)

Question 19

Riociguat clinical use, administration, side effects

Answer 19

Increase cGMP, makes NO

1. PAH
2. Oral - longer H-L
3. NOT PREGNANT **

Question 20

Best drug to give PAH its a combination

Answer 20

Tadalafil + Ambrisentan