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drugs Pulm > pulm HTN > Flashcards

pulm HTN Flashcards

1
Q

What are the Prostanoid drungs?

A

epoprostenol
treprostinil
iloprost
selexipag

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2
Q

what are the the PDE 5 inhibitors

A

sildenafil

tadalafil

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3
Q

what are the endothelin antagonists

A

bosentan
ambrisentan
macicentan

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4
Q

what are the Guanylate cyclase sensitizer

A

riociguat

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5
Q

If the patient has a positive vasopressor test what drugs to use

A

CCB
nifedipine
diltiazem
amlodipine

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6
Q

epoprostenol MOA and effects and Clinical applications

A

MOA: mimics endogenous prostacyclin

  • promotes vascular relaxation
  • suppresses growth of vascular smooth muscle
  • inhibits platelet aggregation

via binding to G protein to generate cAMP

effects: lowers pulmonary arterial resistance
- decreases PHTN
- increases exercise intolerance
- improves short term survival

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7
Q

epoprostenol pk and toxicities

A

Short half life so given IV

Toxicities: sepsis due to chronic catheter

  • nasuea + vomiting
  • headache
  • flushing
  • jawpain
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8
Q

Treprostinil MOA, and Effects

A

MOA: mimics endogenous prostacyclin

  • promotes vascular relaxation
  • suppresses growth of vascular smooth muscle
  • inhibits platelet aggregation

via binding to G protein to generate cAMP

effects: lowers pulmonary arterial resistance
- decreases PHTN
- increases exercise intolerance
- improves short term survival

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9
Q

Treprostinil pk and toxicities

A

pk: subcutaneous infusion but painful
longer half life
can be inhaled and has extended release oral

Toxicities: sepsis due to chronic catheter

  • pain in injection
  • nausea + vomiting
  • diarrhea
  • edema

-if inhaled cough, HA, throat irritation lower incidiences of nausea and dizziness and flushing

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10
Q

iloprost MOA and effects

A

MOA: mimics endogenous prostacyclin

  • promotes vascular relaxation
  • suppresses growth of vascular smooth muscle
  • inhibits platelet aggregation

via binding to G protein to generate cAMP

effects: lowers pulmonary arterial resistance
- decreases PHTN
- increases exercise intolerance
- improves short term survival

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11
Q

iloprost pk and toxicities

A

Pk: administered by inhalation

Toxicities: Fainting due to hypotension

  • cough
  • headache
  • flushing
  • jaw pain
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12
Q

Selexipag MOA and Effects

A

MOA: mimics endogenous prostacyclin

  • promotes vascular relaxation
  • suppresses growth of vascular smooth muscle
  • inhibits platelet aggregation

via binding to G protein to generate cAMP

effects: lowers pulmonary arterial resistance
- decreases PHTN
- increases exercise intolerance
- improves short term survival

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13
Q

Selexipag pk and toxicities

A

PK: administered orally BID
-expensive

Toxicities:

  • HA
  • flushing
  • diarrhea, nausea, vomiting
  • jaw and limb muscle pain
  • skin rash
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14
Q

Bosentan MOA and effects

A

MOA: nonspecifically blocks ETa and ETb endothelin receptors

Effects: improves excercise tolerance and slows symptoms progression

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15
Q

Bosentan PK and toxicities

A

PK: oral drug and metabolized by liver

Toxicities:

  • Hepatotoxicity
  • teratogenesis

-headache, flushing, peripheral edema, nasal congestion, anemia and reduced sperm production

Drug interactions:

  • warfarin
  • oral contraceptives
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16
Q

Ambrisentan MOA and effects

A

MOA: selectively blocks ETa receptors that causes vasoconstriction and promote cell proliferation

effects: improves exercise tolerance and slows symptom progression

17
Q

Ambrisentan pk and toxicities

A

Pk; oral drug

toxicities:

  • teratogenesis
  • others include peripheral edema, nasal congestion, anemia and reduced sperm production

Drug interactions:
-oral contraceptives

18
Q

Macitentan

A

Non selective ETa and ETb agent that has a long half life but inhibits cP450

19
Q

Sildenafil MOA and effects

A

Viagra, Revatio

MOA: Selectively blocks phosphodiesterase type V enzyme that breaks down cGMP an important intracellular mediator smooth muscle relaxation

effects: improves exercise tolerance and slows symptom progression

20
Q

Slidenafil PK and toxicities:

A

PK: oral drug

Toxicites:

  • priapism
  • HA, flushing, and dyspepsia
  • visual disturbances, + hearing losses
  • milde hypotension
21
Q

what is tadalafil

A

cialis, adcirca

selectively blocks phosphodiesterase type V with longer half lifw

22
Q

Riociguat MOA and effects

A

MOA: Dual mode of action
-sensitizes soluble guanylate cyclase to endogenous NO by stabilizing NO-sGC binding

-directly stimulates sGC independant of NO and promotes vasodilation

effects:
- Improves excercise tolerance and slows symptom progression

23
Q

Riociguat PK and Toxicites

A

PK: oral drug with long half life

Toxicities:

  • hypotension, headache, dizziness and dyspepsia are among the more common significant adverse effects; rarely see severe bleeding
  • Tertagonesis
  • no administered wit NO or type V phosphodiesterase inhibitors
  • interacts with both pg transporters and cP450
24
Q

4 classes of PHTN

A

1 = PHTN no limitation

2= PHTN some limitation

3= PHTN marked limitation

4 =PHTN and cant carry out Physical activity

25
Q

what is a common PHTN drug combination

A

Tadalafil and ambrisentan

drugs Pulm (6 decks)

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