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NAPLEX > Pulmonary Arteriole HTN > Flashcards

Pulmonary Arteriole HTN Flashcards

1
Q

How is Pulomonary HTN characterized?

A

continous high BP in the pulmonary arteries

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2
Q

How is PH defined?

A

mean PAP (mPAP) >=25 mmHg

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3
Q

What is group 1 PAH?

A

No identifiable causes

called primary or idiopathic

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4
Q

6 select drugs that can cause PAH?

A
  1. Cocaine
  2. SSRIs during pregnancy this increases the risk in the newborn
  3. Wt loss drugs (diethylpropion, lorcaserin, phendimetrazone)
  4. Methamphetamines
  5. Dasatinib (Sprycel)
  6. Diazoxide (Proglycem)
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5
Q

What diet should PAH patients follow and what is the /day restriction?

A

Sodium restriction

<2.4 g/day

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6
Q

What vaccines are advised in PAH?

A

FLu and pneumococcal

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7
Q

PAH can lead to wht?

A

Puts you in a prothrombic state

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8
Q

Since PAH can put you in a prothrombic state wha can pts treated with and what is the goal?

A

Warfarin can be considered

1.5-2.5 gail INR

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9
Q

What other drugs should you consider for PAH pts?

A

Loop diuretics and Possibly digoxin

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10
Q

What do loop diuretics do in PAH?

A

Treat volume overload

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11
Q

What benefit could digoxin have in PAH?

A

Improve cardiac output and control HR

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12
Q

If patients are considered responders to vasoreactivity testing what class of drugs is recommended?

A

CCBs

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13
Q

What 3 CCBs are recommended to PAH vaso responders?

A
  1. Long acting nifedipine
  2. Diltiazem
  3. Amlodipine
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14
Q

What CCB is not recommended in PAH?

A

Verapamil

due to the more significant negative inotropic effects compared to diltaizem

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15
Q

If pts are not responders to vasoactivity test or fail CCB tx what are the next 4 drug classes

A
  1. Prostaglandin analogs and receptor agonists
  2. Endothelin receptor antagoinists ERAs
  3. PDE-5 inhibitors
  4. soluble guanylcyclase
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16
Q

Pts with group five PAH class should be given?

A

IV epoprostenol

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17
Q

What do prostacyclin analgues do for PAH patients?

A

Prostacyclin synthase is reduced in pts with PAH which decreae prostacyclin I2 which is a potent vasodilator

Analogues are potent vaso dilators and also inhibitors of platelet aggregation

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18
Q

What drugs should be avoided in PAH and why?

A

Drugs that decrease prostaglandin like NSAIDs

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19
Q

Flolan

A

Epoprostenol

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20
Q

Warniings for Flolan?

A

Rebound PH Dont DC or decrease dose abruptly

CHronic IV infusions can cause sepsis or blood stream infections

Epoprostenol has an extrememly short half life 6 minutes

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21
Q

Side effects of Flolan

4

A

Vasodilator rxns, FLushing

Jaw pain

infusion site pain

22
Q

What drug requires ice packs for stability?

A

Flolan Epoperstenol

23
Q

What is consider the most potent of all PAH meds?

24
Q

How should Flolan be stored?

A

Protected from light before and during infusion

25
Q

Remodulin

A

Treprostinil

26
Q

PRostcyclin analog Drug interactions? 2 sets

A
  1. Increase effects of antiplatelets, antihypertensives and anticoagulants
  2. Troprostinil (remodulin): levels are increased by 2C8 inhibitors (gemfibrozil) also should be avoided in selexipag
27
Q

2 generic names for endothelin receptor antagonists?

A
  1. Bosentan
  2. Ambresentan
28
Q

What do ERAs do?

A

Endothelin is a potent vasoconstrictor

ERAs block these on the pulmonary smooth muscle

29
Q

Boxed warning for bosentan

A

Hepatotoxicity

30
Q

Boxed warning for ERAs?

A

Emryo fetal tox, must have negative preg before use and monthly

31
Q

COntraintications of ERAs?

32
Q

Warnings for ERAs?

A

Hepatotoxicity, decreased Hgb and Hct, fluid retention

33
Q

ERA side effects?

34
Q

Bosentan can decrease the effects of?

A

Decrease effects of hormonal contraceptives

35
Q

Bosentan is a substrate and inducer of?

A

Sb 3A4

Induc 2C9

36
Q

Bosentan levels can be increased with? 3 bullets

A

2C9 inhibitors: Amiodarone, fluconazole

3A4 inhibitors: ritonavir

Cyclophosphamide and Glyburide on contraindicated

37
Q

What do PDE-5 inhibitors do?

A

Prevent degradation of cGMP

this increases cGMP and causes pulmonary vasculature relaxation and vasodilation

38
Q

2 PDE 5 inhibitors

Brand and Generic?

A
  1. Revatio: Sildenafil
  2. Adcirca: Tadalafil
39
Q

Contraindications of PDE-5

A

Use with nitrates or riociguat

40
Q

4 warnings of PDE-5s

A
  1. Hearing loss
  2. Vision loss
  3. Nonarteritic anterior ischemic optic neuropathy
  4. Priapism
  5. Hypotension
41
Q

PDE5 SEs

42
Q

PDE-5s are substrates of?

43
Q

Caution should be used in patients on PDE5 with what other class?

A

Alpha Blockers or other HTN meds

44
Q

What does Riociguat do?

A

Sensitizes sGC to endogenous nitric oxide and directly stimulates the receptor which incrreases cGMP

45
Q

Boxed warning for Riociguat?

A

Embryo-fetal tox neg preg before starting and checked monthly

46
Q

What two classes of drugs have boxed warnings for fetal embryo toxicity?

A

ERAs: Bosentan

cG stimulators riociguat

47
Q

Smoking increases the clearance of what drug?

48
Q

Contraindications for Riociguat? 3

A
  1. Pregnancy
  2. Use with PDE-5s
  3. Use with nitrates
49
Q

Warnings and side effects of cGC

A

Riociguat

Hypotension

HA

50
Q

What 6 drugs can cause pulmonary fibrosis?

A
  1. Amiodarone
  2. Bleomycin
  3. Dronedarone
  4. Methotrexate
  5. Nitro
  6. Sulfasalazine

NAPLEX (64 decks)

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