Pulmonary Conditions & Tobacco cessation: Pulmonary Arterial HTN Flashcards
Pulmonary hypertension is…
continues high blood pressure in pulmonary arteries ( > 25 mmHg)
Sodium restricted diet means…
< 2.4g sodium/day
how to confirm diagnosis of PAH?
right heart catheterization
responder to vasoreactivity testing should get…
calcium channel blockers
LA preferred: Nifedipine, diltiazem and amlodipine
If non-responder to vasoreactivity testing, should get….
ERAs = endothelial receptor antagonist = end in -enten**
PDE5i = viagra, cialis,
Prostacyclin analogues
Epoprostenol
treprostinil
Epoprostenol CI
heart failure with dec left ventricular ejection fraction
Treprostinil CI
severe hepatic impairment (Pugh Class C)
Prostacyclin analogue warnings
Vasodilation reactions
Rebound PH
Sepsis with chronic IV infusions
Treprosinil ** oral shell doesnt dissolve **
Prostacyclin analogue side effects
HTN
Flushing
Jaw pain
Infusion-site reaction with SubQ ones
Epoprostenol notes
most protect from light before recon and during infusion
Flolan req ice back when recon for stability
Epoprostenol Dose
start at 2ng/kg/min and inc by 1-2ng Q 15 min intervals
Treprostinil (remodulin = continuous IV version) dosing
1.25 ng/kg/min, inc at weekly intervals 40-80 ng/kg/min
Endothelin Receptor Antagonists (ERAs)
Bosentan = Hepatotoxicity
Ambrisentan
Macitentan
ERA Boxed warnings
Teratogenic, req negative pregnancy test before start and monthly after
Only available through REMS program
Bosentan = Hepatotoxicity
ERAs contraindications
Pregnancy
Bosentan = using w/ cyclosporine or glyburide
ERAs warnings
Hepatotoxicity
Dec Hgb/Hct
Fluid retention
ERAs side effects
Headache
Upper Respiratory tract infections
PDE5-i contraindications
Using with nitrates
PDE5-i warniings
Hearing loss
Vision loss
nonarteritic anterior ischemic optic neuropathy (NAION)
hypotension
priapism
PDE5-i side effects
HA
epistais
flushing
n/d
extremity or back pain
Soluble guanylate cyclase stimulator
Riociguat (Adempas)
Riociguat (Adempas) boxed warnings
Teratogenic, need neg pregnancy test and then monthly
part of REMS program
Riociguat CI
pregnancy
PDE-5i
Riociguat warnings and SE
Warnings: hypotension
SE: HA/N/V/D
Idiopathic Pulmonary fibrosis (IPF) meds
pirfenidone (esbriet)
nintedanib (Ofev)
