pulmonary HTN

Question 1

nifedipine, amlodipine, diltiazem MOA and AE’s / contraindication

Answer 1

decrease Ca++ influx through L-type channels -> decrease contractility, PVR, and BP
hypotension, reflex tachycardia, sympathetic stimulation, RV ischemia (don’t use with R H failure)

Question 2

nifedipine, amlodipine, diltiazem use / pretests

Answer 2

Pulmonary HTN in vasoreactive patients; may worsen condition if pt is not vasoreactive

Question 3

Epoprostenol, Iloprost, Trepostinil MOA, ROA, AE

Answer 3

activate PGI2 receptor -> vasodilation (and platelet aggregation inhibition)
E, T - IV; I - inhaled
IV - HA, jaw pain, diarrhea, anorexia, vomiting
Inhaled - HA, cough, nausea, syncope

Question 4

Sildenafil, Tildalafil MOA, AE’s, contraindication

Answer 4

PDE-5 inhibitors -> block cGMP breakdown -> vasodilation and sustained NO production by NO synthase
epistaxis, HA
don’t use with concomitant use of nitrates

Question 5

Riociugat MOA, AE’s, contraindications

Answer 5

stimulate soluble guanylate cyclase
teratogen, bleeding, hypotension
concomitant use of nitrates, PDE-5 inhibitors, pregnancy

Question 6

bosentan, macitentan, ambrisentan MOA, AE’s, contraindication

Answer 6

endothelin receptor antagonists (ET-1 is implicated in various CVD’s)
hypotension, edema, cold, palpitations, chest pain, fatal hepatotoxicity (monitor AST), teratogen
pregnancy

Question 7

bosentan, macitentan, ambrisentan targets

Answer 7

ETB - initial pressor effect

ETA - prolonged pressor effect