Pulmonary HTN - Israel Flashcards

1
Q

PAH occurs bc of endothelial dysfunction - list the levels/compounds that are altered

A
  • decrease nitric oxide and prostacyclin
  • increase in thromboxane and endothelin

(aka everything leads to constriction–HTN)

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2
Q

Progression of PH:

____ of heart has difficulty pumping blood through the lungs

A

right side

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3
Q

Progression of PH:

More strain on the heart –> _________ & enlargement of _____ –> heart _____

A

fibrosis/remodeling; enlargement of RV; heart failure

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4
Q

How to diagnose PAH

A

ECG; Cardiac Catheterization; Exercise testing; biomarkers

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5
Q

what biomarkers are used to diagnose PAH

A

BNP; NTproBNP

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6
Q

Non-Pharm Therapy for PAH

A
  • immunization (flu & pneumonia)
  • Supplemental O2
  • Avoid Air Travel if possible
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7
Q
what drug options are monotherapy first line for Class II patients
and can be used for pts in class 2 - 4
A
  • PDE inhibitors

- Endothelin antagonist

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8
Q

what drugs are the endothelin antagonists

A
  • bosentan
  • ambrisentan
  • Macitentan
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9
Q

what are some notable ERA side effects

A
  • increase in LFTs (mainly for bosentan)
  • Edema/flushing
  • decrease hemoglobin
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10
Q

which drug is the gold standard for severe PH with RV failure

A

Prostacyclin

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11
Q

When to use PGI2 analogs - INHALED

A

1st line for Class IV pts that do not want to do parenteral options
OR
Class III pt already on PDE5 and ERA

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12
Q

What drugs cannot be used with PDE5 inhibitors

A
  • NITRATES

- Riociguat

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13
Q

Prostacyclin ______ route is first line for CLass IV pts

A

parenteral

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14
Q

what are the prostacyclin agents used as an inhalation

A

Tyvaso - treprostinil

Ventavis - Iloprost

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15
Q

IV options for PGI analogs

A

Epoprostenol (Flolan; Veletri)
or
Treprostinil (Remodulin)

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16
Q

Can you give Epoprostenol IV with other fluids

A

NO!

17
Q

ADEs for PGI analogs (oral or inhaled)

A

antiplatelet effect; Risk of hypotension

18
Q

Adjunct therapy for PAH

A
  • Anticoagulation

- Diuretics to maintain Euvolemia

19
Q

ADEs of PDE-5 inhibitor

A
  • Erections
  • Small vessel dialation - flushing/HA/Nost bleed/hypotension
  • Heartburn (GI)
20
Q

how do PDE5 inhibitors work?

A

more cGMP around because not being broken down by PDE5 which creates more NO — vasodilation