Respiratory Pharmacology Flashcards
what is the MOA of prostanoids?
Mimic prostacyclin -> vasodilation, suppress smooth Ms growth, inhibit platlet aggregation
what is the MOA of bosentan?
nonspecific block ETa & ETb endothelin receptors on smooth Ms.
what is the MOA of Ambrisentan?
block ETa
what is the role of ETa receptor?
vasoconstriction & cell proliferation
what is the MOA of macitentan?
ET1 antagonist on both ETa & ETb
what is the MOA of sildenafil & tadalafil?
PDE-5 inhibitor
what is the MOA of riociguat?
soluble guanylate cyclase stimulator
what medications would be used to improve exercise intolerance in patients with PAH?
Epoprostenol, Treprosinil, Iloprost, Bosentan, Ambrisentan, Sildenafil, Riociguat
A patient was recently started on a new prescription to treat their pulmonary arterial hypertension. They have started feeling dizzy and malaised. Vitals shows a BP of 100/75 and patient says they have had pain around their jaw for the last week. What medications & class was this patient most likely put on?
Epoprostenol, Treprostinil, Selexipag - Prostanoids
A patient has been on a drug to treat their PAH for the last several months but has noticed confusion, loss of appetite, nausea, vomiting, and vision distortions. Looking at her drug list she is on a drug to treat her chronic AFIB. What is the most likely drug she is on for PAH causing these effects?
Epoprostenol, she is showing signs of digoxin toxicity used to treat her chronic AFIB.
What drug interactions should be avoided when prescribing a patient prostanoids?
antihypertensives, diuretics, vasodilators, anti-platlets, & anticoagulants
Patient tells you they recently began taking a prostanoid for their PAH but feel like it is working “too well”. You see they are also on TMP-SMZ (a CYP2C8 inhibitor). What PAH drugs would most likely have been used?
Selexipag or Treprostinil
Both will have enhanced effects in the presence of a CYP2C8 inhibitor.
What is a risk when giving Treprostinil via a central venous catheter?
blood infection or sepsis
What are important risks to beware of when administering Iloprost?
Syncope from hypotension, Pulmonary venous hypertension (edema), bronchospasm (hypersensitivity)
A patient comes in with pulmonary-veno-occlusive disease, what are they at risk of getting if given treatment with ANY PAH drug?
pulmonary edema
when would using bosentan be contraindicated?
liver disease (hepatotoxic), pregnancy (feto-toxic), Cyclosporine A, Glyburide, allergy
giving a patient bosentan has risk of what side-effects?
respiratory infection & anemia (coated)
URI & fever (uncoated)
what drug interactions are likely with bosentan?
CYP2C9 & CYP3A4 or OCP
What combination therapy would be indicated for prevention of progression & hospitalization in PAH?
Tadalafil + Ambrisentan
What is the most significant risk associated with endothelin anatagonists in treatment of PAH?
Embryo-fetal toxicity, hepatotoxicity, low Hgb, pulmonary edema, fluid retention
What are CYP3A4 inhibitors?
Ketoconazole & Ritonavir
What are CYP3A4 inducers?
Rifampin
What drugs should be avoided when prescriping Macitentan?
CYP3A4 inhibitors & inducers
What are likely side-effects in Ambrisentan alone? with Taldalafil?
alone: nasal congestion, sinusitis, flushing
combo: peripheral edema, congestion, bronchitis, anemia
what are likely side-effects in macitentan?
nasopharyngitis, flu, UTI, bronchitis
What drug should avoided when administering PDE-5 inhibitors?
alpha blockers, amlodipine, ritonavir, other PDE-5 inhibitors
what side-effects are likely with PDE-5 inhibitors?
nose bleeds, rhinitis, dyspnea, insomnia, dyspepsia
A patient comes in with chronic thromboembolic pulmonary hypertension, what would be the most appropriate therapy to improve exercise capacity?
Riociguat
avoid co-administering riociguat with what other drugs?
CYP & P-gp/BCRP inhibitors, or antacids
if antacid, delay 1h after stopping
contraindications for using riociguat are
pregnancy, nitrates or NO, PDE inhibitors, hypertension from interstitial pneumonia
