Restrictive lung dz and PH Flashcards
This drug is a surfactant purified from bovine creatures
Beractant
What does Beractant treat?
NRDS
This is Dr. Sweatman’s favorite drug
Methotrexate
Along with being an anticancer agent, what else can methotrexate treat?
Inflammatory disease that can effect the lung such as RA and sarcoidosis
What is methotrexate’s MOA for treating cancer?
It inhibits the dihydrofolatereductase enzyme thus decreasing tetrahydrofolate synthesis –> inhibits formation of thymadine –> inhibits DNA synthesis
What is methotrexate’s MOA for treating inflammatory diseases like RA and sarcoidosis?
Inhibits enzymes involved in purine metabolism –> increased levels of adenosine –> decreased inflammation
This drug is the DOC for treating Wegener’s granulomatosis
Rituximab
What is Rituximab’s MOA?
It is a B cell (CD20) antibody
What is another treatment for Wegener’s
Cyclophosphamide
What is cyclophosphamide’s MOA?
It is an alkylating agent that suppresses B cell activity
What is yet another treatment of Wegener’s?
Azathioprine
Acronym for Wegener’s drugs?
CAR: cyclophosphamide, azathioprine, rituximab
What is the MOA for Azathioprine?
It is a purine analogue that inhibits purine synthesis.. It depresses the immune system
What are the 4 classes of drugs that treat PH?
Prostanoids, Endothelin-1 receptor antagonists, Phosphodiesterase type 5 inhibitors, and Calcium channel blockers
What are the 3 prostanoids?
EIT: Epoprosterenol, Iloprost, Treprostinil (all have “prost” in the name)
What is the general side affect that you must watch for in all the prostenoids?
Bleeding (be careful giving these drugs in combination with antithrombic drugs like warfarin, aspirin)
Which prostanoid is especially known for hemoptysis?
Iloprost
Which prostanoid is a pain in the ass cuz you have to take 6-9 inhaled doses/day?
Iloprost
Which prostanoid has the longest half life (4hr) and can be given SC or IV?
Treprostinil
Which prostanoid has a weird side effect of jaw pain?
Treprostinil
Which prostanoid is metabolized by CYP2C8 and thus has decreased clearance with gemfibrozil and increased clearance with rifampin?
Treprostinil
What is the MOA of the prostanoids? 3 things
- Induce vasodilation
- Retard smooth muscle growth
- Disrupt platelet aggregation
What are the 2 endothelia-1 receptor antagonists?
BA: Bosentan, Ambrisentan (“sentan”)
What is the MOA of the endothelia-1 antagonsits?
Endothelin-1 is a potent vasoconstrictor so these drugs antagonize the vasoconstriction –> vasodilation
How are these drugs different/better than prostacyclins?
They are orally active
What is a contraindication in both the endothelia-1 antagonists?
Pregnancy
Which endothelia-1 receptor antagonist has ADE’s including blood and liver toxicities and you need to check LFT’s?
Bosentan
Both the endothelia-1 antagonists are metabolized by what enzymes in the liver?
CYP3A4 and CYP2C9 (the most common ones)
What is the only drug on the condensed drug list that is a Phosphodiesterase type 5 inhibitor?
Tadalafil
What is Tadalafil’s MOA?
Prepetuate endogenous cGMP –> vasodilation and decreased cell proliferation
What is the weird and highly Sweatmany ADE of Tadalafil?
Change in color vision
What are the 3 calcium channel blockers that treat PH?
DAV: Deltiazem, Amlodipine, Verapamil
What is the MOA of the calcium channel blockers?
Block Calcium channels.. calcium is the key mediator of smooth muscle contraction
What is the test you must do before giving someone a calcium channel blocker for PH?
Vasodilator challenge!!!
Describe the vasodilator challenge
Give the patient IV epoprosterenol, IV adenosine, and inhaled NO. Monitor their PAP and CO. “Passing” the test means that they had a decrease in PAP and no change in CO
What are some “in general” ADE’s of calcium channel blockers?
Hypotension, bradycardia, flushing, edema
Which calcium channel blocker is very favorable because of its long half life and thus easier dosing schedule?
Amlodipine (half life: 35-50 hr)
This calcium channel blocker is contraindicated in PH
Verapamil
