Pulmonary Hypertension Flashcards
pulmonary hypertension definition and causes
-Characterized by elevated pulmonary arterial pressure and secondary right ventricular failure
Causes:
-Idiopathic
-Congenital heart disease
-Genetic
-Drugs:
-fenfluramine, dexfenfluramine & PPA (withdrawn from market)
-SSRIs, amphetamines, chemo drugs, cocaine
-Connective Tissue Diseases
-HIV
-Portal HTN
“I Can Get Drugs Causing High Pressure”
I: Idiopathic
Can: Congenital heart disease
Get: Genetic
Drugs: Drugs (fenfluramine, dexfenfluramine, PPA, SSRIs, amphetamines, chemo drugs, cocaine)
Causing: Connective Tissue Diseases
High: HIV
Pressure: Portal Hypertension
pulmonary hypertension: drug causes
Drugs:
- Fenfluramine
- Dexfenfluramine
- PPA (withdrawn from market)
-SSRIs
- Amphetamines
- Chemo drugs
- Cocaine
“Festive Dancers Perform Sassy, Amazing, Choreographed Concerts”
FEstive: Fenfluramine
Dancers: Dexfenfluramine
Perform: PPA (Phenylpropanolamine)
SaSSy: SSRIs
AMazing: Amphetamines
CHoreographed: Chemo drugs
COncerts: Cocaine
pulmonary HTN- pathophysiology chart
Initial hypoxic event releases cytokines/chemokines that cause remodeling vasospasms and pulm htn
pulmonary HTN chart
pulmonary HTN chart-he wants us to understand there is a lot going on this chart
pulmonary HTN- classification
Group 1: Pulmonary Arterial Hypertension (PAH).
Group 2: PH with left heart disease (PVH)
Group 3: PH associated with lung diseases and/or hypoxemia.
Group 4: PH due to chronic thrombotic and/or embolic disease.
Group 5: Miscellaneous causes of PH
treatment of PH
All Classification Groups should receive:
-Diuretics (to decrease congestion and edema) -> decrease fluid volume
-Oxygen (in patients w/ hypoxemia)
-Warfarin (INR of around 2)
-Digoxin (to improve LVEF and control HR)
-Exercise (to improve functional class and O2 consumption
More targeted treatment varies by group and depends on response to a basal vasoreactivity test
“Ex - DOWN!!!! or Ex- DDOW(n)
“(beat yo ex stop the hyperventilation/lung hypertension”)
-Exercise
-Diuretics
-Oxygen
-Warfarin
-N: digoxiN
Targeted Treatment examples + drug names
-oral calcium channel blockers: nifedipine, amlodipine, diltiazem
- oral PDE inhibitors: sildenafil
- oral endothelin receptor blockers: bosentan, ambrisentan
-parenteral prostanoids: epoprostenol, treprostinil, iloprost
targeted tx for PAH: Oral CCBs (calcium channel blocker)
-use only for pts who respond to the basal reactivity test
Usually use high doses of:
- nifedipine-
amlodipine
-diltiazem
targeted tx for PAH: oral PDE inhibitors (phosphodiesterase inhibitors)
MOA: prolong the vasodilatory effect of nitric oxide
Contraindications: don’t use w/ nitrates and alpha-1 blockers
ADRs:
- headache
- flushing, etc
drug: Sildenafil
- Sildenafil (Revatio) = main agent used
- less data for other agents in PAH
-> only low dose needed to treat -> higher dose is viagra
- silDENafil = slide -> prolong/dilate effects of NO in pDE
Oral endothelin receptor blockers MOA + drug examples
-Initial preferred therapy for Group 1 PAH **
MOA:
- reduces vasoconstriction by blocking endothelin-1 (vasoconstrictor)
- causes proliferation of vascular smooth muscle cells
Examples:
-bosentan
-ambrisentan – more selective, less side effects
”- sENTan = ENdoThelin”
Oral endothelin receptor blockers ADR + DDI
ADRs:
- hepatotoxicity-
- teratogenicity: Category X!!!!
- headache
- flushing
- edema
DDIs: several
-Bosentan can only be prescribed/dispensed through direct access programs
-bosentan
-ambrisentan – more selective, less side effects
targeted tx for PH: parenteral prostanoids
Epoprostenol IV:
-First line tx in severe PAH**
-MOA: VASODILATES and inhibits platelet aggregation -> helps PH but also prevents CLOTS!
-Administration: Start in hospital. This is a continuous IV infusion given indefinitely
-ADRs: chest pain, anxiety, h/a, dizziness, flushing, bradycardia
-Treprostinil: administration advantages (IV, SQ, InH)
-Iloprost Inh
“-PROST = Parenteral PROSTanoids”
-epoPROSTenol
-trePROSTinil
-iloPROST
first line treatment of initial PAH and severe PAH
initial PAH tx: oral endothelin receptor blockers
severe PAH: epoprosternol IV
Slidenafil contraindications
Dont use with nitrates and alpha 1 blockers
