Pulmonary HTN - Israel Flashcards
PAH occurs bc of endothelial dysfunction - list the levels/compounds that are altered
- decrease nitric oxide and prostacyclin
- increase in thromboxane and endothelin
(aka everything leads to constriction–HTN)
Progression of PH:
____ of heart has difficulty pumping blood through the lungs
right side
Progression of PH:
More strain on the heart –> _________ & enlargement of _____ –> heart _____
fibrosis/remodeling; enlargement of RV; heart failure
How to diagnose PAH
ECG; Cardiac Catheterization; Exercise testing; biomarkers
what biomarkers are used to diagnose PAH
BNP; NTproBNP
Non-Pharm Therapy for PAH
- immunization (flu & pneumonia)
- Supplemental O2
- Avoid Air Travel if possible
what drug options are monotherapy first line for Class II patients and can be used for pts in class 2 - 4
- PDE inhibitors
- Endothelin antagonist
what drugs are the endothelin antagonists
- bosentan
- ambrisentan
- Macitentan
what are some notable ERA side effects
- increase in LFTs (mainly for bosentan)
- Edema/flushing
- decrease hemoglobin
which drug is the gold standard for severe PH with RV failure
Prostacyclin
When to use PGI2 analogs - INHALED
1st line for Class IV pts that do not want to do parenteral options
OR
Class III pt already on PDE5 and ERA
What drugs cannot be used with PDE5 inhibitors
- NITRATES
- Riociguat
Prostacyclin ______ route is first line for CLass IV pts
parenteral
what are the prostacyclin agents used as an inhalation
Tyvaso - treprostinil
Ventavis - Iloprost
IV options for PGI analogs
Epoprostenol (Flolan; Veletri)
or
Treprostinil (Remodulin)
