Pulmonary Hypertension Flashcards
(37 cards)
What is Pulmonary Hypertension?
When the normal blood pressure is higher in the LUNGS
What is the WHO classification of Pulmonary Hypertension?
Group 1[~3% of patients]
-With an unknown cause
-Treated with lung transplant or CCB
What is the epidemiology of PAH?
The epidemiology is unknown, but it could be caused by like certain medications
-2 to 8 cases per million each year [0.002%]
-Mainly causes problems on the right side of the heart
What are the signs and symptoms of PAH?
SOB [most common], Chest Pain, Fatigue, Edema, Light-Headedness
-Could also resemble COPD/Asthma
How do you determine the diagnosis of PAH?
-Echocardiogram
-Walking for 6 minutes
-Right Heart Catheterization [CONFIRMS IT]
-Other biomarkers
What are the effects on the body caused by PAH?
The pulmonary arterial wall becomes damaged, causing a decrease in blood flow to the lungs.
-Right side of the heart becomes larger
-Left side of the heart becomes smaller
What happens within the arteries when vascular injury occurs?
-Decrease in NO synthase
-Decrease Prostacyclin Production
-Increase Thromboxance Production
-Increase Endothelin 1 Production
*all will cause a start in vasoconstriction
What does Endothlin 1 do?
It is a potent vasoconstrictor
What are the WHO functional classes and difference between them?
-Class I: Symptom-free
-Class II: Slight Limitation; Comfortable at rest
-Class III: Marked Limitation; Comfortable at rest
-Class IV: Symptoms at rest
What is an Acute Vasoreactivity Test?
It is a test to see whether or not a patient is going to need to use a CCB or not.
-Recommended CCBs: Amlodipine, Nifedipine, Diltalizem
What is the treatment recommendations for a patient with WHO FC I?
Continue to monitor the disease progression and possibly determine a start of medication
What is the treatment recommendation for a patient with WHO FC II?
See if they can tolerate combo therapy;
-Yes: do Ambreisentan + Tadalafil
-No: Use a ERA, Riocigant, or PDE5 Inhibitor
What is the treatment recommendation for a patient with WHO FC III Low [without rapid progression]?
The same as WHO FC II
See if they can tolerate combo therapy;
-Yes: Ambrisentan + Tadalafil
-No: ERA, Riocigant, or PDE5 Inhibitor
What is the treatment recommendation for a patient with WHO FC III High [with rapid progression]?
See if they are a candidate for Parenteral prostanoids
-Yes: SC Treprostinil
-No: Inhaled or Oral Prostanoids
What is the treatment recommendation for a patient with WHO FC IV?
The same as WHO FC III High
*See if they are a candidate for Parenteral Prostanoids
-Yes: SC Treprostinil
-No: Oral Prostanoids
What are the therapeutic pathways for treating PAH?
Prostacyclin Pathway, NO Pathway, Endothelim Pathway
What is the MOA for the PDE-5i?
They will block the conversion of cGMP to GMP
-The increase of the cGMP will cause pulmonary dilation.
What are the PDE5i?
Sildenifil, Tadalafil
How is Sildenifil and Tadalafil dosed?
Sildenifil is BID
Tadalafil is ONCE DAILY
What are the Drug Interactions with the PDE5i?
Avoid use with Riocigant or Nitrates & CYP3A4
What are the side effects of the PDE5i?
Headache, Blue Vision, Flushing, Hypotension, Loss of vision and hearing
What is the MOA for the Endothelin Receptor Antagonist?
ET found within the vasocular smooth muscle with cause vasoconstriction; so ET-1 will cause some bad remodeling. So, blocking ET will result in vasodilation
What are the ERAs?
Ambrisetan, Bosetan, Machitentan
How are the ERAs dosed?
Ambrisetan and Macitentan are ONCE DAILY
Bosetan is BID
