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44 Cards in this Set
- Front
- Back
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What causes peripheral artery disease (PAD)?
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atherosclerosis
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What are the 3 main drug classes to treat peripheral artery disease (PAD)?
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1. anti-platelets
2. lipid lowering agents 3. ACE inhibitors |
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What happens in PAD?
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plaque in aa.->reduced flow distal to plaque->endothelial dysfunction->less NO->less vasodilation->RBC's won't deform to get through capillary->accumulation of platelets and RBC's->further inhibition of perfusion
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T or F: vasodilators will prevent claudication from PAD.
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false
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What are the 2 agents given specifically for claudication?
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cilostazol and pentoxifylline
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What is the MOA for cilostazol?
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inhibits phosphodiesterase type III->increases cAMP in platelets and vasculature->decreases platelet aggregation (major) and causes vasodilation (minor)
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Cilostazol is contraindicated in what disease?
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HF-vasodilation will lead to reflex tachycardia, puts too much pressure on the heart
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What are the adverse effects of cilostazol?
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1. headache
2. diarrhea 3. palpitation 4. dizziness |
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What is the MOA for pentoxifylline?
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makes RBC’s less stiff so they can slip through capillaries more easily (also decreases fibrinogen and blood viscosity)
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What are the adverse effects of pentoxifylline?
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1. NVD
2. dizziness 3. HA |
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What causes Raynaud's Disease? What is the treatment?
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1. vasospasm of small arteries in the skin of the hands and feet with intermittent pallor or cyanosis
2. CCB's (best), alpha-antagonists, nitrates, and ACEI's |
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What group does pulmonary arterial hypertension (PAH) fall under?
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Group 1
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T or F: pulmonary beds are usually high pressure.
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false
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What is the sequence of events in PAH?
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increased pulmonary vascular resistance->pulmonary HTN->right-sided HF
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What is the mechanism by which pulmonary vascular resistance is elevated?
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neurohormonal imbalance
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What are 3 possible mechanisms for developing PAH?
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1. increased endothelin
2. decreased prostacyclin and NO 3. smooth muscle dysfunction (abnormal Ca++ handling) |
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What does endothelin do?
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vasoconstricts and increases cell proliferation
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What do prostacyclin and NO do?
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1. vasodilates
2. decreases cell proliferation 3. inhibits platelet aggregation |
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What are the functional classes of PAH? What is the prognosis for Class IV PAH? Which population is most affected?
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1. Classes I-IV (IV-worst)
2. life expectancy w/o tx is 2 years 3. young women |
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What are the treatment goals for PAH?
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1. prevent thromboembolism
2. reduce peripheral edema 3. reduce pulmonary vascular resistance and remodeling of pulmonary arteries to increase CO, exercise capacity and reduce mortality |
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What drugs are used to treat PAH?
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1. CCB
2. endothelin blocker 3. PGI2 4. PDE-5 inhibitor (prevents destruction of cGMP) |
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What is the main mechanism when treating PAH?
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1. dilate pulmonary vasculature
2. some drugs cause antiproliferative and antiplatelet effects |
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What CCB dose is needed to treat PAH?
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2-3x dose for HTN
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Which CCB has the most inotropic effects?
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verapamil
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How do you determine if a person will respond to a CCB?
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perform an acute vasoreactivity test
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What will happen if someone is given nifedipine for PAH?
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they will vasodilate too much due to the 4 hour half life and will die
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PAH patients should receive CCB's when?
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only in patients that respond to IV epoprostenol, inhaled NO, or IV adenosine
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T or F: patients that exhibit a sustained response to CCB's should remain on them.
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true
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What determines if an acute vasoreactivity test is positive or not?
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mean pulmonary arterial pressure will drop and CO will either stay the same or increase
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What are the 3 prostacyclin analogues?
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1. epoprostenol
2. treprostinil 3. iloprost |
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Which of the prostacyclin analogues are given IV? IV or SQ? Inhalation?
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1. epoprostenol
2. treprostinil 3. iloprost |
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What are the adverse effects from epoprostenol?
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1. jaw pain
2. N & D 3. hypotension 4. HA 5. flushing 6. thrombocytopenia 7. leukocytic classic vasculitis 8. leg and foot pain |
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What is the difference between epoprostenol, treprostinil and iloprost?
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pharmacokinetics
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Which of these drugs has the shortest 1/2 life: epoprostenol, treprostinil and iloprost?
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epoprostenol
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Epoprostenol, treprostinil and iloprost: which drug is very painful? Which drug requires multiple treatments? Which drugs require central line?
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1. treprostinil
2. iloprost 3. epoprostenol and treprostinil |
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If the catheter comes out, you may die if you are on which prostacyclin analogue?
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epoprostenol
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What are the 2 endothelin receptor blockers? How are these drugs given?
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1. bosentan and ambrisentan
2. orally |
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Which endothelin receptors will endothelin receptor blockers work on?
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A and B
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What can happen if too many endothelin receptor blockers are given?
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1. vasoconstriction
2. fibrosis 3. hypertrophy and hyperplasia 4. increases vascular permeability |
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What are the main adverse effects of bosentan?
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1. liver enzyme elevations
2. lowered HGB and HCT 3. teratogenic 4. can decrease contraception concentration 5. nasopharyngitis |
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What is the PDE-5 inhibitor?
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sildenafil
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How does sildenafil work in PAH?
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inhibits PDE-5->cGMP is not broken down quickly->enhances pulmonary vasodilation
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What are the adverse effects of sildenafil?
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1. HA
2. facial flushing 3. GI irritation 4. epistaxis 5. Nonarteritic ischemic optic neuropathy (NAION) |
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What is the first line treatment for the most severe (functional Class IV) PAH patients?
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epoprostenol
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