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44 Cards in this Set

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