Pulm Htn

Front 1

Definition of Pulm HTN

Back 1

Increase in Pulmonary Arterial Pressure (PAP) by ≥25 mmHg at rest

(normal is 12-16)

Front 2

Agents used for vasodilator test

Back 2

Nitric oxide (preferred agent)- inhaled

Adenosine- IV

Epoprostenol- IV

Front 3

If pt has a positive acute vasoreactivity test, what medication should be prescribed?

Back 3

Oral CCB

Front 4

Who is more likely to get pulmonary HTN, men or women?

Back 4

Women (2:1)

Front 5

Which group of Pulm HTN would someone with L heart disease fall into?

Back 5

Group 2

Front 6

Which group of Pulm HTN would someone with HIV fall into?

Back 6

Group 1

Front 7

Which group of Pulm HTN would someone with chronic thromboembolic dx fall into?

Back 7

Group 4

Front 8

Pathogenesis of Pulm HTN

Back 8

-restricted flow thru pulm art. circulation

-increased pulm vascular resistance

-right heart failure

Front 9

WHO functional classification of pulm HTN

Back 9

(same as NYHA for heart failure)

I- no limits of ordinary activity

II- mild limits of activity, normal at rest

III- marked limits of activity, normal at rest

IV- Inability to carry out normal activities, signs of right heart failure, sx at rest

Front 10

Supportive therapy for pulm HTN should include what?

Back 10

-O2 supplementation

-Diuretics

-Digoxin (improve CO acutely, slow vent rate)

-Anticoagulation for idiopathic PAH, advanced dx on continuous IV therapy

Front 11

What should the INR goal be if giving anticoags for PAH?

Back 11

1.5-2.5

Front 12

What do you give a patient who has a positive response to acute vasoreactivity testing?

Back 12

CCBs

(most commonly Diltiazem, Amlodipine, or Nifedipine)

higher doses used than HTN tx

Front 13

Which CCBs would be given if baseline bradycardia? tachycardia?

Back 13

Brady: Nifedipine, Amlodipine (DHP)

Tachy: Diltiazem (non-DHP)

Front 14

Contraindication of all Endothelia Receptor Antagonists

Back 14

Pregnancy!

Front 15

All PDE-5 inhibitors are contraindicated with which drug?

Back 15

Nitroglycerin

Front 16

When would an atrial septostomy be indicated for PAH?

Back 16

Best for bridging to transplantation (30-40% success rate)

but high mortality rate (5-50%)

Front 17

Which drugs can be used together for combination therapy of PAH?

Back 17

Endothelin Receptor Antagonists (ERAs)

and PDEs