Pulmonary Arterial Hypertension

Front 1

What do you use for acute vasodilator response testing

Back 1

Use IV flolan, inhaled nitric oxide, IV adenosine

Positive response is decrease in pulmonary arterial pressure at least 10mm Hg to less than 40

Positive response predicts mortality reduction with long term CCB or vasodilator use

Front 2

What is the initial PAH treatment algorithim

Back 2

1) Supportive care, treat hypoxemia
2) Maintain O2 sat
3) Oral anticoagulation, warfarin 1.5-2.5 INR to prevent catheter thrombosis and VTE with IV prostaglandin use
4) Immunization for influenza and Pneumococcal
5) Birth control
6) Initiate oral CCB, if no response, use lower risk algorthim
7) Lower risk
- 1St line: Endothelin receptor antagonist (Bosentan) or PDE inhibitor orally
- Alternatives: Flolan, inhaled iloprost, SC treprostinil

Front 3

What are the phosphodieseterase inhibitors

Back 3

1) Sildenafil - HA, dyspepsia, do not use with nitrates, avoid use with CYP3A4 inhibitors (ritonavir, cimetidine, erythomycin)

2) Tadalafil - dose adjust in renal dysfunction, Child Pugh scores > C do not use

Front 4

What are the endothelin receptor antagonists

Back 4

1) Bosentan (Tracleer)
- peripheral edema, hypotension, severe intxn with glyburide, cyclosporine, monitor LFTs

2) Ambrisentan (Letairis) - peripheral edema, hypotension, palpitations, no CYP interactions