Restrictive Lung Disease & Pulm Htn Pharm

Front 1

Treatment of NRDS

Back 1

Antenatal corticosteroids to women at risk of delivery before 34 weeks.
Exogenous surfactant for neonates < 30 weeks (poractant alfa, calfactant, beractant)

Front 2

Treatment of sarcoidosis

Back 2

Glucocorticoids
Methotrexate

Front 3

Adverse effects of corticosteroids

Back 3

Suppression of HPA axis, osteoporosis, pancreatitis, diabetes, cataracts, glaucoma, psychosis, opportunistic infections, immunosuppression, weight gain, skin atrophy.

Front 4

Mechanism of methotrexate

Back 4

DHFR inhibition. Increase in adenosine-mediated immunosuppression (increased levels of adenosine activate GPCR that increase cAMP in cells).

Front 5

Adverse effects of methotrexate

Back 5

Dermatologic rxns, birth defects, malignant lymphoma, increased risk of infection, potentially fatal lung issues

Front 6

Treatment of Goodpasture Syndrome

Back 6

Plasmapheresis to remove Abs to alpha3 chain of type IV collagen

Front 7

Treatment of Wegener's ganulomatosis

Back 7

Rituximab
Azathioprine (DNA & RNA synthesis inhibitor that causes immunosuppression)
Cyclophosphamide (alkylating agent that causes lymphopenia, selective suppression of B-cell activity, and decreased Ig secretion)
Corticosteroids

Front 8

Adverse effects of Rituximab

Back 8

HTN, asthenia, pruritis, urticaria, rhinitis, athralgia

Front 9

Adverse effects of Azathioprine

Back 9

Increased risk of infxn, neoplasm. Leukopenic & thrombocytopenic toxicity.

Front 10

Adverse effects of cyclophosphamide

Back 10

Bladder cancer, myelo/lymphoproliferative malignancies, neutro/thrombocytopenia.

Front 11

Mechanism of the prostanoids

Back 11

Pulmonary artery vasodilation, prevent smooth muscle growth, prevent platelet aggregation

Front 12

Administration of prostanoids

Back 12

Epoprostenol

continuous IV infusion
Iloprost

Front 13

Side effects of epoprostenol

Back 13

Dose limiting hypotension, muscle pains, HA, flushing. Monitor for bleeding.

Front 14

Side effects of iloprost

Back 14

Cough, flushing, HA. Monitor for bleeding. Hemoptysis.

Front 15

Side effects of treprostinil

Back 15

Injection site erythema, rash. Vasodilation, jaw pain. Monitor for bleeding.
CYP2C8 interactions possible! (rifampin)

Front 16

Mechanism of bosentan & ambrisentan

Back 16

Endothelin-1 receptor antagonists to prevent smooth muscle proliferation & pulmonary artery vasoconstriction.

Front 17

Advantages & disadvantages of endothelin-1 receptor antagonists

Back 17

Orally active!
Teratogenic (cat. X). Bosentan = liver & blood toxicities.

Front 18

Side effects of bosentan

Back 18

Elevated LFTs.
Anemia. CYP inducer. Metabolism by CYP2C9 & CYP3A4.

Front 19

Side effects of ambrisentan

Back 19

Peripheral edema, HA.
Hepatic metabolism

CYP2C9, 2A4, OATP, P-gp substrate.

Front 20

Mechanism of sildenafil & tadalafil

Back 20

PDE-5 inhibitors prevent breakdown of cGMP to promote vasodilation & decrease cellular proliferation

Front 21

Side effects of sildenafil

Back 21

HA, epistaxis, flushing, dyspepsia. Rare dizziness + sudden hearing loss.
CYP3A4 substrate.

Front 22

Side effects of tadalafil

Back 22

HA, back pain, dyspepsia.
Change in color vision.
CYP3A4 substrate.

Front 23

CCB avoided in PAH

Back 23

Verapamil

negative inotrope can cause bradycardia

Front 24

Side effects of CCB

Back 24

hypotension, edema, CYP3A4 substrate

Front 25

Treatment of NRDS

Back 25

Antenatal corticosteroids to women at risk of delivery before 34 weeks.
Exogenous surfactant for neonates < 30 weeks (poractant alfa, calfactant, beractant)

Front 26

Treatment of sarcoidosis

Back 26

Glucocorticoids
Methotrexate

Front 27

Adverse effects of corticosteroids

Back 27

Suppression of HPA axis, osteoporosis, pancreatitis, diabetes, cataracts, glaucoma, psychosis, opportunistic infections, immunosuppression, weight gain, skin atrophy.

Front 28

Mechanism of methotrexate

Back 28

DHFR inhibition. Increase in adenosine-mediated immunosuppression (increased levels of adenosine activate GPCR that increase cAMP in cells).

Front 29

Adverse effects of methotrexate

Back 29

Dermatologic rxns, birth defects, malignant lymphoma, increased risk of infection, potentially fatal lung issues

Front 30

Treatment of Goodpasture Syndrome

Back 30

Plasmapheresis to remove Abs to alpha3 chain of type IV collagen

Front 31

Treatment of Wegener's ganulomatosis

Back 31

Rituximab
Azathioprine (DNA & RNA synthesis inhibitor that causes immunosuppression)
Cyclophosphamide (alkylating agent that causes lymphopenia, selective suppression of B-cell activity, and decreased Ig secretion)
Corticosteroids

Front 32

Adverse effects of Rituximab

Back 32

HTN, asthenia, pruritis, urticaria, rhinitis, athralgia

Front 33

Adverse effects of Azathioprine

Back 33

Increased risk of infxn, neoplasm. Leukopenic & thrombocytopenic toxicity.

Front 34

Adverse effects of cyclophosphamide

Back 34

Bladder cancer, myelo/lymphoproliferative malignancies, neutro/thrombocytopenia.

Front 35

Mechanism of the prostanoids

Back 35

Pulmonary artery vasodilation, prevent smooth muscle growth, prevent platelet aggregation

Front 36

Administration of prostanoids

Back 36

Epoprostenol - continuous IV infusion
Iloprost - 6-9 inhaled doses/day
Treprostinil - sub-Q or IV infusion, longest half-life

Front 37

Side effects of epoprostenol

Back 37

Dose limiting hypotension, muscle pains, HA, flushing. Monitor for bleeding.

Front 38

Side effects of iloprost

Back 38

Cough, flushing, HA. Monitor for bleeding. Hemoptysis.

Front 39

Side effects of treprostinil

Back 39

Injection site erythema, rash. Vasodilation, jaw pain. Monitor for bleeding.
CYP2C8 interactions possible! (rifampin)

Front 40

Mechanism of bosentan & ambrisentan

Back 40

Endothelin-1 receptor antagonists to prevent smooth muscle proliferation & pulmonary artery vasoconstriction.

Front 41

Advantages & disadvantages of endothelin-1 receptor antagonists

Back 41

Orally active!
Teratogenic (cat. X). Bosentan = liver & blood toxicities.

Front 42

Side effects of bosentan

Back 42

Elevated LFTs.
Anemia. CYP inducer. Metabolism by CYP2C9 & CYP3A4.

Front 43

Side effects of ambrisentan

Back 43

Peripheral edema, HA.
Hepatic metabolism - CYP2C9, 2A4, OATP, P-gp substrate.

Front 44

Mechanism of sildenafil & tadalafil

Back 44

PDE-5 inhibitors - prevent breakdown of cGMP to promote vasodilation & decrease cellular proliferation

Front 45

Side effects of sildenafil

Back 45

HA, epistaxis, flushing, dyspepsia. Rare - dizziness + sudden hearing loss.
CYP3A4 substrate.

Front 46

Side effects of tadalafil

Back 46

HA, back pain, dyspepsia.
Change in color vision.
CYP3A4 substrate.

Front 47

CCB avoided in PAH

Back 47

Verapamil - negative inotrope can cause bradycardia

Front 48

Side effects of CCB

Back 48

hypotension, edema, CYP3A4 substrate