if patients are able to be treated with CCBs
What does the Acute Vasoreactivity test tell us?
amlodipine, diltiazem, nifedipine
What are the CCBs of choice in PAH? (3)
a
No symptoms with exercise or at rest.
a) Class I
b) Class II
c) Class III
d) Class IV
b
No symptoms at rest; SOB with normal activity.
a) Class I
b) Class II
c) Class III
d) Class IV
c
May or may not have symptoms at rest; SOB, and fatigue limit normal
activities.
a) Class I
b) Class II
c) Class III
d) Class IV
d
Symptoms at rest and severe symptoms with any activity.
a) Class I
b) Class II
c) Class III
d) Class IV
none; monitor for disease progression
What is the treatment for WHO FC I?
ambrisentan + tadalafil
What is the combo therapy for treatment-naive patients?
ERAs, PDE5 inhibitors, Riociguat
What are the treatment options for WHO FC III-treatment naive who can't
tolerate combo therapy? (3)
bosentan, macitentan, riociguat, sildenafil
What are the treatment options for WHO FC II who can't tolerate combo therapy? (4)
continuous IV epoprostenol; treprostinil; titrate both
What are the treatment options for WHO FC III-Rapid disease progression? (2)
continuous IV epoprostenol
What is the 1st line therapy for WHO FC IV patients?
inhaled prostacyclin, oral ERA antagonist, PDE-5 inhibitor, Riociguat
What are the treatment options for WHO FC IV patients who can't tolerate
the 1st line option? (4)
lung transplant; palliative care (if patient is not a candidate)
If inadequate response to maximal therapy, what are the treatments? (2)
thrombocytopenia
The prostacyclin analogs have a class effect of ____________.
a
Which is contraindicated in hepatic impairment when taken orally?
a) treprostinil
b) epoprostenol
c) illoprost
d) selexipag
b
Which is contraindicated in HFrEF + decreased LV EF?
a) treprostinil
b) epoprostenol
c) illoprost
d) selexipag
c,d
Which have no contraindications?
a) treprostinil
b) epoprostenol
c) illoprost
d) selexipag
cyclosporine, glyburide, pregnancy
Bosentan Contraindications? (3)
negative pregnancy test monthly
What do the ERA require before prescribing?
pregnancy
Who are the ERAs contraindicated in?
pregnancy, idiothetic pulmonary fibrosis
Ambrisentan CIs? (2)
c
Which has to be taken with food?
a) ERA
b) PDE-5 inhibitors
c) Nintedanib
d) Pirfenidone
b
Which can cause hearing loss?
a) ERA
b) PDE-5 inhibitors
c) Nintedanib
d) Pirfenidone
drop in mAP >=10 mmHg; absolute mAP of <40mmHg
What confirms a positive Vasoreactivity test? (2)
riociguat, ERAs
Which drugs require REMS? (2)