Monday, November 18, 2019

Pharmacologic treatment of pulmonary hypertension (notes and mnemonics)

Hi!

Vasodilator response: A favorable vasodilator response is defined as a fall in mPAP of 10 mm Hg or greater to less than 40 mm Hg with an unchanged or improved cardiac output, in response to an agent such as inhaled NO or IV epoprostenol.


Patients demonstrating a positive vasoreactivity response are initially treated with an oral calcium channel antagonist, such as long-acting nifedipine, amlodipine, or diltiazem.

Oral endothelin receptor antagonists:
Bosentan
Ambrisentan
Macitentan
Mnemonic: BAM!

Oral phosphodiesterase type 5 (PDE5) inhibitors:
Tadalafil
Sildenafil
Mnemonic: PTSD

Oral soluble guanylyl cyclase agonists:
Riociguat
Mnemonic: SgCAR

Prostacyclin analogues:
Treprostinil
Iloprost
Epoprostenol
Mnemonic: ProstaTIE

Epoprostenol remains the only approved agent with a documented survival benefit in PAH and the drug of choice in patients with class IV PAH.

-IkaN

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