3 Written Questions

1. SQ or IV no oral class 2-4
   
   SE: Nausea, vomiting, headache, jaw pain, flushing, hypotension, bradycardia, reflex tachycardia (at higher doses), flu-like symptoms
   Antiplatelet effect Line infections, sepsis, catheter obstruction (with IV formulation), infusion-site pain/swelling (with SQ formulation)
   
   Safer, more convenient, and less temperature-labile than epoprostenol Portable pump
2. Prostacyclin Analogues for class III and first line class IV and catheter
   SE: Nausea, vomiting, headache, jaw pain, flushing, hypotension, bradycardia, reflex tachycardia (at higher doses), flu-like symptoms
   Antiplatelet effect Line infections, sepsis, catheter obstruction
   
   CI: Development of pulmonary edema, CHF due to severe L ventricular systolic dysfunction
   
   Portable infusion pump --- pump failure ordislodging can result in rebound pulmonary hypertension and possible death medical emergency unstable at room temperature a
3. protable neubulizer /inhale
   class 3 and 4
   syncope SBP<85mmHg
   cough,flusing,flu-like syndrome,jaw pain, bronchospasms, antiplatlet effects
   neb adaptive aerosol delivery system

3 Multiple Choice Questions

1. act like NO sustain cGMP
   class 1,2,3
   cause flushing, HA, heartburn, muscle aches, vision (rare). vasorelaxation
   1. Treprostinil
   2. adjunct therapies
   3. Bosentan 2C9 3A4
   4. sildenafil/tadalafil
2. endotherial receptotr antagonist
   
   2-4
   FDA black box warning for hepatic toxicity, monthly LFTs
   Pregnancy category X monthly pregnancy test, two methods of contraception (except IUD) during and one month after stopping bosentan therapy in females of childbearing potential
   Headache, flushing, peripheral edema, decreased sperm count, angioedema
   Anemia: monitor hematocrit every 3 months
   1. adjunct therapies
   2. Treprostinil
   3. ambrisentan 3A4 2C19
   4. Bosentan 2C9 3A4
3. class 3
   SE same as others, pro throat irritation cough
   1. Treprostinil
   2. inhaled treprostini
   3. adjunct therapies
   4. lloprost

2 True/False Questions

1. ambrisentan 3A4 2C19 → endotherial receptotr antagonist
   
   2-4
   FDA black box warning for hepatic toxicity, monthly LFTs
   Pregnancy category X monthly pregnancy test, two methods of contraception (except IUD) during and one month after stopping bosentan therapy in females of childbearing potential
   Headache, flushing, peripheral edema, decreased sperm count, angioedema
   Anemia: monitor hematocrit every 3 months

   True        False

2. adjunct therapies → treatment of HF digoxin diuretics oxygen chronic anticoagulation warfarin
   limit Na intake and get immunized

   True        False