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pulmonary hypertention

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Epoprostenol (Flolan®)
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
Treprostinil
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
inhaled treprostini
class 3
SE same as others, pro throat irritation cough
lloprost
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
sildenafil/tadalafil
act like NO sustain cGMP
class 1,2,3
cause flushing, HA, heartburn, muscle aches, vision (rare). vasorelaxation
Bosentan 2C9 3A4
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
ambrisentan 3A4 2C19
endptherial receptor antgaonist
adjunct therapies
treatment of HF digoxin diuretics oxygen chronic anticoagulation warfarin
limit Na intake and get immunized