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Review of Pharmacology - 9E (2015)

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Recent Topics<br />

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If the patient has WHO Class 3 symptoms, then prostacyclin analogs (epoprostenol<br />

intravenously, iloprost by inhalation, or beraprost or treprostinal subcutaneously)<br />

should be added to the regimen.<br />

––<br />

For patients with WHO Class 4 symptoms, either epoprostenol or iloprost<br />

should be used as the sole agent, though some experts still advocate combination<br />

therapies.<br />

• Most authorities advocate long-term oral anticoagulation.<br />

• Supplemental oxygen, particularly at night, appears to improve symptoms and<br />

helps reduce pulmonary pressures.<br />

• Diuretics help with right heart edema.<br />

• Pulmonary transplantation is a viable option in selected centers, though the operative<br />

mortality is high (around 20–25%).<br />

• Women with significant pulmonary hypertension should not get pregnant, and<br />

permanent birth control measures should be considered.<br />

• Future advances in therapy include the possible use <strong>of</strong> angiogenesis inhibitors,<br />

growth factor inhibitors, and endothelial stem cells or progenitor cells.<br />

Calcium channel blockers<br />

(including amlodipine, diltiazem,<br />

and nifedipine) are the first-line<br />

therapy for idiopathic pulmonary<br />

hypertenstion.<br />

General Recent <strong>Pharmacology</strong><br />

Topics<br />

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