Pulmonary Arterial Hypertension (PAH) belong to group 1 in the classification of Pulmonary Hypertension (PH). It is a chronic progressive disease caused by narrowing of the minor pulmonary arteries due to vascular proliferation and remodeling.
Figure 1: Changes occur in blood vessels in PAH.
The estimated prevalence for PAH is 15-50 cases per million although it is a rare disease. The female to male ratio is 1.7:1 with higher prevalence between 30-40 years old. To date there are 52 cases per million population of Scotland diagnosed with PAH. (1)
The current treatments available for PAH are prostaglandin (PG), calcium channel blocker (CCB), Endothelin Receptor Antagonist (ERA), and Phosphodiesterase-5-inhibitors (PDE-5-I). The need for new drug therapy is due to the drawbacks of the current treatment as shown in the tables below. (3) This has led to the development of Opsumit (Macitentan), a new drug therapy for PAH.
Table 1: Drawbacks of using Calcium Channel Blocker (CCB) in PAH
Calcium Channel Blocker (Nifedipine, Diltiazem) The proportion of patient benefited from this drug is too little.(2)
Table 2: Drawbacks of using Prostaglandins (PGs) in PAH
Epoprostenol I.V Iloprost nebulized Treprostinil S.C
- Inconvenience administration through IV route which requires hospitalization
- Unpresentable body image
- Administration of the drug might be associated with high risk of infection (need to be given through continuous I.V infusion due to short half-life)
No matter how it is administered when used on a long-term basis, the complications become very abundant. Adequate nutrition is often not provided due to problems with diarrhea, tube clogging, and aspiration.
The dosage was to high for the patient because the chart started going over the regular normal level
Pulmonary hypertension is a lung disorder. The arteries that carry blood from the heart to the lungs become narrowed, making it very hard for the blood to get through the vessels, this then causes the pressure in the arteries to increase more than usual (high blood pressure). Scientists think that the procedure starts with injury to the layer of cells that line the small blood vessels of the lungs.
et al. 2017). Pulmonary hypertensions occurs in about 8-23% of premature infants (Vyas-Read S et. al. 2017). One method of determine if a patient has pulmonary arterial hypertension is by lung function test (Davis R and Mychaliska G, 2013). One current method used to help treat pulmonary arterial hypertension is assisted ventilation, the method helps lower blood pressure (Davis R and Mychaliska G, 2013). However assisted ventilation can not be used in all preterm infants some extracorporeal life support which will provide respiratory and veno-arterial support (Davis R and Mychaliska G, 2013).
With the growing reliance on medication therapy as the primary intervention for most illnesses, patients receiving medication interventions are exposed to potential harm as well as benefits. Medicines have proven to be very beneficial for treating illness and preventing disease. This success has resulted in a dramatic increase in medication use in recent times. Unfortunately, this increase in use and expansion of the pharmaceutical industry has also brought with it an increase in hazards, error and adverse events associated with medication use.
Patients may shy away from an injectable formulation, despite its value in providing a full month of protection from relapse.
can have adverse effect on the functionality of the patient. It is also a threat to the health of the
3.3. A pharmacist should verify the ordering provider is appropriate as noted in section 2.
Secondly, this drug is for patients that are 18 years and older and they are terminally ill.
However, per AbbVie citing CIPO, the mere presence of a fixed dosage and fixed dosing schedule cannot always be sufficient “to avoid the method of medical treatment prohibition” (AbbVie at [18]).
The human body is a very complex organism composed of different types of systems and functions. All the functions that each system has, is what makes possible for the body to obtain life. One of the most important systems in one’s body is the circulatory system, where the heart, the lungs, and the blood vessels work together to form the circle part of the circulatory system. The pumping of the heart forces the blood on its journey. The body’s circulatory system really has three parts: pulmonary circulation, coronary circulation, and systemic circulation. Each part must be working independently in order for them to all work together. However, when one of the parts of the circulatory system does not
To begin the search on Pulmonary Arterial Hypertension (PAH), pulmonary arterial hypertension was typed into PubMed and was limited for review articles in English. This approach was taken because the main interest of the search was the disease state and a review article was desired. The incidence of PAH is approximately between 5 to 52 cases per one million people. Also, the disease affects women more than men in a 2:1 ratio3. The pathophysiology of Pulmonary Arterial Hypertension occurs when vasodilators, like nitric oxide and prostacyclins, are under expressed and vasoconstrictors, like endothelin, are overproduced. The underproduction of vasodilators
Pulmonary vascular disease is used to identify any disorder that may affect blood flow through the vessels between the heart and lungs. Blood flow begins at the right side of the heart and makes its way to the lungs in the process of oxygenation. Deoxygenated blood from the tissue travels to the right side of the heart through the veins and is eventually pumped towards the lungs through pulmonary arteries. The lungs oxygenate the blood and send it towards the left side of the heart through the pulmonary vein in order to pump it throughout the body. Any disruption of this process would be labeled a Pulmonary Vascular Disease. There are several kinds of PVD, the two main types are Pulmonary Embolism and Pulmonary Hypertension. Pulmonary Embolism
For this review, the Kettering College library online database was used to find peer reviewed articles as references. Beginning on February 22, 2015, the search “treatment of pulmonary hypertension” was used to narrow the results for the study. To shorten the results further, the year limit was set from 2005
The purpose of this report is two discuss the Pharmacodynamics, pharmacokinetics, proposed benefits, research method, results of research, and possible-nursing implications of newly approved drugs for the treatment of hypertension. These drugs include Atacand HCT and Diltiazem HCL. All newly approved drugs from the FDA are either new drugs or new formulations of older drugs. The information contained in this report was derived from various web pages and online search engines.