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Discussion Starter #1
INPATIENT/ ER/ CLINIC/ OTHER - clinic
PATIENT PROFILE - 40 yo female, c/o dyspnea and weakness, lung biopsy reveals decreased intraluminal diameter of small branches of pulmonary artery and medial hypertrophy, scheduled for lung transplant
FAMILY HX - mother had similar sx and died at age of 40
QUESTION - during waiting period, whch of the following medicines is indicated?

A etarnercept
B bosentan
C clopidogrel
D indomethacin
E enalapril
 

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B. Bosentan

To reduce pulmonary Hypertention..
 

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Ans - bosentan à competitive antagonist of endothelin receptors used for Rx of primary (idiopathic) pulmonary arterial hypertension

PH à increased pressure in pulmonary artery causes increased thickness of smooth muscle of arterioles (medial hypertrophy) and fibrosis of intima causing decreased luminal diameter.
Primary pulmonary hypertension, inherited, associated with decreased apoptosis of endothelial and smooth muscle cells in pulmonary arterioles.
Etiology à endothelin is a potent vasoconstrictor and stimulant of endothelial proliferation
Rx vasodilation and lung transplant (ultimate treatment).
 
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