Pulmonary Arterial Hypertension: Practice Points for Pharmacists to Improve Patient Outcomes

Post Activity Self-Assessment and Activity Evaluation

Post-Activity Test

Question Title

1. A 45-year-old woman has been referred to the pulmonary clinic by her primary care physician for progressive dyspnea on exertion. Her medical history is unremarkable, has given birth to 3 full-term healthy children, and currently takes a combined oral contraceptive. She reports that she first experienced shortness of breath about 6 months ago, usually when walking or climbing stairs. She now cannot walk a block without stopping to take a break and often develops lower leg swelling. In addition to these symptoms, what other finding would be most consistent with a diagnosis of pulmonary hypertension?

Acute chest pain

Polyuria

Chest tightness

Pulsating headache

Question Title

2. A 63-year-old male is diagnosed with PAH via right heart catheterization and is at NYHA Functional Class III. His medical history includes rheumatoid arthritis and venous thromboembolism and he was hospitalized 2 months ago for chest pain. Examination reveals a blood pressure of 92/60 mm Hg, heart rate of 98/min, and respiratory rate of 22/minute. Laboratory results include elevated LFTs and BNP 1200 pg/mL. His eGFR is 50 mL/min/1.73 m². Right heart catheterization found mPAP 48 mm Hg and PVR 10 Wood units. He walked about 120 meters during the 6MWD with frequent stops and continuous O2 requirement. What is the calculated 1-year mortality risk according to REVEAL 2.0?

Low, predicted 1-year mortality risk <5%

Average, predicted 1-year mortality risk 5%

Intermediate, predicted 1-year mortality risk 5–10%

High, predicted 1-year mortality risk >10%

Question Title

3. A 56-year-old female who is being actively managed for PAH is admitted for worsening dyspnea on exertion. She is currently on tadalafil and inhaled treprostinil × 6 months with little to no improvement in symptoms. The pulmonary hypertension team decides to initiate subcutaneous treprostinil and stop inhaled treprostinil. Which of the following are most important to determine prior to initiating infused treprostinil?

Dosing weight and plan for transition from inhaled treprostinil

Dosing weight and plan for discharge

Vial concentration and plan for discharge

Next reservoir change and vial concentration

Question Title

4. A 34-year-old female is recently diagnosed with PAH and will initiate treatment with tadalafil and ambrisentan. She has no immediate intention of getting pregnant and her primary birth control method is barrier (male condoms). The patient should be counseled about which of the following regarding ambrisentan use?

There is no teratogenic risk with the use of this agent.

She can continue using a barrier method for contraception.

She should switch to two effective or one highly-effective form of contraception.

Ambrisentan is safe for the fetus until the second trimester of pregnancy.