Autonomic Nervous Systems
Which of the following is not used in treatment of pulmonary hypertension?
(Ref. KDT Pharmacology 6th ed. pg. 295; Harrison's Principles of Internal Medicine 16th Edition pg. 1405)
Because the pulmonary artery pressure in PPH increases dramatically with exercise, patients should be cautioned against participating in activities that demand increased physical stress.
a. Digoxin may increase cardiac output and lower circulating levels of norepinephrine.
b. Diuretic therapy relieves peripheral edema and may be useful in reducing RV volume overload in the presence of tricuspid regurgitation.
c. Resting and exercise pulse oximetry should be obtained, as oxygen supplementation helps to alleviate dyspnea and RV ischemia in patients whose arterial oxygen saturation is reduced.
d. Anticoagulant therapy is advocated for all patients with PPH since thrombin deposition occurs in the pulmonary circulation; thrombin can serve as a growth factor to promote the disease process.
e. One retrospective study and one prospective study demonstrated that the anticoagulant warfarin increases survival of patients with PPH. The dose of warfarin is generally titrated to achieve an INR of two to three times control.
Other Drugs Useful Are:
a. Calcium Channel Blockers
b. Prostacyclins Epoprostenol
c. Endothelin Receptor Antagonists e.g. Bosentan