Management of the Patient With Pulmonary Arterial Hypertension Receiving Intravenous Prostacyclin

Kingman, Martha; Lombardi, S

doi:10.1097/nan.0000000000000017

Cited by 6 publications

(6 citation statements)

References 40 publications

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“…Similarly to the potassium concentration increase mechanism, glutamate levels increase at the synaptic cleft due to a slower clearance rate in Cx30/43 knockout mice, resulting in an increase in synaptic transmission (Pannasch et al, 2011; Figure 2). In addition, astroglial glutamate uptake is an important process for neurotransmitter recycling and production of new pools of glutamate and GABA neurotransmitters, known as the glutamate-glutamine cycle, which affects behavior (Mazaud et al, 2019) and is thought to maintain neurotransmission at excitatory synapses (Schousboe et al, 1993;Tani et al, 2014), although this is still debated (Kam & Nicoll, 2007). Thus, a reduced diffusion of glutamate through the astrocytic network could affect the pool of neurotransmitters available for distant neurons, possibly affecting neuronal transmission during high activity (Figure 2).…”

Section: Gjs Tune Down Synaptic Transmissionmentioning

confidence: 99%

The many ways astroglial connexins regulate neurotransmission and behavior

Mazaud

Capano

Rouach

2021

Glia

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Astrocytes have emerged as major players in the brain, contributing to many functions such as energy supply, neurotransmission, and behavior. They accomplish these functions in part via their capacity to form widespread intercellular networks and to release neuroactive factors, which can modulate neurotransmission at different levels, from individual synapses to neuronal networks. The extensive network communication of astrocytes is primarily mediated by gap junction channels composed of two connexins, Cx30 and Cx43, which present distinct temporal and spatial expression patterns. Yet, astroglial connexins are also involved in direct exchange with the extracellular space via hemichannels, as well as in adhesion and signaling processes via unconventional nonchannel functions. Accumulating evidence indicate that astrocytes modulate neurotransmission and behavior through these diverse connexin functions. We here review the many ways astroglial connexins regulate neuronal activity from the molecular level to behavior.

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Section: Gjs Tune Down Synaptic Transmissionmentioning

confidence: 99%

The many ways astroglial connexins regulate neurotransmission and behavior

Mazaud

Capano

Rouach

2021

Glia

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“…Pulmoner arterlerin vazodila-tasyonu, sağ ventrikülün iş yükünü azaltmakta, akciğerlere gelen kan akışını artırmakta ve pulmoner arter basıncını düşürmektedir; bunların hepsi PAH semptomlarının ve egzersiz kapasitesinin iyileşmesine neden olmaktadır. [2,19,20,21]…”

Section: Sürekli İntravenöz Prostasiklinlerin Etki Mekanizmasıunclassified

Sürekli İntravenöz Prostasiklin Tedavisi Alan Pulmoner Arteriyel Hipertansiyon Hastalarının Hemşirelik Bakımı ve Eğitimi

Sezgin¹

2019

J Cardiovasc Nurs

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Pulmoner hipertansiyon pulmoner arter basıncının yükselmesi ile karakterize, sağ kalp yetersizliği ve ölümle sonuçlanabilen bir hastalıktır. Hastaların yaşadıkları semptomlar günlük yaşam aktivitelerini ve yaşam kalitesini önemli derecede kısıtlayabilmektedir. Son yıllarda artış gösteren tedavi seçenekleri hasta sonuçlarını olumlu yönde etkilemektedir. Sürekli intravenöz prostasiklinler ileri evre pulmoner arteriyel hipertansiyon (PAH) tedavisinde tercih edilen tedavi seçeneğidir ve uzun süreli klinik yarar sağlamakta, sağ kalımı iyileştirmektedir. Sürekli intravenöz prostasiklin tedavisi karmaşıktır. Tedavi sürecinin yönetilmesi kritik önem taşır, dozdaki ani artış ve kesintiler ölümcül olabilir. Bu nedenle hemşirelerin hastalara ve bakım verenlerine eğitim vermesi ve izlemesi gerekmektedir. PAH hastaları farklı bir hastalık nedeniyle PAH merkezi dışındaki birimler ve hastanelere yattıklarında bu birimlerde çalışan hemşireler prostasiklin tedavileri ile karşı karşıya kalabilmekte, tedaviyi yönetmede sıkıntı yaşayabilmektedirler. Bu makalenin amacı, sürekli intravenöz prostasiklin tedavisi (epoprostenol) alan hastaların yönetiminde çok önemli rolü olan hemşirelere tedavi sürecinde hastalara sağlayacakları bakım, izlem, eğitim ve danışmanlık hizmetlerine rehber olmaktır. Anahtar sözcükler: Epoprostenol; hemşire; pulmoner arteriyel hipertansiyon; sürekli intravenöz prostasiklin.

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“…Because prostacyclin plays many roles in both normal and pathophysiological processes throughout the body, and its analogs have varying affinities for specific receptor subtypes, the spectrum of side effects associated with these agents varies between patients. Among the side effects commonly encountered by prostacyclins are headache, jaw pain, nausea, vomiting, diarrhea, pain in the extremities, flushing, and thrombocytopenia [23].…”

Section: Agents Acting On the Prostacyclin Pathwaymentioning

confidence: 99%

“…Intravenous prostacyclins are the cornerstone of therapy for patients with advanced PAH but can be associated with substantial side effects and complications, thus, should only be prescribed by clinicians who are experts in PH [5,23]. Prostacyclins present unique challenges for both patients and healthcare providers.…”

Section: Agents Acting On the Prostacyclin Pathwaymentioning

confidence: 99%

Titration of pulmonary arterial hypertension therapeutics: Experience-based recommendations

Lombardi

Kingman

Duncan

et al. 2018

Respiratory Medicine

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The availability of new medications has improved exercise capacity, enhanced quality of life, and extended time to clinical worsening in patients with pulmonary arterial hypertension (PAH). For many of these medications, careful individualized dose titration is required to maximize therapeutic effectiveness while minimizing side effects. In addition, specific routes of administration, including intravenous (IV), subcutaneous (SC), and inhaled administration may present additional challenges for patients and healthcare providers. These challenges include the possibility of catheter-related infections (IV), infusion site pain (SC), and adherence to frequent dosing schedules (inhaled). Temporary discontinuations may require re-titration and, in some cases, may even be life threatening. Here, based on our clinical experience, we provide our recommendations for dose titration schemes for PAH medications that require individualized dosing in adult patients, including agents acting on the endothelin-1 pathway (bosentan and ambrisentan), the prostacyclin pathway (epoprostenol, treprostinil, and selexipag), and the nitric oxide pathway (tadalafil and the soluble guanylate cyclase stimulator riociguat). A case study that illustrates the application of best practices for PAH medication dose titration in a real-world setting is presented. Good two-way communication between specialty pharmacies and other healthcare providers promotes optimal medication usage and patient health. Experience has shown that slow, cautious up-titration is generally associated with better long-term outcomes. In all cases, patient education, frequent monitoring and careful management of side effects, and treatment adherence are critical.

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Management of the Patient With Pulmonary Arterial Hypertension Receiving Intravenous Prostacyclin

Cited by 6 publications

References 40 publications

The many ways astroglial connexins regulate neurotransmission and behavior

The many ways astroglial connexins regulate neurotransmission and behavior

Sürekli İntravenöz Prostasiklin Tedavisi Alan Pulmoner Arteriyel Hipertansiyon Hastalarının Hemşirelik Bakımı ve Eğitimi

Titration of pulmonary arterial hypertension therapeutics: Experience-based recommendations

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