CME Post-Test

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1. Which of the following statements is correct?
   1. An acute vasoreactivity response is defined as a decrease in mean PAP ≥10 to ≤40 mm Hg with an unchanged or increased cardiac output
   2. Calcium channel blockers may be considered in patients with an acute response to vasoreactivity testing
   3. Tadalafil was not included in the 2007 ACCP guidelines
   4. The strongest evidence for benefit with sildenafil monotherapy is in functional class II and III patients
   5. All of the above
2. All of the following statements about prostanoid therapy are true except:
   1. Epoprostenol likely improves survival in functional class III and IV patients
   2. The most common adverse effect of intravenous epoprostenol use is site pain
   3. Though subcutaneous treprostinil is beneficial in functional class III and IV patients, its use is limited by its most common adverse effect
   4. Long-term efficacy of intravenous treprostinil is still being evaluated
   5. The most common adverse effect of intravenous epoprostenol is line-related infection
3. Which of the following statements about endothelin receptor antagonists is false?
   1. Bosentan monotherapy appears to be most beneficial in functional class III patients
   2. Sitaxsentan is not considered in the 2007 ACCP guidelines
   3. Ambrisentan may be considered as an alternative endothelin receptor antagonist for patients in functional class III
   4. Hepatotoxicity is the most common severe adverse effect of endothelin receptor antagonists
   5. None of the above
4. The oral prostacyclin form is being tested in a randomized controlled trial as PAH therapy. The primary objective of this study is to determine which of the following?
   1. safety and efficacy of this agent
   2. effect on biomarker profile
   3. change in 6-minute walk test distance
   4. effects on exercise capacity and time to clinical worsening
5. The rationale for testing low-dose sildenafil in a randomized controlled trial is based on which of the following?
   1. lack of evidence of a dose-response relationship
   2. improvement in hemodynamics at higher sildenafil doses
   3. need for lower doses of sildenafil
   4. cost of the drug
6. Inclusion criteria for the randomized controlled trial testing escitalopram, a serotonin transporter inhibitor, do not include which of the following?
   1. PAH associated with connective tissue disease
   2. familial PAH
   3. PAH associated with HIV infection
   4. chronic thromboembolic disease
   5. PAH associated with repaired congenital defect
7. The doses of tadalafil, a phosphodiesterase-5 inhibitor, used in a recent randomized controlled trial were 2.5 mg, 10 mg, 20 mg, and 40 mg. The mechanism of action of this class of drug does not include which of the following?
   1. increase in intracellular calcium and inhibition of platelet aggregation
   2. blocking the breakdown of cyclic guanosine monophosphate
   3. increase in endogenous nitric oxide activity
8. Among the three possible combination therapies for PAH, which of the following did not demonstrate efficacy in a randomized controlled trial?
   1. an intravenous prostacyclin and a phosphodiesterase- 5 inhibitor
   2. an inhaled prostanoid and an endothelin-1 receptor antagonist (ETRA)
   3. an intravenous prostanoid and an ETRA
9. Regarding the initial patients reported in the REVEAL database, which of the following is false?
   1. more than 75% of patients were receiving monotherapy for PAH
   2. data were available for more than 100 patients
   3. most patients were receiving combination therapy
10. Pharmacologic studies revealed that there is interaction between sildenafil and bosentan. Which of the following statements regarding this interaction is true?
    1. sildenafil decreases bosentan levels and bosentan increases sildenafil levels
    2. bosentan decreases sildenafil levels and sildenafil increases bosentan levels
    3. sildenafil decreases bosentan levels and bosentan decreases sildenafil levels
    4. sildenafil increases bosentan levels and bosentan increases sildenafil levels