A 42-year-old man comes to the physician because of a 4-month history of increased fatigue and exertional shortness of breath. Cardiac examination shows a loud S2 in the 2nd left intercostal space. She does not use tobacco, alcohol, or illicit drugs. Her mother had similar symptoms and died at age 42. Right heart catheterization shows a pulmonary artery pressure of 32 mm Hg. Which of the following is the most appropriate pharmacotherapy for this patient's current condition?

Question

A 42-year-old man comes to the physician because of a 4-month history of increased fatigue and exertional shortness of breath. Cardiac examination shows a loud S2 in the 2nd left intercostal space. She does not use tobacco, alcohol, or illicit drugs.  Her mother had similar symptoms and died at age 42. Right heart catheterization shows a pulmonary artery pressure of 32 mm Hg. Which of the following is the most appropriate pharmacotherapy for this patient's current condition?

Quizplus · Accepted Answer

Eductional Objective: Endothelin receptor antagonists (e.g., bosentan) competitively antagonize endothelin-1 receptors. Endothelin normally promotes vasoconstriction and can increase resistance in pulmonary vessels, leading to pulmonary arterial hypertension. Targeting the endothelin receptor, therefore, prevents pulmonary vasoconstriction.

A 42-Year-Old Man Comes to the Physician Because of a 4-Month