16.Reteta:HTA, stadiu lll, 70 ani

Question 1

Rp 1/ 2/ 3

Answer 1

Rp1/Perindopril cpr 10 mg
AO nr I (unu)
DS oral 1 cpr/zi , 30 zile
#
Rp2/Indapamid cpr 1,5 mg
AO nr I (unu)
DS oral 1 cpr/zi, dimineata 30 zile
#
Rp3/ Spironolactona cpr 50 mg
AO nr I (unu)
DS oral 1 cpr/zi, dimineata, 30 zile
#

Question 2

1.Clasificare

Answer 2

Perindopril - antihipertensiv, inhibitor al enzimei de conversie (IECA)

Indapamid – antihipertensiv, diuretic tiazidic, tiazid-like

Spironolactona – antihipertensiv, diuretic care economiseste K( antialdosteronic)

Question 3

2. Forma farmaceutica + doza + mod de adm

Answer 3

Perindopril cpr 5mg, 10 mg (oral)

Indapamid (Tertensif SR) – cpr 1,5mg (oral)

Spironolactona – dj. 25mg, 50mg, cps. 100mg (oral)

Question 4

Actiune FD

Answer 4

IECA inhiba formarea de AG II (puternic efect VC), urmata de VD si scade RVP.
Efectul hipotensor se produce prin scaderea RVS, fara modif DC si FC.
 Inhiba fibroza miocardica produsa de AG II
 Inhiba remodelarea cardiaca dupa IMA
 Inhiba degradarea de Bradikinina -> acumulare de Bradikinina în exces (VD) -> creste sinteza PG => TUSE SEACĂ/USCATĂ
 rol VD si diuretic
 Inhiba secretia de Aldosteron, cu scaderea reabs Na+ si H2O la nivel renal
 creste excretia de Na+

Indapamid: eliminare crescuta H2O, K+, Na+, Cl-
 inhiba reabs de Na+ si Cl- in TCD
 act. la nivelul TCD (segm de dilutie) – actioneaza tardiv => efect antiHTA slab comparativ cu diureticele de ansa
 in doza mare inhiba Anhidraza Carbonica

Question 5

3.Indicatii terapeutice

Answer 5

Spironolactona:
 Insuficienta Cardiaca
 HiperALDO primar si secundar
 Hipopotasemie
 edeme, in asociere cu Furosemd (diuretic de ansa)

Perindopril: IECA sunt antihipertensive de electie
 reduc HVS, in boala coronariana (postIMA) se pot utiliza si la pacientii hipertensivi cu risc crescut (varstnici, diabetic)
 insuficienta cardiaca cronica
 nefropatie diabetica

Indapamid:
HTA usoara/moderata, in Insuf Cardiaca, edeme usoare de origine cardiaca, hepatica sau alergica

Question 6

4.Efecte adverse

Answer 6

Spironolactona:
creste K+,
tulburari endocrine: impotenta sexuala, ginecomastie la B si hirsutism si amenoree la F.

Perindopril:
-tuse seaca (Bradikinina – VD), bronhospasm
 Hipotensiune arteriala, favorizata de tratam in prealabil cu diuretice, stenoza de A Renala, IC, hipovolemie (febra, varsaturi) sau dieta hiposodata.
 Insuf Renala, hiperkaliemie prin hiperALDO
 gust metalic

Indapamid: scade K+, Mg2+, Cl- si creste Glicemia, Acid Uric, Colesterol, Ca2+
 Hipopotasemie
 creste riscul intoxicatiei digitalice!

Question 7

5.Contraind

Answer 7

Spironolactona:
HiperK+,
IRA (Cl creatinina<30mg/dl)
Insuf Hepatica grava

Perindopril:
 Angioedem
 Sarcina si perioada de alaptare
 stenoza bi- sau unilaterala de artera renala
 stenoza aortica, stenoza mitrala, cardiomiopatie hipertrofica
 IR avansata, afect autoimune si tratam cu imunosupres