19.Reteta: HTA, II, insuficienta cardiaca congestiva clasa NYHA lll

Question 1

Rp 1/ 2/ 3

Answer 1

Rp1/Perindopril cpr 5 mg
AO nr I (unu)
DS oral 1 cpr/zi, 30 zile
#
Rp2/Diurex cpr 70 mg
AO nr I (unu)
DS oral 1 cpr/zi, dimineata, 30 zile
#
Rp3/Digoxin cpr 0,25 mg
AO nr I (unu)
DS oral 1 cpr/zi, dimineata, 6 zile/saptamana, 30 zile

Question 2

1.Clasificare

Answer 2

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

Diurex: contine 2 subst active: Furosemid – antiHTA, diuretic de ansa si Spironolactona – antiHTA, diuretic economisitor de K (antialdosteronic)

Digoxin – tonicardiac direct, cardiotonice steroidiene- digitalice

Question 3

2. Forma farmaceutica + doza + mod de adm

Answer 3

Diurex: Furosemid cpr 20mg + Spironolactona cpr 50mg (=70mg), dimineata

Digoxin cpr 0,25mg (oral), sol inj 0,5mg/2ml (iv), fiole 0,25mg/ml (parenteral, iv)

Perindopril 5mg, 10mg (oral)

Question 4

3. Actiune FD

Answer 4

Digoxin:
 efect inotrop +, batmotrop +
 efect cronotrop-, dromotrop-
 efect diuretic prin cresterea FG
Pe vase: scade RVP, tonusul venos si Fluxul sangvin creste

Perindopril:
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+

Question 5

5.Indicatii terapeutice

Answer 5

Digoxin:
 insuficienta cardiaca acuta (EPA)
 insuficienta cardiaca congestive cronica cu fibrilatie atriala rapida
 tulburari de ritm: fibrilatie, flutter atrial, TPSV

Diurex: criza hipertensiva,Insuf renala, edeme din ciroza hepatica,IC, hiperALDO, HipoK+

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

Question 6

6.Efecte adverse

Answer 6

Perindopril: tuse seaca, hipotensiune arteriala, bronhospasm, IR, hiperkaliemie

Digoxin: Intoxicatia digitalica
-tulb neuro-psihice: cefalee, somnolenta, fatigabilitate, confuzii, halucinatii

Diurex: scade K+, deshidratare, surditate trecatoare, creste Acid uric, si Glicemia

Question 7

7.Contraindicatii

Answer 7

Diurex: hipovolemie sau deshidratare, hipokalemie si hiponatriemie severe

Digoxin:
absoluta – intoxicatia digitalica
relative: bradicardie, BAV, tulburari de ritm ventric, IC prin disfunctie diastolica

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