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Sem12019 > 3011-Cat 1 drugs > Flashcards

3011-Cat 1 drugs Flashcards

1
Q

Digoxin - Class and indication

A

Antiarrhythmic
cardiac glycoside antiarrhythmic
Indication: atrial fibillation, atrial flutter and hypertension

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2
Q

Digoxin - Dose

A

Dose:
Initial: 250-500 micrograms every 4-6hr (onset 0.5-2hr, max effect at 2-6hr)
Maintenance: 125-250 micrograms/day
Maximum: 1.5mg/day, 500 micrograms in elderly (initial), 500 micrograms/day and 125 micrograms/day in elderly
Situation where adjustment required: Elderly = 62.5-250 micrograms every 4-6hr (halved) max 500 micrograms

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3
Q

Digoxin - MOA

A

slows heart rate and reduces AV nodal conduction by an increase in vagal tone (PSNS) and reduction in sympathetic activity
reversibly inhibits Na/K ATPase alpha subunit
positively inotropic and negative chronotropic activity

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4
Q

Digoxin - Common AEs

A

Anorexia, nausea, vomiting, diarrhoea, visual disturbance, may worsen arrhythmia, seizure, confusion (uncommon if <0.8 microgram/L)

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5
Q

Digoxin - Counselling

A

monitoring

  • Regularly assess the pt for digoxin toxicity including resting heart rate
  • When use to control ventricular rate in AF, aim for a ventricular rate <110beats/min
  • Tell your dr or pharmacist that you are taking digoxin before using any other medicines including over-the-counter and herbal products
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6
Q

Amiodarone - class and indication

A

cardiac glycoside antiarrhythmic

treatment and prophylaxis of serious tachyarrythmis (ventricular, arial fibrillation and SV tachycardia

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7
Q

Amiodarone - Dose

A

Initial: 200mg tid for 1 week, then 200mg bd for 1 week
Maintenance: 100-400mg/day (max effect 1-3 months)
Maximum: 400mg/day
Situation where adjustment required: Dose doubled in significant obesity or ventricular arrhythmia, halved in underweight

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8
Q

Amiodarone - MOA

A
  1. decrease SA node automaticity
  2. slows AV node conduction
  3. prolongs refractory period
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9
Q

Amiodarone - Common AEs

A

Nausea and vomiting (especially upon loading dose), constipation, anorexia, taste disturbance, thyroid function alteration, fever, potential to worsen arrhythmias (slow to resolve), hepatotoxicity, optic neuropathy, SIADH

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10
Q

Amiodarone - Counselling

A

monitoring
-if you develop problems with vision, difficulty breathing, a dry cough, weight loss, muscle weakness, a severe rash or worsening of your heart symptoms, tell your dr

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11
Q

Atenolol - class and indication

A

cardioselective betablocker antihypertensive

indication: hypertension, angina, tachyarrythmias, MI

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12
Q

Atenolol - Dose

A 
Initial:
Adult: 25-50mg/day, increase if required to 100mg/day in 1 or 2 doses
Child: 0.5-2mg/kg/day in 1 or 2 doses
Maintenance: Patient specific
Maximum:
Hypertension: 50mg/day
Tachyarrhythmia: 100mg/day
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13
Q

Atenolol - MOA

A

Competitively block beta-receptors in heart, peripheral vasculature, bronchi, pancreas, uterus, kidney, brain and liver. Reduce heart rate, blood pressure, cardiac contractility, decrease sinoatrial node and atrioventricular node rates and prolong atrial refractory period.

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14
Q

Atenolol - Common AEs

A

Bradycardia, hypotension, nausea, diarrhoea, cold extremities, fatigue, abnormal vision, hallucinations, insomnia, nightmares, depression, heart block, rash, alopecia

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15
Q

Atenolol - Counselling

A

counselling

  • you may feel tired or lacking in energy for a few days after starting this medication or when the dose is increased
  • this medicine can cause fatigue, nausea, diarrhoea, constipation and headaches. These may decrease or disappear with continued use
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16
Q

Bisoprolol - Class and Indication

A

cardioselective betablocker antihypertensive

indication: chronic heart failure with reduced ejection fraction

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17
Q

Bisoprolol - dose

A

Initial: 1.25mg/day for 1 week, if well tolerated increase dose to 2.5mg/day for 1 week, then 3.75mg/day for 1 week then 5mg/day for 4 weeks, then 7.5mg/day for 4 weeks then 10mg/day
Maintenance: 10mg/day
Maximum: 10mg/day

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18
Q

Bisoprolol - MOA

A

Competitively block beta receptors in heart, peripheral vasculature, bronchi, pancreas, uterus, kidney, brain and liver. Reduce heart rate, blood pressure, cardiac contractility, decrease sinoatrial node and atrioventricular node rates and prolong atrial refractory period.

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19
Q

Bisoprolol - Common AEs

A

Hyperthyroidism, hypotension, nausea, diarrhoea, cold extremities, vision disturbances, hallucinations, insomnia, nightmares, heart block, rash, alopecia

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20
Q

Bisoprolol - Counselling

A
  • you may feel tired or lacking in energy for a few days after starting this medication or when the dose is increased
  • take your dose of medicine in the morning
  • this medicine can cause fatigue, nausea, diarrhoea, constipation and headaches. These may decrease or disappear with continued use
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21
Q

Carvedilol - class and indication

A

alpha 1 receptor and non-selective betablocker antihypertensive

indication: Hypertension, chronic heart failure with reduced ejection fraction
- Avoid in severe asthma

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22
Q

Carvedilol - Dose

A

Initial:
Hypertension: 12.5mg/day for 2 days
Heart failure: 3.125 mg bd for 2 weeks then increase at at least 2 week intervals to 6.25mg bd, then 12.5mg bd, then 25mg bd
Maintenance:
Hypertension: 25mg/day, increased if required at intervals of at least 2 weeks
Maximum:
Hypertension: 50mg/day in 1 or 2 doses
Heart failure: 25mg bd if <85kg or severe heart failure, 50mg bd if >85kg
Situation where adjustment required: Weight difference/degree heart failure in heart failure, not tolerating treatment

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23
Q

Carvedilol - MOA

A

Competitively block beta receptors in heart, peripheral vasculature, bronchi, pancreas, uterus, kidney, brain and liver. Reduce heart rate, blood pressure, cardiac contractility, decrease sinoatrial node and atrioventricular node rates and prolong atrial refractory period

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24
Q

Carvedilol - Common AEs

A

Bradycardia, orthostatic hypotension, nausea, diarrhoea, cold extremities, vision disturbance, hallucinations, insomnia, nightmares, depression, heart block, rash, alopecia

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25
Q

Carvedilol - counselling

A

monitoring

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26
Q

Metoprolol - class and indication

A

selective beta-1 blocker antihypertensive

indication: Hypertension, angina, tachyarrhythmias, MI, chronic heart failure with reduced ejection fraction

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27
Q

Metoprolol - Dose

A 
Initial:
Hypertension: 50-100mg/day in 1 or 2 doses
Angina: 25-50mg bd
Tachyarrhythmias: 25-100mg bd
Heart failure (CONTROLLED RELEASE): 23.75mg/day for a minimum of 2 weeks, if well tolerated increase dose remaining at each new dose for at least 2 weeks: 47.5mg, 95mg, 190mg
Maintenance:
Hypertension: 50-100mg/day or bd
Angina: 50-100mg bd or tid
MI: 25-50mg bd
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28
Q

Metoprolol - MOA

A

Competitively block beta receptors in heart, peripheral vasculature, bronchi, pancreas, uterus, kidney, brain and liver. Reduce heart rate, blood pressure, cardiac contractility, depress sinoatrial node and atrioventricular node rate and prolong atrial refractory period.

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29
Q

Metoprolol - Common AEs

A

Bradycardia, hypotension, nausea, diarrhoea, cold extremities, vision disturbances, hallucinations, insomnia, nightmares, depression, heart block, rash, alopecia

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30
Q

Metoprolol - counselling

A
  • you may feel tired or lacking in energy for a few days after starting this medication or when the dose is increased
  • this medicine can cause fatigue, nausea, diarrhoea, constipation and headaches. These may decrease or disappear with continued use
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31
Q

Aspirin - class and indication

A

antiplatelet

indication: Analgesic, anti-inflammatory, antiplatelet, antipyretic

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32
Q

Aspirin - dose

A

Initial:
300mg
maintenance 75-150mg

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33
Q

Aspirin - MOA

A

Inhibits platelet aggregation by irreversible inhibition of COX, reducing the synthesis of thromboxane A2 for the life of the platelet

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34
Q

Aspirin - common AEs

A

Association with Reye’s syndrome (<16yr), abdominal pain, dose-related tinnitus, GI bleeding (concomitant use with other NSAIDs will increase), concomitant use of anticoagulants increases risk of bleeding

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35
Q

Aspirin - counselling

A

monitoring

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36
Q

Clopirogrel - class and indication

A

thienoyridine antiplatelet agent ‘

indication: History of symptomatic atherosclerosis, acute coronary syndrome
- Contraindicated in active bleeding disorders, severe hepatic impairment

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37
Q

Clopidogrel - dose

A

Initial:
APF: 75mg/day(300-600mg loading dose may be given for some indications)
AMH:
o Prevention of vascular ischaemic events: 75mg/day
o Acute coronary syndrome: 300mg, then 75mg/day with Aspirin for 1-12 months
o Placement of coronary stent: 300-600mg for 6 hours before procedure, then 75mg/day with Aspirin for 1-12 months
Maintenance: As above

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38
Q

Clopidogrel - MOA

A

Active metabolite of the thienopyridines irreversibly binds to the platelet P2Y12 receptor and inhibits platelet aggregation for the life of the platelet.

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39
Q

Clopidogrel - common AEs

A

Skin reactions, diarrhoea, GI ulcer, SJS, neutropenia, SIADH

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40
Q

Clopidogrel - counselling

A

monitoring

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41
Q

Ticagrelor - class and indication

A

thienopyridine antiplatelet
indication: acute coronary syndrome (with aspirin)
Contraindications: active bleeding disorder, history of intracranial haemorrhage, mod-severe hepatic impairment

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42
Q

Ticagrelor - dose

A

Initial: 180mg, then 90mg bd for at least 12 months in combination with low dose Aspirin (75-100mg/day)
Maintenance: 180mg/day

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43
Q

ticagrelor - MOA

A

Reversibly binds to platelet PDY12 receptor and inhibits platelet aggregation for the life of the platelet.

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44
Q

Ticagrelor - common AEs

A

Dyspnoea, nausea, vomiting, diarrhoea, constipation, dizziness, shortness of breath, non-cardiac chest pain, headache, raised uric acid/creatinine concentration

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45
Q

Ticagrelor - drug interactions

A

CYP3A4 and Pgp substrate and inhibitor, NSAIDs/SSRIs possible increased risk of bleeding, grapefruit increases risk of bleeding

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46
Q

Ticagrelor - counselling

A

monitoring - renal function test 1 month after initiation

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47
Q

Heparin - class and indication

A

anticoagulant

indication: Prevention and treatment of VTE, treatment of acute coronary syndrome, peripheral arterial occlusion
- Contraindicate: severe thrombocytopenia, active bleeding or risk of, severe heaptic impairment/disease

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48
Q

Heparin - Dose

A

Initial:
Prevention VTE: SC 5000 units 2hr prior, then 5000 units bd or qid for 7-10 days until mobilised
Treatment VTE: IV bolus 5000 units, then IV infusion 1300 units/hr
Maintenance: As above
Maximum: IV bolus: 30000 units/24hrs
Situation where adjustment required: Renal impairment, surgery, elderly

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49
Q

Heparin - MOA

A

Inactivate clotting factors IIa (thrombin) and Xa by binding to antithrombin III

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50
Q

Heparin - common AEs

A

Bleeding, bruising, pain at injection site, hyperkalaemia, mild reversible thrombocytopenia, transient ALT elevation, skin necrosis, osteoporosis, alopecia

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51
Q

Heparin - counselling

A

monitoring
Tell your dr if you have any signs of bleeding eg. nosebleed, black or tarry bowel motions or unexplained bruising) during and after treatment

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52
Q

Warfarin - class and indication

A

anticoagulant

indication: prevention and treatment of VTW, prevention fo stoke with previous MI

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53
Q

Warfarin -dose

A

Initial: 5-10mg/day for 2 days then adjust according to INR
Maintenance: 1-10mg/day (dose at same time every day, immediately notify doctor if missed dose, do not swap brands of warfarin, maintain a normal, balanced diet and limit alcohol intake)
Maximum: 10mg/day
Situation where adjustment required: Elderly, hepatic or renal impairment

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54
Q

Warfarin - MOA

A

Inhibits synthesis of vitamin K-dependent clotting factors and the antithrombotic factors protein C and protein S

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55
Q

Warfarin - common AES

A

Bleeding, skin necrosis, purple discolouration, alopecia, fever, rash, nausea, vomiting, diarrhoea

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56
Q

Warfarin - DI

A

CYP1A2, 2C9, 2C19 and 3A4 substrate, vitamin K containing foods/drinks, medicines that affect blood blotting, paracetamol (regular use may increase INR)

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57
Q

Warfarin - counselling

A

INR (target 2-3)

  • Take the tablets at about the same time each day. Use a calendar or anticoagulant book to keep a record of your dose and mark off the date immediately after taking a dose
  • if you forget to take a dose, notify the dr immediately. Take the dose as soon as possible on the same day. Don’t take a double dose the next day to make up for the missed dose.
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58
Q

Dabigatran - class and indication

A

anticoagulant/NOACS
indication: Prevention VTE after elective total hip or knee replacement, treatment of acute VTE, prevention of subsequent VTEs, non-valvular, AF and high-risk stroke or systemic embolism

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59
Q

Dabigatran - dose

A

Initial:
Hip/knee replacement: treatment for 10 day and 28-35 days after knee and hip surgery respectively: 110mg within 1-4hr of surgery, then 220mg/day
AF/acute VTE/prevention: treatment for over 3 months: 150mg bd
>75yrs = 110mg bd
Maintenance: As above

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60
Q

Dabigatran - MOA

A

Reversibly inhibit both free and fibrin-bound thrombin, preventing conversion of fibrinogen to fibrin, preventing thrombus formation. Thrombin-induced platelet aggregation is also inhibited.

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61
Q

Dabigatran - common AEs

A

Gastritis, dyspepsia, GI bleeding, oesophageal ulcers, increased liver enzymes and bilirubin

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62
Q

Dabigatran - DIs

A

Anticoagulants, NSAIDs, antiplatelets, SSRIs increase risk of bleeding, Pgp inducers and inhibitors may affect concentration (especially verapamil)

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63
Q

Dabigatran - counselling

A

monitoring of renal function

  • this medicine may cause nausea and diarrhoea
  • if you develop signs of bleeding or bleeding that will not stop or if you suddenly feel weak, dizzy and short or breath, seek immediate medical attention
  • tell your dentist you are taking this
  • NSAIDs and SSRIs increase risk of bleeding
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64
Q

Rivaroxaban - class and indication

A

anticoagulant: factor Xa inhibitor/NOACs
indication: Prevention VTE following elective hip/knee replacement, treatment acute VTE, prevention subsequent VTE, non-valvular AF and high-risk stroke

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65
Q

Rivaroxaban - dose

A

Initial:
Hip/knee replacement: Oral: 10mg/day starting 6-10hr after surgery, continue 2 wk after knee, 5 wk after hip
VTE: Oral: 15mg bd for 3 wk, then 20mg/day
Prevention emboli in AF: Oral: 20mg/day
Take dose at the same time every day, exactly as prescribed, with good
Maintenance:
Maximum: 30mg/day

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66
Q

Rivaroxaban - MOA

A

Selectively inhibit factor Xa, blocking thrombin production, conversion of fibrinogen to fibrin and thrombus development

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67
Q

Rivaroxaban - DI

A

Azoles, HIV-PIs, antiplatelets/NSAODs

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68
Q

Rivaroxaban - common AEs

A

Peripheral oedema, itch, skin blisters, muscle spasm, hepatotoxicity

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69
Q

Rivaroxaban - counselling

A

Renal function
Target test results: >50mL/min
-it is important to take this medicine exactly as prescribed. Take the tablets at about the same time each day. It may help to mark off on a calendar each time you take a dose.
-Once daily dose: if you forget to take a dose, take a tablet immediately and continue on the following day with one tablet at the normal time do not double dose
-Twice daily dose: if you forget to take a dose, take a tablet immediately to ensure that you take a total dose of 30mg on that day. If necessary you can take your morning dose at same time as your evening dose.

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70
Q

Enoxaparin - class and indication

A

anticoagulant (low MW heparin)

indication: Prevention and treatment of VTE, treatment of acute STEMI and non-STEMI, and unstable angina

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71
Q

Enoxaparin - dose

A

Initial:
Prevention VTE: SC: 20mg/day 7-10day
Tx VTE: SC: 1mg/kg bd or 1.5mg/kg/day
Unstable angina/non-STEMI: SC: 1mg/kg bd for 2-8 day w/ Aspirin
Maintenance:
Maximum: Varies according to indication, risk factors and weight
Situation where adjustment required: Low/high weight, renal impairment, hypertension, risk factors, indication

72
Q

Enoxaparin - MOA

A

Inactivate clotting factors IIa (thrombin) and Xa by binding to antithrombin III; high efficacy.

73
Q

Enoxaparin - DIs

A

Anticoagulants, antiplatelet agents, NSAIDs (increased risk of bleeding)

74
Q

Enoxaparin - Common AEs

A

Bleeding, bruising/pain at injection site, hyperkalaemia, mild reversible thrombocytopenia, transient elevation of liver aminotransferases, severe thrombocytopenia, skin necrosis, osteoporosis, alopecia

75
Q

Enoxaparin - counselling

A

bleeding risk if DIs
-inject into a fold of skin on the stomach. Do not rub the area after injecting a dose, rotate injection site.
NSAIDs increase risk of bleeding

76
Q

Perindopril - class and indication

A

ACEI

indication: Hypertension, chronic heart failure, reduction MI risk

77
Q

Perindopril - dose

A 
Hypertension
o   PA- 5mg/day, max 10mg/day
o   PE- 4mg/day, max 8mg/day
HF:
o   PA: 2.5mg/day à 5mg/day
o   PE: 2mg/day à 4mg/day
Reduction CV events
o   PA: 5mg/day 2wks à 10mg/day
o   PE: 4mg/day 2wks à 8mg/day
 May take 2-4 weeks to optimal effect
78
Q

Perindopril - MOA

A

Prodrug metabolized to perindoprilat = potent, competitive ACEI. Blocks conversion of angiotensin I to angiotensin II and the breakdown of bradykinin. Reduced effects of vasoconstriction, Na retention and aldosterone release, and effect on SNS activity/GF’s

79
Q

Perindopril - DIs

A

NSAIDS, sacubitril with valsartan, medicines that increase K+ concentration, Li, digoxin, DPP-4 inhibitors, Angiotensin II receptor antagonists

80
Q

Perindopril - Common AEs

A

Hypertension, headache, dizziness, cough (improves within 1-4 wks of stopping), fatigue, nausea, renal impairment, angioedema, rash, diarrhoea

81
Q

Perindopril - counselling

A

monitoring of electrolytes and renal function pre-treatment and then review after 1-2 weeks

82
Q

Ramipril - class and indication

A

ACEI
indication: Hypertension, post MI with heart failure, prevention MI and cardiovascular death, revascularisation over 55 years

83
Q

Ramipril - Dose

A

Initial:
APF: 2.5-10mg/day in 1 or 2 doses
AMH:
Hypertension: 2.5mg/day increase after 2-3wks to 5mg prn.
HF: 2.5mg bd beginning 2-10 post-MI, increase at intervals of 1-3 days to 10mg/day in 2 doses
CV risk: 2.5mg/day increase after 1 wk to 5mg/day, after 3 wk 10mg/day
Maintenance: As above
Maximum:
Hypertension: Max 10mg/day in 1 or 2 doses
HF: 10mg/day in 2 doses
CV risk: 10mg/day
Situation where adjustment required: Volume/Na depletion, primary hyperaldosteronism, black African/Caribbean descent, aortic stenosis, PVD/atherosclerosis, renal impairment, surgery, elderly, women planning to conceive

84
Q

Ramipril - MOA

A

Metabolised to ramiprilat- potent, competitive ACEI. Blocks conversion of angiotensin I to angiotensin II and the breakdown of bradykinin. Reduced effects of vasoconstriction, Na retention and aldosterone release, and effect on SNS activity/GF’s

85
Q

Ramipril - DIs

A

NSAIDs (increased risk of renal impairment- esp. avoid in those taking diuretics to avoid triple whammy), sacubitril with valsartan (increased risk of angioedema), medicines that increase K+ concentration (increased risk of hyperkalaemia), Li, digoxin, DPP-4 inhibitors, Angiotensin II receptor antagonists

86
Q

Ramipril - Common AEs

A

Hypertension, headache, dizziness, cough (improves within 1-4 wks of stopping), fatigue, nausea, renal impairment, angioedema, rash, diarrhoea

87
Q

Ramipril - Counselling

A

Electrolytes and renal function pre-treatment and then review after 1-2 weeks

88
Q

Fursemide - class and indication

A

loop diuretic

indication: Oedema associated with heart failure and hepatic cirrhosis, renal impairment and nephrotic syndrome

89
Q

Fursemide - dose

A

Initial:
Take dose in morning or if bd then morning and lunch time
- Oedema:
o Adult
§ Oral: 20-40mg/day or bd adjust according to clinical response to maintenance dose
§ IV/IM: 20-40mg, repeat at intervals of over 2 hours until desired diuretic effect
o Child
§ Oral: 1-2mg/kg, if required increase dose by 1-2mg/kg every 6-8hr once satisfactory diuresis adjust to lowest effective dose
§ IV/IM: 0.5-1mg/kg, if required increase dose by 1mg/kg at intervals of over 2 hours until desired diuresis
Hypercalcaemia:
o IV: 80-100mg q 1-2hr
Maximum:
Oedema
o Adult
§ Oral: 1g/day
o Child
§ Oral: 6mg/kg every 6 hours
Situation where adjustment required: Renal impairment and hepatic impairment

90
Q

Frusemide - MOA

A

Fast onset and short duration (4-6hr). Inhibit reabsorption of Na and Cl in the ascending limb of the loop of Henle à potent.

91
Q

Frusemide - DIs

A

ACEI/Angiotensin II receptor antagonist + NSAIDs (risk of nephrotoxicity), Li, ototoxic medicines, medicines that reduce K+ concentration, digoxin

92
Q

Frusemide - Common AEs

A

Electrolyte disturbances, dehydration, metabolic alkalosis, gout, orthostatic hypotension, dyslipidemia, rash, tinnitus, vertigo, SJS, agranulocytosis, polyuria

93
Q

Frusemide - Counselling

A

serum electrolytes and body weight

94
Q

Hydrochlorothiazide - class and indication

A

thiazide diuretic

indication: Hypertension, oedema associated with heart failure, hepatic cirrhosis/nephrotic syndrome

95
Q

Hydrochlorothiazide - dose

A 
Initial:
Single or 2 doses, can take u to 4 weeks to reduce blood pressure effectively
Hypertension:
o   Oral:12.5mg-50mg/day
Oedema:
o   Oral: 25-100mg/day, or intermittently on 3-5 days/wk
Kidney stones:
o   Oral: 25-50mg 1 or 2 x /day
Maintenance:
Maximum:
Adult
o   Hypertension: 100mg/day
o   Oedema: 200mg/day
Child
o   1mnth-12yrs: 3mg/kg (not to exceed 50mg)/day
o   >12yrs: 50mg/day
Situation where adjustment required: Elderly, hepatic impairment, renal impairment
96
Q

Hydrochlorothiazide - MOA

A

Moderately potent diuretic. Inhibit reabsorption of Na and Cl in the proximal segment of the distal convoluted tubule, increasing delivery of Na to the collecting tubules and producing a corresponding increase in K+ excretion. Lower BP by a vasodilator effect.

97
Q

Hydrochlorothiazide - DIs

A

ACEI + NSAID (risk of nephrotoxicity), Li, antihyperglycaemics

98
Q

Hydrochlorothiazide - Common AEs

A

Dizziness, dyslipidaemia, blurred vision, impotence, renal impairment, weakness, muscle cramps, polyuria, orthostatic hypotension, electrolyte disturbances

99
Q

Hydrochlorothaizide - counselling

A

hepatic and renal testing

100
Q

Sprionolactone - class and indication

A

diuretic
indication: Primary hyperaldosteronism, refractory oedema associated with secondary hyperaldosteronism, resistant hypertension, hirsutism in female

101
Q

Spironolactone - dose

A 
Initial:
Primary hyperaldosteronism
o   Oral: 50-200mg in 1 or 2 doses
Oedema:
o   Oral: 100mg/day, maintenance 25-200mg/day (max 200mg) in 1 or 2 doses
Resistant hypertension:
o   Oral: 12.5-50mg/day
Hirsutism
o   Oral: 50-100mg/day in 1 or 2 doses
Maintenance:
Maximum: 200mg/day
Situation where adjustment required: Renal impairment
102
Q

Spironolactone - MOA

A

Inhibit Na absorption in the distal tubule by antagonizing aldosterone, increasing Na and water excretion and reducing K+ excretion (weak diuretic). May contribute to reducing aldosterone role in heart failure.

103
Q

Spironolactone - DIs

A

NSAID + ACEI (increased risk of hyperkalaemia), digoxin

104
Q

Spironolactone - Common AEs

A

Nausea, vomiting, diarrhoea, drowsiness, headaches, hyperkalaemia, hyponatraemia, gastric bleeding or ulceration, confusion, mastalgia, reversible gynaecomastia, impotence, menstrual irregularities, alopecia

105
Q

Spironolactone - counselling

A

Serum K+ (dietary potassium- dried bananas/fruit, salt substitutes) and renal function

106
Q

Varenicline - class and indication

A

Anti-smoking agent

indication: smoking cessation

107
Q

Varenicline - dose

A

Initial: 0.5mg/day for 3 days, then 0.5mg bd for 4 days, then maintenance
Maintenance: 1mg bd for 11-23 weeks
Maximum: 2mg/day

108
Q

Varenicline - MOA

A

Neuronal NAChR partial agonist = decrease withdrawal effects and decrease pleasure of smoking.

109
Q

Varenicline - DIs

A

NRT (increase risk of AEs), CYP1A2 Inhibitor

110
Q

Varenicline - Common AEs

A

Nausea, constipation, dyspepsia, flatulence, headaches, dizziness, taste disturbances, insomnia, abnormal dreams, mood disturbances

111
Q

Varenicline - counselling

A

neuropsychiatric symptoms

112
Q

Irbesartan - class and indication

A

Angiotensin II receptor antagonist
indication: Hypertension, reduction of renal disease progress in patients with Type II diabetes, hypertension, microalbuminuria, proteinuria

113
Q

Irbesartan - dose

A 
Initial:
Hypertension- max effect 4-6 weeks after initiation
o   Oral: 150mg/day
Prevention of renal disease progression
o   Oral: Maintenance dose 300mg/day
Maintenance: 300mg/day
Maximum: 300mg/day
Situation where adjustment required: Elderly, renal impairment
114
Q

Irbesartan - MOA

A

Competitively block binding of angiotensin II to type 1 angiotensin (AT1) receptors. They reduce angiotensin II-induced vasoconstriction, Na reabsorption and aldosterone release. They also reduce the effect of angiotensin II on SNS and growth factors.

115
Q

Irbesartan - DIs

A

NSAIDs (increased risk of renal impairment), medicines that increase K+ concentration, Li, Digoxin, ACEI

116
Q

Irbesartan - Common AEs

A

Dizziness, headache, hyperkalaemia, rash, diarrhoea, dyspepsia, muscle cramp, myalgia, insomnia, nasal congestion, cough, urticaria

117
Q

Irbesartan - counselling

A

Renal function and electrolytes before initiation and after 1-2 weeks,

118
Q

Atorvastatin - class and indication

A

statin dyslipidaemic

indication: Hypercholesterolemia, hypertensive patient with additional risk for heart disease

119
Q

Atorvastatin - Dose

A 
Initial: Increase after 4wk if required
Adult: 10-80mg/day
Child (>8yr): 10mg/day
Maintenance:
Maximum: 80mg/day
Situation where adjustment required: Hepatic impairment
120
Q

Atorvastatin - MOA

A

Competitively inhibit 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase. Increase hepatic cholesterol uptake from blood, reduce conc. of total cholesterol, LDL and triglyceride, and produce a small increase in HDL concentrations.

121
Q

Atorvastatin - DIs

A

CYP3A4 substrate, fibrate, colchicine (increased risk of myopathy), sodium fusidate (oral) (CI), grapefruit juice

122
Q

Atorvastatin - Common AEs

A

Myalgia (dose-related), mild transient GI sx, headache, sleep disturbance, dizziness

123
Q

Atorvastatin - counselling

A

Monitor aminotransferase and creatine kinase at baseline, repeat if indicated
Target test results: Stop if aminotransferase concentration persistently elevated to >4 x ULN, CK concentration is >10 x ULN, persistent unexplained muscle pain or weakness

124
Q

Simvastatin - class and indication

A

statin dyslipidaemic

indication: Hypercholesterolemia, high risk coronary heart disease

125
Q

Simvastatin - Dose

A

Initial: Increase if required after 4 weeks, take at same time every day
Adult/>8yr: 10-40mg/day
CHD/risk
o 40mg/day
Maintenance:
Maximum: 80mg/day
Situation where adjustment required: Hepatic impairment

126
Q

Simvastatin - MOA

A

Competitively inhibit 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase. Increase hepatic cholesterol uptake from blood, reduce conc. of total cholesterol, LDL and triglyceride, and produce a small increase in HDL concentrations.

127
Q

Simvastatin - DIs

A

CYP3A4 substrate, fibrate, colchicine (increased risk of myopathy), sodium fusidate (oral) (CI), grapefruit juice, warfarin (possible INR increase)

128
Q

Simvastatin - Common AEs

A

Myalgia (dose-related), mild transient GI sx, headache, sleep disturbance, dizziness

129
Q

Simvastatin - counselling

A

Monitor aminotransferase and creatine kinase at baseline, repeat if indicated, INR monitoring if tx with warfarin
Target test results: Stop if aminotransferase concentration persistently elevated to >4 x ULN, CK concentration is >10 x ULN, persistent unexplained muscle pain or weakness

130
Q

Rosuvastatin - class and indication

A

statin dyslipidaemic

indication: Hypercholesterolemia, high risk CV disease

131
Q

Rosuvastatin - dose

A 
Initial: Increase if required after 4 weeks
Hypercholesterolemia
o   Oral: 5-10mg/day
 High CV risk:
o   Oral: 20mg/day
Maintenance:
Hypercholesterolemia
o   Oral: 5-20mg/day
Maximum:
Hypercholesterolemia
o   Oral: 40mg/day
Situation where adjustment required: Concomitant ciclosporin or gemfibrozil or lopinavir with ritonavir, Asian ancestry (different max)
132
Q

Rosuvastatin - MOA

A

Competitively inhibit 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase. Increase hepatic cholesterol uptake from blood, reduce conc. of total cholesterol, LDL and triglyceride, and produce a small increase in HDL concentrations.

133
Q

Rosuvastatin - DIs

A

Fibrate, colchicine (increased risk of myopathy), sodium fusidate (oral) (CI), grapefruit juice, warfarin (possible INR increase)

134
Q

Rosuvastatin - Common AEs

A

Headache, nausea, insomnia, myopathy, rhabdomyolysis, elevated serum transaminases, hepatitis, interstitial lung disease, hypersensitivity reactions

135
Q

Rosuvastatin - counselling

A

Monitor aminotransferase and creatine kinase at baseline, repeat if indicated, INR monitoring if tx with warfarin
Target test results: Stop if aminotransferase concentration persistently elevated to >4 x ULN, CK concentration is >10 x ULN, persistent unexplained muscle pain or weakness

136
Q

Predsnisolone - class and indication

A

corticosteriods

indication:

137
Q

Predsnisolone - dose

A

Initial: Morning dose to avoid night time insomnia, in prolonged therapy calcium, vitamin D supplements and bisphosphonates may be required.
Adult: Dose determined by severity, prognosis, duration
o Range: 2.5-80mg/day in 1-4 doses or alternate days
o Acute asthma: 40-50mg/day for 3-10 days
o RA: 2.5-10mg/day
Child: Acute asthma: 0.5-2mg/kg/day for at least 3 days
o Croup: 1mg/kg, may be repeated after 12-24hrs
Autoimmune/inflammatory disease: 1-2mg/kg/day, when stabilised reduced to minimum effective dose
Maintenance:
Maximum: 80mg/day

138
Q

Predsnisolone - MOA

A

nhibit leukocyte infiltration at the site of inflammation, interfere with mediators of inflammatory response, and suppress humoral immune responses. Involves PPLA2 inhibitory proteins, lipocortin’s and thus prostaglandins. Limits capillary dilation and permeability of vascular structures.

139
Q

Predsnisolone - DIs

A

Antihyperglycaemics, NSAIDs, diuretics, digoxin

140
Q

Predsnisolone - Common AEs

A

Nausea, changed appetite, diarrhoea/constipation, headaches, mood change, diabetes, hypertension, heart failure, glaucoma, peptic ulcer disease, psychiatric disorders, etc.

141
Q

Prednisolone - counselling

A

Blood glucose, electrolytes, weight, BP and BMD may be necessary

142
Q

Amlodipine - class and indication

A

antihypertensive

indication: hypertension, angina

143
Q

Amlodipine - dose

A

Initial:
Can take up to 2 weeks to decrease blood pressure
Adult: 2.5-5mg/day, increase when required after 1-2wk
<6yr: 0.05-0.2mg/kg/day, increase if required at intervals of 1-2 weeks to 0.6mg/kg, (in 2 doses may be more appropriate to control BP)
Elderly: 2.5mg/day
Maintenance: As above
Maximum: Adult: 10mg/day
Situation where adjustment required: Hepatic impairment, elderly

144
Q

Amlodipine - MOA

A

Block inward current of Ca2+ into cells in vascular smooth muscle, myocardium and cardiac conducting system via L-type Ca channels. Acts on coronary arteriolar smooth muscle to reduce vascular resistance and myocardial oxygen requirements, relieving angina sx. Act mainly on arteriolar smooth muscle to reduce peripheral vascular resistance and BP.

145
Q

Amlodipine - DIs

A

Simvastatin, CYP3A4 substrate, natural liquorice, grapefruit juice

146
Q

Amlodipine - Common AEs

A

Nausea, vasodilatory effects (headache, flushing, dizziness, hypotension, peripheral oedema)

147
Q

Amlodipine - counselling

A

monitoring

148
Q

Diltiazem - class and indication

A

antihypertensive

indication: angina, hypertensive

149
Q

Diltiazem - Dose

A

Initial:
Angina/AF/Atrial flutter
o Oral: 30mg tid/qid increase when required
o CR: 180mg/day, increase when required to 360mg/day
Hypertension (may take up to 2 weeks to lower BP)
o CR: 180-240mg/day increase prn to 360mg/day
Maintenance:
Maximum:
- Angina/AF/Atrial flutter: max 360mg/day in 3 or 4 dose
Situation where adjustment required: Hepatic impairment, elderly

150
Q

Diltiazem - MOA

A

Block inward current of Ca2+ into cells in vascular smooth muscle, myocardium and cardiac conducting system via L-type Ca channels. Acts on coronary arteriolar smooth muscle to reduce vascular resistance and myocardial oxygen requirements, relieving angina sx. Act mainly on arteriolar smooth muscle to reduce peripheral vascular resistance and BP

151
Q

Diltiazem - DIs

A

Medicines that slow cardiac conduction, CYP3A4 substrate, digoxin

152
Q

Diltiazem - Common AEs

A

Nausea, vasodilatory effects (headache, flushing, dizziness, hypotension, peripheral oedema), rash,

153
Q

Diltiazem - counselling

A

monitoring

HT: this medicine can take up to 2 weeks to reduce your blood pressure effectively

154
Q

Verapamil - class and indication

A

antihypertensive

indication: SVT, AF/Atrial flutter, hypertension, angina

155
Q

Verapamil -Dose

A

Initial:
Conventional tablet: 80-160mg bd or tid
Sustained released: 120-240mg bd or tid
Maintenance:
Angina: maintenance 160mg bd or tid
SVT/AF/Atrial flutter: maintenance 160mg bd or tid
Hypertension: maintenance 160mg bd or tid
Maximum: 480mg/day
Situation where adjustment required: Elderly and hepatic impairment

156
Q

Verapamil - MOA

A

Block inward current of Ca2+ into cells in vascular smooth muscle, myocardium and cardiac conducting system via L-type Ca channels. Acts on coronary arteriolar smooth muscle to reduce vascular resistance and myocardial oxygen requirements, relieving angina sx. Act mainly on arteriolar smooth muscle to reduce peripheral vascular resistance and BP.

157
Q

Verapamil - DIs

A

CYP3A4 substrate and inhibitor, beta-blockers (increased risk of hypotension, heart block), antiarrhythmics, digoxin

158
Q

Verapamil - Common AEs

A

Constipation, bradycardia, AV block, development/worsening heart failure, ileus

159
Q

Verapamil - counselling

A

monitoring
-this medicine can increase and prolong the effects of alcohol. Limit your alcohol intake until you know how it is going to affect you

160
Q

Lercanidipine - class and indication

A

antihypertensive

indication: hypertension

161
Q

Lercanidipine - dose

A

Initial: 10mg/day, increase if required after at least 2 weeks
Maintenance:
Maximum: 20mg/day
Situation where adjustment required: Hepatic impairment, renal impairment, elderly

162
Q

Lercanidipine - MOA

A

Block inward current of Ca2+ into cells in vascular smooth muscle, myocardium and cardiac conducting system via L-type Ca channels. Acts on coronary arteriolar smooth muscle to reduce vascular resistance and myocardial oxygen requirements, relieving angina sx. Act mainly on arteriolar smooth muscle to reduce peripheral vascular resistance and BP

163
Q

Lercanidipine - DIs

A

CYP3A4 substrate

164
Q

Lercanidipine - Common AEs

A

Nausea, vasodilatory effects (headache, flushing, dizziness, hypotension, peripheral oedema)

165
Q

Lercanidipine - counselling

A

monitoring

166
Q

Glyceryl Trinitrate - class and indication

A

nitrate

indication: Prevention and tx of stable angina, heart failureassociated with acute MI

167
Q

Glyceryl Trinitrate - dose

A

Initial:
Angina
o SL tab: 300-600 micrograms every 3-4min until pain resolved, max 1800 microgram
o SL spray: 400-800 micrograms (1-2 spray), repeat after 5 min prn to max 3 spray
Prevention chronic angina
o Patch: apply 1 x 5mg/24hr patch/day for 12-14hr each day, if required increase strength to 15mg/24hr
Maintenance:
Maximum: 1800microgram/day

168
Q

Glyceryl Trinitrate - MOA

A

Provide exogenous source of NO (mediates vasodilator effects). Predominantly vasodilators, reduce venous return and preload to the heart = reducing myocardial oxygen requirement

169
Q

Glyceryl Trinitrate - DIs

A

PDE-5 Inhibitors, vasodilators, antihypertensives

170
Q

Glyceryl Trinitrate - Common AEs

A

Headache, flushing, palpitations, orthostatic hypotension, peripheral oedema, contact dermatitis, rebound angina

171
Q

Glyceryl trinitrate - Counselling

A

monitoring

172
Q

Isosorbide Mononitrate - class and indication

A

nitrate

indication:

173
Q

Isosorbide Mononitrate - dose

A

Once daily dosing allows nitrate-free interval, minimising risk of tolerance with prolonged use
Initial: 30-120mg/day
Maintenance:
Maximum: 120mg/day
Situation where adjustment required: Renal impairment

174
Q

Isosorbide Mononitrate - MOA

A

?

175
Q

Isosorbide Mononitrate - DIs

A

PDE-5 inhibitors, vasodilators, antihypertensives

176
Q

Isosorbide Mononitrate - Common AEs

A

Headaches (initially), hypotension, fainting tachycardia, loss of appetite, nausea, diarrhoea, rash

177
Q

Isosorbide Mononitrate - counselling

A

monitoring

Sem12019 (12 decks)

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