DOTD pt1 Flashcards
Drug class: Losartan
Angiotensin II receptor antagonists
Drug class: Indapamide
Thiazide-like diuretic
Drug class: Amlodipine
Dihydropyridine Ca Channel Blocker
Drug class: Atorvastatin
Statin
(One of the most efficacious currently in class and best value. Good starting point for prescribing statins)
Drug class: Spironolactone
Potassium sparing diuretics - mineralocorticoid (aldosterone) receptor antagonist
Indications: Losartan
Hypertension, HF, Diabetic nephropathy
Indications: Indapamide
Hypertension
Indications: Amlodipine
Hypertension
Indications: Atorvastatin
Hyperlipidaemia
Reduce CVD risk
Also familial hypercholesterolemia
Primary prevention - 20 mg once daily (if QRISK >10%)
Secondary prevention - 80 mg once daily (if had major cardiovascular event e.g. heart attack/stroke, may be reduced to 20mg if have CKD)
Need a full lipid profile + HDL, non-HDL and TAGs before prescribing. Aim to reduce non-HDL-C by ~>40% at 3 months
Indications: Spironolactone
Chronic heart failure (oedema), ascites, nephrotic
Mechanism of action: Losartan
Blocks Ang II R
Mechanism of action: Indapamide
Blocks Na/Cl cotransporter in DCT
Mechanism of action: Amlodipine
Targets Ca initiated smooth muscle contraction -> vasodilation
Mechanism of action: Atorvastatin
Competitive inhibition of HMG-CoA reductase
Mechanism of action: Spironolactone
Aldosterone antagonist/ mineralocorticoid receptor antagonist
Adverse drug reactions: Losartan
Anaemia, Syncope, hypoglycaemia, postural disorders, A fib, hepatitis, stroke
Adverse drug reactions: Indapamide
HyperCa, HypoK, Hyperglycaemia, Hyperuricemia
Adverse drug reactions: Amlodipine
Peripheral oedema, headaches, palpitations
Adverse drug reactions: Atorvastatin
GI disruption, nausea, headache
Myalgia - dose related
Rarely rhabdomyolysis
Increased liver enzymes
Adverse drug reactions: Spironolactone
Gynaecomastia (increases oestrogen), hyperkalaemia, SCARs (severe cutaneous adverse reactions)
Contraindications, Warnings, DDIs: Losartan
Aliskiren (renin inhibitor), K sparing diuretics, NSAIDs
Contraindications, Warnings, DDIs: Indapamide
Alcohol, amlodipine
Contraindications, Warnings, DDIs: Amlodipine
Simvastatin and other statins
Contraindications, Warnings, DDIs: Atorvastatin
CYP3A4 inhibition -> increased [statins]
- e.g. Amlodipine, amiodarone, diltiazem, macrolides - increases plasma [statin]
- Grapefruit/juice also inhibits CYP3A4
Amlodipine also increases plasma [statins] but not sure if via CYP3A4
Can pause short term while taking e.g. macrolide antibiotic course
Contraindications, Warnings, DDIs: Spironolactone
Contraindicated in Addison’s disease, anuria, hyperkalaemia
Alcohol, amiloride (K sparing diuretic), ACEi, ARBs