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Pharmacy > HTN, HF, AF, Haem Drugs > Flashcards

HTN, HF, AF, Haem Drugs Flashcards

To know the various MOA, Class, Doses

1
Q

class of peridopril

A

ACEi

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2
Q

Class of Diltiazem

A

Non-DHP CCB

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3
Q

Class of Verapamil

A

Non-DHP CCB

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4
Q

Class of methyldopa

A

Central-acting

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5
Q

Class of hydralazine

A

Direct Arterial Vasodilator

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6
Q

MOA of ACEi

A

Inhibits the Angiotensin Converting Enzyme which is responsible for conversion of biologically inert angiotensin I to angiontensin II

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7
Q

different packaging & Max dose for captopril

A

12.5mg & 25mg
max: 150mg (UTD), 450mg (NHG)

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8
Q

different packaging & Max dose for enalapril

A

5mg,10mg,20mg
max: 40mg/d

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9
Q

different packaging & Max dose for lisinopril

A

5mg,10mg,20mg
max: 40mg/d

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9
Q

different packaging & Max dose for peridopril

A

A - 20mg
E - 16mg

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10
Q

different salt forms of peridopril & their packaging

A

5mg - arginine
4mg - erbumine

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11
Q

how are the salt forms equivalent

A

4mg E = 5mg A

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12
Q

Side effects of ACEi

A
  • Persistent dry cough
  • Dizziness
  • increased potassium levels → Hyperkalemia
  • Angioedema
  • AKI → When used with NSAIDs or diuretics can lead to AKI
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13
Q

CI of ACEi

A
  • Pregnancy / Breastfeeding
  • History of angioedema
  • Bilateral renal artery stenosis (narrowing of arteries that bring blood to kidneys)
  • Hyperkalemia
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14
Q

MOA of ARBs

A

Selective inhibition of angiotensin II by competitive antagonism of the AT1 receptors (Angiotensin II type 1 receptors)

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15
Q

different packaging & Max dose for Losartan

A

50mg,100mg
max: 100mg/d

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16
Q

different packaging & Max dose for
candesartan

A

8mg tab
max: 32mg/d

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17
Q

different packaging & Max dose for
Irbesartan

A

100mg,300mg
max: 300mg/d

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18
Q

different packaging & Max dose for
Telmisartan

A

40mg, 80mg
Max: 80mg/d

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19
Q

different packaging & Max dose for
Valsartan

A

80mg,160mg
max: 320mg/d

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20
Q

which ARBs require a dose adjustment?

A

candesartan: initial 4mg OD
losartan: Crcl<20: initial 25mg OD
valsartan: Crcl<10: use with caution

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21
Q

MOA of ARNi

A

inhibits neprilysin (neutral endopeptidase) through the active metabolite LBQ657, leading to increased levels of peptides, including natriuretic peptides;

induces vasodilation and natriuresis (process of sodium excretion in the urine through the action of the kidneys)

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22
Q

different packaging & Max dose for
Entresto

A

49/51 & 97/103

Max: 97/103 BID

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23
Q

What is the ingredients in ARNI

A

Sacubitril / Valsartan

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24
Q

SE of ARNi

A

Hyperkalemia (increase K+)
Dizziness & light-headedness (will improve with time)
Cough
Angioedema

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25
Q

what to do if you are on an ACEi/ARB but want to switch to ARNi

A

washout period for ACEi - 36hr
NO washout period for ARB

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26
Q

MOA of CCB

A

prevents calcium from entering the cells of the heart and arteries, which reduces contraction of arteries and allows vasodilation

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27
Q

different packaging & Max dose for
amlodipine

A

5mg,10mg
max dose: 10mg/d

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28
Q

different packaging & Max dose for
Nifedipine

A

30mg,60mg
max: 120mg

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29
Q

different packaging & Max dose for
Diltiazem

A

normal Tab: 30,60mg
SR tabs: 90,100,200mg

max: 360mg/d

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30
Q

SE of DHP CCB

A

Peripheral Edema (leg swelling) - to lift up the legs
Headache
Hypotension

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31
Q

SE of non-DHP CCB

A

Peripheral Edema (leg swelling) - to lift up the legs
Headache
Hypotension
(Bradycardia)
(constipation)

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32
Q

CI for non-DHP CCB

A

Systolic HF, 2nd or 3rd degree AV block, pulmonary congestion, acuteMI
Decompensated is an issue

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33
Q

what to counsel the patient to avoid when taking CCB

A

Avoid grapefruit juice

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34
Q

MOA of thiazide diuretics

A

Inhibit Na and H2O reabsorption in the proximal distal tubule

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35
Q

different packaging & Max dose for
Hydrochlorothiazide

A

25mg
max: 50mg/d

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36
Q

different packaging & Max dose for
Indapamide

A

Tab: 2.5mg (max: 5mg/d)
SR: 1.5mg (max: 1.5mg/d)

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37
Q

SE of thiazides

A

Hypotension
Frequent urination
Muscle cramps, tired (due to the electrolytes being lost)
May cause a gout attack
Light sensitivity → sunblock, avoid strong sun
Electrolyte imbalance - K+ low, Na low
DM - may cause hyperglycaemia

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38
Q

rare SE for hydrochlorothiazide

A

non-melanoma skin cancer
- Consult a doctor if there are lumps or patches on the skin that does not heal or go away
- To minimise exposure to sunlight

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39
Q

CI for diuretics

A

Sulfonamide allergy - cross reactivity is rare
Pregnancy
Persistent anuria/oliguria
Advanced kidney failure
Diabetes (caution)
Hyperlipidemia

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40
Q

MOA of loops

A

Inhibits the Na/K/2Cl co-transporter, which transport Cl across the lining cells of the ascending limb of the loop of Henle

41
Q

Max dose & packaging for frusemide

A

20mg
max: 80mg/d

42
Q

SE of Loops

A

Hypotension
Frequent urination
May cause some electrolyte imbalance - may have some muscle cramps etc but there will be constant monitoring to ensure

43
Q

MOA of BBs

A

blocks the neurotransmitters norepinephrine and epinephrine from binding to receptors
Mainly blocks the Beta-receptors
Sometimes it may block the alpha receptors as well - mainly for those that are NOT cardio selective

44
Q

Who are cardioselective?

A

Bisoprolol, Atenolol. Metoprolol (BAM)

45
Q

Who are non-cardio selective

A

Carvedilol (has B blockade & alpha blockade), Propranolol

46
Q

Which BB needs to be renally adjusted

A
  1. atenolol (Crcl 15-35: max 50; crcl<15: max 25mg)
  2. bisoprolol (Crcl<20; max: 10mg)
47
Q

Max dose & packaging for Atenolol

A

50mg,100mg
max: 100mg

48
Q

Max dose & packaging for Bisoprolol

A

2.5mg, 5mg
max: 20mg

49
Q

Max dose & packaging for Carvedilol

A

6.25mg, 25mg
max: 50mg/d

50
Q

Max dose & packaging for Metoprolol

A

50mg,100mg
max: 450mg/d

51
Q

Max dose & packaging for Propanolol

A

10mg,40mg,80mg
max: 320mg/d

52
Q

SE of BB

A

Masking of hypoglycemia
Bradycardia
Heart block
Hypotension
bronchospasm (especially noncardioselective beta blockers)

53
Q

CI of BB

A

asthma, 2nd or 3rd heart block, systolic HF, decompensated HF

54
Q

MOA of MRA

A

Act on the distal tubule to inhibit Na/K exchange at the site of aldosterone action

55
Q

Max dose & adjustment for Spironolactone

A

25-50 OD/BD

GFR 30 to 50: Initial: 12.5 mg once daily or every other day; may double the dose every 4 weeks if serum potassium remains <5 mEq/L and kidney function is stable, up to a maximum target dose of 25 mg/day

eGFR <30: Use not recommended

56
Q

SE of MRA

A

Hirusutism
Gynecomastia → generally on higher doses & longer durations
Hyperkalemia
Hyponatremia

57
Q

MOA of Ivabradine

A

Slow down your HR

58
Q

Dose of Ivabradine

A

7.5mg BD

59
Q

SE of Ivabradine

A

symptomatic bradycardia: breathlessness, fatigue, syncope, dizziness;
other side effects: luminous visual phenomena.

60
Q

CI of ivabradine

A

AF
unstable CVS condition (eg. ACS, TIA)
pregnancy
severe liver dysfunction

61
Q

MOA Hydralazine

A

direct relaxation of peripheral smooth arteries, reducing peripheral resistance

62
Q

Max dose & packaging for Hydralazine

A

10,25,50mg
max: 300mg/d

63
Q

SE of Hydralazine

A

palpitation
flushing
headache

64
Q

CI of Hydralazine

A

Mitral Valve heart disease

65
Q

Trimetazidine (MOA, SE, Monitoring)

A

Fatty acid oxidation inhibitors
Manage symptoms of chest pain
common side effects: nausea, diarrhoea, headaches
Rarely, side effects some movement disturbances like tremors, uncontrolled body movement. \
Monitoring: Uncontrolled movements, BP, HR, renal panel (sCr)

66
Q

MOA of Digoxin

A

Inhibition of the Na/K ATPase pump in myocardial cells results in a transient increase of intracellular sodium, which in turn promotes calcium influx via the sodium-calcium exchange pump leading to increased contractility. May improve baroreflex sensitivity

67
Q

Dosing of Digoxin

A

62.5mg Daily
Initial dose: <15mL/min: 50% dose
Maintenance: <60mL/min for dose adjustment

68
Q

SE of Digoxin

A

(normal) Diarrhoea, nausea and vomiting

Some rare side effects can include:
Blurring of vision. If this occurs do not drive or operate machinery
Palpitations of slowed heart rate
Should these symptoms occur, please let your healthcare provider know

69
Q

What condition can affect digoxin levels

A

K+ levels due to pump

70
Q

MOA of Amiodarone

A

It works by correcting the rhythm of your heartbeat and also by slowing your heartbeat if it is beating too fast.

71
Q

SE of amiodarone

A

Need to see notes for more details

72
Q

MOA of methyldopa

A

stimulate alpha 2 receptors

73
Q

Max dose & packaging of methyldopa

A

250mg
max: 3g/d

74
Q

SE of methyldopa

A

Postural hypotension
drowsiness
headache

75
Q

CI of methyldopa

A

MAOI therapy
active liver disease

76
Q

name of Renin Inhibitors

A

Aliskiren

77
Q

MOA of aliskiren

A

direct inhibitor of renin, inhibit conversion of angiotensin to angiotensin I, cause vasodilation & reduce blood pressure

78
Q

CI of aliskiren

A

co-commitant use with ACEi, ARB in DM, CKD patients
pregnancy

79
Q

Max dose & Packaging of prazosin

A

1mg,5mg
max: 20mg

80
Q

Max dose & packaging for terazosin

A

2mg,5mg
max: 20mg

81
Q

difference in MOA between clopidogrel & ticagrelor

A

Clopidogrel: Irreversibly binds to the ADP binding site on the P2Y12 receptor

Ticagrelor: Reversibly bind at a allosteric site (not ADP binding site)

82
Q

Patient is a CYP2C19 poor metaboliser, which antiplatelet to avoid & why

A

Clopidogrel
Pro-drug → active metabolite
Delayed onset (peak action 6-8hr) & interindividual variability due to CYP2C19-mediated metabolism. hence you cannot convert to the active form

83
Q

Max dose of aspirin

A

100mg/d

84
Q

SE of antiplatelets (Generally)

A

Minor Bleeding:
- Unexplained nosebleed
-Bleeding from gums when brushing teeth. Use a soft bristle toothbrush to avoid gum bleeds.
-Bleeding from small cuts for 10-15 minutes even as you apply pressure on the wound. Check with your doctor if the bleeding does not stop within 15 minutes or if you feel unwell.

Serious Bleeding (Seek help immediately!)
- Blood in the urine
- Black and sticky stools (if you are not using iron supplements at the same time)
- Unexplained large bruises
- Coughing up blood or coffee ground-like vomit
- Sudden severe headache with nausea or loss of consciousness

85
Q

Other SE of ticagrelor

A

Bradycardia
Dyspnea → let pt know to seek doc if this happens

86
Q

Who is more potent Ticagrelor or clopidogrel

A

Ticagrelor

87
Q

Dose of clopidogrel & ticagrelor

A

Clopidogrel: a loading dose of 300 to 600 mg once, followed by 75 mg once daily

Ticagrelor: Loading 180mg, followed by 90mg once daily

88
Q

Which factors does warfarin inhibit

A

II, VII, ix,x

89
Q

Which factors does NOAC inhibit

A

Xa

90
Q

Which factor does dabigatran inhibit

A

II (thrombin)

91
Q

Dosing for ampixaban & rivaroxaban (plus dose adjustment)

A

Apixaban: 5mg BD normally
If: >80yo, <60kg, sCr > 133 (2 of the criteria met): to lower the dose to 2.5mg BD
Dose adjustment in liver impairment & kidney impairment

Rivaroxaban:
CrCl 15 to 50 mL/minute: 15 mg once daily with the evening meal
Crcl<15: avoid use

92
Q

The saving agents for the anticoagulants

A

warfarin: vitamin K
NOAC: aldenaxet alfa or PCC
Dabigatran: Idarucizumab

93
Q

Who is the antiplatelet - dabigatran or dypiradamole

A

dypiradamole

94
Q

CI of NOAC

A

Mitral valve stenosis (mod-severe)
Mitral valve replacement
APS
Left ventricular thrombosis
Mechanical valve replacement
Co-comittant use of AZOLES

95
Q

INR > 3 means?

A

Increase risk of bleeding

96
Q

IMPT counselling for warfarin

A
  1. Avoid making any MAJOR CHANGES to your diet (e.g. becoming a vegetarian) without first consulting your doctor or pharmacist Leafy greens, green tea stuff, soy milk
    Vitamin K interacts with the warfarin, it can reduce efficacy of medications
  2. Avoid excessive alcohol consumption. It is advisable not to take more than 5 cans of beer or 1 bottle of wine per week
  3. Avoid any form of traditional or herbal remedies and over-the-counter supplements (e.g. gingko, garlic, cordyceps and ginseng) as their effect on warfarin is unpredictable (eg. green tea, chrysanthemum tea)
  4. Avoid sports that increases your risk of bleeding/injury(eg. high contact sports)
    Inform doc if you are going for procedures that you are on blood thinners
97
Q

What are the factors that will affect your INR range

A

INR can be raised in febrile states → increased turnover of clotting factors
Repeat INR in 3-5d after starting therapies
Sudden increase in physical activity: increase warfarin metabolism → decrease INR
Smoking: CYP450 enzyme induction → increase warfarin metabolism → decrease INR
Liver:
Decreased clotting factor synthesis,
Decrease warfarin metabolism → increase INR
Fluid retention:
Absorption from oedematous gut (red INR) VS liver (increase INR) congestion
Thyroid disease:
Hyperthyroidism increase clotting factor turnover → increase INR
Hypothyroidism → reduce INR

98
Q

Hypercoagulable state of warfarin

A

To load with LMWH

99
Q

LWMH, Parenterals, changing of doses - to read guidelines & documents

A

to read guidelines & documents

Pharmacy (5 decks)

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