TLD Flashcards
name the conventional thiazides
- bendroflumethiazide
- hydrochlorthiazide
- chlorothiazide
name the TLD
- indapamide
- metolazone
- chlortalidone
- xipimide
contraindications of TLDs
- refractory HYPOkalaemia
- HYPOnatraemia
- HYPERcalcaemia
- Addison’s
- sympatomtic HYPERuricaemia
- severe liver disease
- severe RI (CrCl <30)
- pregnancy
why are TLDs contraindicated in pregnancy
risk of neonatal thrombocytopenia, bone marrow suppression, jaundice, electrolyte disturbances, hyperglycaemia, reduced parenteral perfusion
which 3 conditions can TLD exacerbate and therefore its use is cautioned
SLE
diabetes
gout
Which ones exacerbate diabetes more - loops or thiazides?
Thiazides
Which ones cause hypokalaemia more - thiazides or loop?
thiazides
cautions for TLD
- elderly
- risk of exacerbation: diabetes, gout, SLE
- severe CVD, or being treated with cardiac glycosides
- mild to moderate HI
Why are TLDs cautioned in pt with severe CVD or being treated with cardiac glycosides
danger posed by hypokalaemia
adverse effects - electrolyte imbalances include the following…
when is it advisable to monitor
- hyperglycaemia
- hypokalaemia
- hyponatraemia
- hypomagnesemia
- hypercalcaemia
- monitor esp with high doses and long term use, and in people with RI
adverse effects of TLDs include
- electrolyte imbalances
- hypochloraemia alkalosis
- mild GI disturbances
- altered plasma lipid conc
- cardiac arrhythmias
- dizziness and headache
- ED
- choroidal effusion, acute transient myopia, acute secondary CAG
- blood and lymphatic system disorders rarely occur
dose of indapamide for hypertension
2.5mg OD in the morning
or 1.5mg daily using MR prep
monitoring requirements for all TLDs
- electrolytes, esp if high dose or long term
TLD are ineffective in CrCl
under 30
interactions - drugs that concern blood pressure
- ARBs/ACEi: can cause rapid fall in BP in a pt who is volume depleted
- alpha blockers: enhanced hypotensive effect and increased risk of 1st dose hypotension
- TCAs: increased risk of postural hypotension
Use of lithium and TLDs
risk of increased levels and toxicity
monitor levels regularly if used together
TLDs and aminoglycosides
increased risk of ototoxicity
What monitoring is recommended if a pt is on high dose diuretic and an ACE/ARB is to be started
- if dose of diuretic is >80mg furosemide or equivalent, ACEi/ARB should be initiated under close supervision, and in some cases diuretic dose may need to be reduced or discontinued at least 24h beforehand
- if high dose diuretic cannot be stopped, close observation is recommended for at least 2h following 1st dose of ACE/ARB, or until BP is stable
concomitant use of TLDs and NSAIDs
increased risk of nephrotoxicity and antagonism of diuretic effect
Increased risk hyponatraemia and acute renal failure
Use of CCs and TLDs
may potentiate hypokalaemia effect
use of insulin and oral anti-diabetics with TLDs
may require dose adjustment - thiazids cause HYPERglycaemia
Use of alprostadil, CCBs, BBs, hydralazine, nitrates, anxiolytics, MAOIs, methyldomia, minoxidil with TLDs
enhances hypotensive effect
amiodarone, disopyramide, fleicanide, antipsychotics, fluconazole, methadone, quinines etc and TLDs
increase risk of hypokalaemia (increases risk of cardiac toxicity of these drugs e..g anti arrhtyhmics)
use of allopurinol with TLDs
concurrent use may increase incidence of hypersensitivity reactions to allopurinol
