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Twynsta Flashcards

0
Q

In what patients should Twynsta be used?

A

Patients who already receive telmisartan and amlodipine separately can instead receive the fixed-combination TWYNSTA.

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1
Q

List the contraindications for Twynsta?

A
  • Hypersensitivity to the active ingredients or to any of the excipients.
  • Hypersensitive to dihydropyridine derivatives
  • Breastfeeding
  • Lactation
  • Biliary obstructive disorder
  • Severe hepatic impairment
  • Cardiogenic shock
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2
Q

What are the storage conditions for Twynsta?

A
  • Below 30
  • Away from light and moisture
  • Tablets should not be removed from their packaging till required
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3
Q

How many repeats are on a script of Micardis plus?

A

5

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4
Q

What is volume of distribution of Micardis?

A

6.6L/kg

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5
Q

How is Telmisartan excreted?

A

Almost exclusively hepatically, only <1% is excreted in renal.

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6
Q

Explain why Twynsta has a reduced incidence of peripheral oedema compared to CCB mono therapy?

A

The presence of Telmisartan results in both arterial and venous dilation, helping to balance the pressure between the blood vessels in the peripheral capillaries; reducing the pressure, reduces the fluid leakage and result in reduced peripheral oedema.

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7
Q

How would you describe Micardis’ side effect profile?

A

Mild and transient.

Similar side effect to that of placebo.

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8
Q

What is the half life of Micardis?

A

18.3-23 hrs

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9
Q

How is HCTZ excreted?

A

HCTZ is not metabolized in the body and almost exclusively excreted through renal.

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10
Q

What is the indication for Twynsta?

A

Hypertension

Treatment should not be initiated with this fixed dose combination.

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11
Q

What is the trough-peak ratio for Micardis according to PI?

A

> 70%

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12
Q

Is Micardis metabolised by the cytochrome P450 system?

A

No

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13
Q

Based on National Heart Foundation Guidelines, based on available evidence, what is the most effective combination therapy?

A

ARB (AIIRA) or ACEi with CCB

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14
Q

According to national health foundation guidelines, what percentage of patients will require combination therapy to reach BP?

A

50-75%

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15
Q

What are two most common side effect for Twynsta?

A

Dizziness

Peripheral oedema

16
Q

How many tablet in a pack of Micardis/Micardis plus?

A

28

17
Q

List the contraindications for Micardis plus?

A
  • Hypersensitivity to any of the compounds or sulphonamide derived substances
  • Pregnancy or lactation
  • Cholestasis
  • Biliary obstructive disorder
  • Severe hepatic impairment
  • Severe renal impairment
  • Refractory hypokalaemia, hypercalcaemia
18
Q

Name 3 competitors of AIIRA / ACEi + CCB combination currently available on the Australian market.

A

Coveram (perindopril + amlodipine)
Ex-forge (Diovan + amlodipine)
Sevikar (Olmetec + amlodipine)

19
Q

Is Twynsta metabolised in cytochrome P450 system?

A

Partially, Telmisartan is not metabolised but amlodipine is.

20
Q

What is the pregnancy category for Twynsta?

A

Category D

21
Q

Briefly outline the main features of the accomplish trial.

A
  • Compare the cardiovascular outcome of an ACEi/CCB and ACEi/HCTZ
  • 11,506 pts with hypertension and high risk of CV events
  • History of coronary events, MI, revascularization or stroke, impaired renal function, peripheral arterial disease, LVH, diabetes.
22
Q

List 4 advantages of combination therapy.

A
  • Additive BP lowering
  • Reduction in side effect
  • Improved patient compliance
  • Reduced cost
23
Q

Onset antihypertensive occurs gradually within how many hours of taking Telmisartan ?

A

3 hours

24
Q

Which medication taken with Micardis plus constitutes the ‘triple whammy’?

A

NSAIDs or COX2 inhibitor

25
Q

What is the half life of Telmisartan and amlodipine ?

A

Telmisartan 18.3 - 23

Amlodipine 30 - 50

26
Q

How long after Micardis is initiated until maximal BP reductions are attained?

A

4-8 weeks

27
Q

What is the dose adjustment required for renal/hepatic impaired patients?

A

Renal: no adjustments needed including those in haemodialysis.
Hepatic: mild to moderate hepatic impairment, <=40mg for Telmisartan. Severe hepatic impairment, CI.

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