Vascular Drugs Flashcards
What is the MOA of apremilast?
PDE4 inhibitor
Role in chronic inflammation
What are the contraindications to apremilast?
Hypersensitivity
Pregnancy/lactation
Children <18 years
Severe renal impairment
Depression/suicidality
Galactose intolerance
What are the adverse effects of apremilast?
GI effects, URTI, weight loss, depression, headache, hypersensitivity
What baseline and ongoing monitoring is required for apremilast?
Baseline - FBC, UEC, LFT, BhCG
Ongoing - Nil
How is apremilast dosed?
Day 1: 10mg mane
2: 10mg BD
3: 10mg mane, 20mg nocte
4: 20mg BD
5: 20mg mane, 30mg nocte
6: 30mg BD
What are the contraindications to propranolol?
Hypersensitivity
Hypoglycaemia
Heart block
HR/BP abnormalities
Frequent wheezing
What are the adverse effects of propranolol?
Wheezing
Cool peripheries
GI effects
Sleep disturbance, somnolence
Cognitive impairment
Urticaria
Alopecia
What baseline and ongoing monitoring is required for propranolol?
HR, BP, peripheral pulses, auscultation of lungs and heart, palpate for HSM
Glucose
ECG
Consider TTE
How would you start propranolol in an uncomplicated infant?
Outpatient
1mg/kg in two divided doses
Increase to 2mg/kg after 1 week
If IH not responding and drug tolerated, increase to 3mg/kg
Adjust dose with weight increases
Follow up every 2-3 months
Which infants require impatient monitoring for initiation of propranolol?
Premature
<5 weeks age corrected
<2.5kg
Hypoglycaemia
Significant comorbidities
PHACES
Poor social support
Lower initial dose eg 0.5mg/kg/day
Monitor HR/BP every 30 mins for 4 hrs
Measure BSL pre and post
What are the indications for pentoxyfylline?
Venous ulcers
Raynaud’s phenomenon
Livedoid vasculopathy
NLD
Generalised GA
What are the contraindications to pentoxyfylline?
Hypersensitivity
Recent severe haemorrhage
Cardiac disease
CVA
Renal or hepatic impairment
Children <18yrs
What drugs interact with pentoxyfylline?
Anticoagulants/antiplatelets
What are the adverse effects of pentoxyfylline?
Bleeding
GI effects
Headache, dizziness
Angina, palpitations
How is pentoxyfylline dosed and what is the onset of action?
400mg tds
2-4 months
What are MOAs of tranexamic acid?
- Antifibrinolytic
- Inhibits VEGF/angiogenesis
- Blocks transfer of melanin to keratinocytes
What are the contraindications to tranexamic acid?
Hypersensitivity
Pregnancy
Impaired colour vision
Hx of thrombosis/haemorrhage
What are the adverse effects of tranexamic acid?
GI effects
Thrombosis
Visual disturbances
Rash
What baseline screening is required and how do you start tranexamic acid?
Coagulation profile
250mg BD for 8-12 weeks
NO ongoing monitoring required
What are the indications for sirolimus?
Angiofibromas
Kaposi sarcoma
Capillary/venous/lymphatic malformation
Tufted haemangioma/KHE
GvHD, SSc, pachyonychia congenita
What are the contraindications to sirolimus?
Hypersensitivity
Pregnancy/lactation
Children <18 years
What drugs interact with sirolimus?
CYP3A4 drugs
ACE inhibitors
Grapefruit juice
Other immunosuppressants
Other Calcineurin inhibitors
Live vaccines
What are the adverse effects of sirolimus?
Skin: acne, folliculitis, nail fragility, alopecia, hypertrichosis, poor wound healing, epistaxis, mouth ulcers
GI: n/v/d, transaminitis, pancreatitis
CVS: hypertension, tachycardia, peripheral oedema
Endo: DM, hyperlipidemia, subfertility (males)
General: headache, fever, fatigue, dizziness, myalgia
Infection eg URTI, HsV, cystitis, pneumonia
Malignancy eg NMSC, lymphoprolif
What baseline and ongoing monitoring is required for sirolimus?
Baseline
Blood pressure
FBC, UEC, LFT, CMP, BhCG, lipids, BSL
Urinalysis
Immunosuppression screen
D-dimer, fibrinogen
*Ongoing
Blood pressure
Sirolimus level (aim 5-10 ng/dl)
FBC, UEC, CMP, LFT, lipids, BSL
D-dimer, fibrinogen
*Monthly for 3 months and then every 3-4 months
What are the indications for apremilast?
Plaque psoriasis
Psoriatic arthritis
Palmoplantar psoriasis
Behcet disease
Aphthous ulcers
