DOTD pt1

Question 1

Drug class: Losartan

Answer 1

Angiotensin II receptor antagonists

Question 2

Drug class: Indapamide

Answer 2

Thiazide-like diuretic

Question 3

Drug class: Amlodipine

Answer 3

Dihydropyridine Ca Channel Blocker

Question 4

Drug class: Atorvastatin

Answer 4

Statin

(One of the most efficacious currently in class and best value. Good starting point for prescribing statins)

Question 5

Drug class: Spironolactone

Answer 5

Potassium sparing diuretics - mineralocorticoid (aldosterone) receptor antagonist

Question 6

Indications: Losartan

Answer 6

Hypertension, HF, Diabetic nephropathy

Question 7

Indications: Indapamide

Answer 7

Hypertension

Question 8

Indications: Amlodipine

Answer 8

Hypertension

Question 9

Indications: Atorvastatin

Answer 9

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

Question 10

Indications: Spironolactone

Answer 10

Chronic heart failure (oedema), ascites, nephrotic

Question 11

Mechanism of action: Losartan

Answer 11

Blocks Ang II R

Question 12

Mechanism of action: Indapamide

Answer 12

Blocks Na/Cl cotransporter in DCT

Question 13

Mechanism of action: Amlodipine

Answer 13

Targets Ca initiated smooth muscle contraction -> vasodilation

Question 14

Mechanism of action: Atorvastatin

Answer 14

Competitive inhibition of HMG-CoA reductase

Question 15

Mechanism of action: Spironolactone

Answer 15

Aldosterone antagonist/ mineralocorticoid receptor antagonist

Question 16

Adverse drug reactions: Losartan

Answer 16

Anaemia, Syncope, hypoglycaemia, postural disorders, A fib, hepatitis, stroke

Question 17

Adverse drug reactions: Indapamide

Answer 17

HyperCa, HypoK, Hyperglycaemia, Hyperuricemia

Question 18

Adverse drug reactions: Amlodipine

Answer 18

Peripheral oedema, headaches, palpitations

Question 19

Adverse drug reactions: Atorvastatin

Answer 19

GI disruption, nausea, headache
Myalgia - dose related
Rarely rhabdomyolysis
Increased liver enzymes

Question 20

Adverse drug reactions: Spironolactone

Answer 20

Gynaecomastia (increases oestrogen), hyperkalaemia, SCARs (severe cutaneous adverse reactions)

Question 21

Contraindications, Warnings, DDIs: Losartan

Answer 21

Aliskiren (renin inhibitor), K sparing diuretics, NSAIDs

Question 22

Contraindications, Warnings, DDIs: Indapamide

Answer 22

Alcohol, amlodipine

Question 23

Contraindications, Warnings, DDIs: Amlodipine

Answer 23

Simvastatin and other statins

Question 24

Contraindications, Warnings, DDIs: Atorvastatin

Answer 24

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

Question 25

Contraindications, Warnings, DDIs: Spironolactone

Answer 25

Contraindicated in Addison’s disease, anuria, hyperkalaemia

Alcohol, amiloride (K sparing diuretic), ACEi, ARBs