Cardiovascular Flashcards
(23 cards)
1
Q
Moxonidine
- Drug class
- Indication
- Dosage range, Frequency and best admin time
- Monitoring
- Counselling
A
- Antihypertensive
- Hypertension
- 200mcg-400microg D mane or in 2 doses. Max 600mcg d.
- BP
Can cause drowsiness and decreases BP and heart rate; monitor for increased sedation, bradycardia or hypotension if given with other drugs* with these effects.
Hx angioedema—manufacturer caution.
C/I:
- HF - increased mortality
- Bradycardia - <50bpm
- Heart block
- CrCl <30 mL/minute; reduce dose if CrCl 30–60 mL/minute.
Coronary heart disease may be exacerbated by moxonidine.
Practice points - w/draw moxonidine gradually over few days; if bblocker given in combo, w/draw bblocker first then moxonidine after few days
LOTS OF INTERACTIONS - w/antipsychotics and antidepressants - S/Es: dry mouth, weakness, dizziness, hache, nausea, somnolence, sleep disturbance, vasodilation
Infrequent - rash
LABEL 9, 12, 16
https://www-mimsonline-com-au.ezproxy.lib.monash.edu.au/Search/DrugAlertSearch.aspx?ModuleName=Drug%20Interactions&searchKeyword=Moxonidine
2
Q
Ivabradine
- Drug class
- Indication
- Dosage range, Frequency and best admin time
- Monitoring
- Counselling
A
- Antianginal
- Stable angina w/normal sinus rhythm and HR>70bpm
Stable chronic HF in sinus rhythm and HR>77bpm, as adjunct to optimal standard treatment (including beta-blocker) - Titrate dose to attain a resting HR of 50–60bpm.
Start 5mg BD; adjust dose after 2–4 weeks, according to HR; range 2.5–7.5mg BD.
Elderly, mod hepatic impairment, other bradycardic drugs start with 2.5mg BD. - HR
Visual effects (luminous effects, blurriness)
AF, palpitations
Worsening of angina
STOP tx if resting HR remains <50bpm at lowest dose.
- Tx w/drugs that inhibit CYP3A4 may reduce ivabradine’s CL and increase risk of S/Es: tx w/potent CYP3A4 inhibitors (eg itraconazole, clarithromycin) - Reduces your heart rate to control symptoms of angina.
Labels: 5, 12, 13, 18, 21, A, B
Take w/food - better absorbed.
Measure and tell dr if your pulse rate is slow (you may feel SOB, tired or dizzy) as your dose may need adjusting.
Luminous effects – COMMON= Your vision may be blurred and you may see bright areas, especially when there are sudden changes in light intensity. These effects are most likely in the first 2 months and generally do not persist throughout treatment. Do not drive (especially at night) or operate machinery if you are affected.
3
Q
Amiloride
- Drug class
- Indication
- Dosage range, Frequency and best admin time
- Monitoring
- Counselling
A
- Potassium-sparing diuretic
- Prev of diuretic-induced hypokalaemia
Oedema due to HF, hepatic cirrhosis or nephrotic syndrome, as an adjunct to thiazide or loop diuretic
HTN
Fixed-dose combo w/HCT - 2.5-20mg d.
This medicine is usually taken once daily in the morning. If you are taking it twice a day, take the first dose in the morning and the second dose before 6 pm.
Hypokalaemia 2.5–5mg d.
Oedema 5mg d, max 20mg d; after diuresis, gradually reduce to lowest effective dose.
HTN 5–10mg d; max 20mg d.
W/HCT:
HTN 1 tablet once daily.
Oedema 1–2 tablets d; may be increased up to a maximum of 4 tablets daily; after diuresis, gradually reduce to lowest effective dose.
- BP
Renal fn - C/I in failure
Hepatic fn - pts w/cirrhosis, may precipitate renal failure, hyperchloraemic metabolic acidosis (in association w/hyperkalaemia), and hepatic encephalopathy; risk increased when amiloride used w/other diuretics.
ELDERLY - More susceptible to orthostatic hypotension and hyperkalaemia.
Hyperkalaemia - C/I if serum K+ conc >5mmol/L; avoid/use cautiously if >3.5 mmol/L.
Debilitated pt w/carpulm disease or uncontrolled diabetes—increased risk of hyperkalaemia and respiratory or metabolic acidosis.
Tx w/drugs that can increase K+ conc (trimeth,ciclosporin) avoid combo or MONITOR K+ CONC.
- LABEL 11, 16
This medicine is usually taken once daily in the morning. If you are taking it twice a day, take the first dose in the morning and the second dose before 6 pm.
4
Q
Telmisartan
- Drug class
- Indication
- Dosage range, Frequency and best admin time
- Monitoring
- Counselling
A
- Sartan/angiotensin II receptor inhibitor
- HTN, Prevention of cardiovascular morbidity & mortality in patients with coronary artery disease, peripheral artery disease, high-risk diabetes, previous stroke or TIA
- HTN = 40-80mg OD.
4. BP HR Hepatic fn Renal fn Electrolytes (esp. K+) Sprue-like enteropathy - smx incl severe, often watery, chronic diarrhoea with N&V, dehydration and weight loss, and are associated w/small bowel villous atrophy. Onset is delayed months to years after starting the sartan and symptoms resolve gradually, over weeks to months, after stopping. Misdiagnosis (eg as coeliac disease) is common. It is a rare adverse effect and although it is mostly reported with olmesartan, a recent cohort study and several case reports describe similar symptoms occurring with other sartans. Elderly - more predisposed to first-dose hypotension, hyperkalaemia and renovascular disease than younger patients. Start tx w/lower doses; monitor renal function closely. Pregnancy - Avoid use
5. LABEL= 5, 11, 12†, 16†, 21, A S/Es dizziness, headache, first-dose hypotension INTERACTIONS - NSAIDS - ACEI - additive toxicity - K+ & drugs that increase K+
5
Q
Amiodarone
- Drug class
- Indication
- Dosage range, Frequency and best admin time
- Monitoring
- Counselling
A
- Antiarrhythmic
- Srs tachyarrhythmias refractory to other tx incl. ventricular tachycardia, AF and SVT.
- Consult local protocols and use lowest effective maintenance dose. Comes in 100 and 200mg tabs. LD 200mg TDS for 1 week, 200mg BD for 1 week, then maintenance of 100-200mg OD. (400mg may be required for ventricular arrhythmias.)
4. TDM rarely necessary- range= 1-2.5mg/L. Toxicity= >2.5mg/L. BASELINE AND EVERY 6 MONTHS. T - thyroid function- hypo/hyper E - eyes (ocular effects photophobia) and electrolytes serum conc. (hypoK+, hyperK+, hypo Mg2+) ↑ risk of arrhythmias L - liver function (hepatotoxicity) L - lung function (pulmonary toxicity) E - ECG - QT prolongation S - skin pigmentation (blue-grey)
- LABELs: 5, 8, 18
You will need regular blood tests, ECGs and chest x-rays while you are taking amiodarone.
Tell Dr if SOB, dry cough, problems w/vision, muscle weakness, worsening of heart symptoms.
May get vivd dreams/nightmares, taste disturbance, h/ache, dizziness, fatigue.
6
Q
Spironolactone, Eplerenone
A
- Aldosterone antagonists
- S= Primary hyperaldosteronism, oedema, hirtuism in females, heart failure.
E= HF after 3-4 days of an acute MI, HF w/LVEF<35% w/QRS >130milisecs. - S= 12.5mgHTN-400mg in ascites.
E= 25-50mg OD. - S= endocrine A/Es.
Renal fn
Electrolytes esp K+ conc.
Monitor dietary potassium intake (e.g. bananas, dried fruit, salt substitutes) and use of complementary medicines containing potassium (e.g. some glucosamine products) in patients at risk of hyperkalaemia.
Diabetes= ↑ risk of hyperkalaemia, metabolic acidosis - S= LABELS: 11, 12, 16, A, B
This medicine can cause nausea, vomiting, diarrhoea, drowsiness and headaches.
E= LABELS: 11, 12, 18
This medicine can cause dizziness, nausea, and diarrhoea or constipation.
7
Q
Furosemide
A
- Loop diuretic
- Oedema associated with heart failure, hepatic cirrhosis, renal impairment and nephrotic syndrome
- 20-400mg once or twice daily. Pts w/severe renal impair may need up to 1,000mg daily.
- Gout- may be aggravated by diuretic-induced hyperuraceamia.
Ototoxicity= if tx w/ototoxic drugs, esp w/IV.
Electrolytes esp K+ conc.
Fluid balance/intake/output
Weight (daily)
Oedema
5. LABELS: 3b, 16 Diuretic, get rid of excess fluid. You will be going to the toilet more frequently to urinate. Label: 16 Get up slowly from sitting/lying. If taking BD take mane and midi. Adhere to fluid restrictions. Weight
8
Q
Sacubitril with valsartan
A
- Neprilysin inhibitor and a sartan
- HFrEF, if still smx w/ACEI/ARB
- Stop ACEI 36 hours before starting Sacubitril with valsartan.
24/26mg-97/103mg BD
Initially 24/26mg BD, if tolerated, double the dose every 2-4 weeks to 97/103mg BD.
If △ from full-dose ACE inhibitor or sartan, start with 49/51mg BD and ↑ as above.
- C/I- ACEI- angioedema
Electrolytes esp K+ conc regularly.= tx w.drugs that ↑ K+ (trimethoprim, ciclosporin)
Renal function, then monitor SERUM CREATININE regularly.
BP regularly when starting tx or if dose △.
Avoid use if systolic BP <100 mm Hg or serum K+ >5.4 mmol/L.
- LABELS: 5, 11, 12, 13, 16, 21, A
Cough, diarrhoea, nausea, h/aches, fatigue, weakness and back pain.
Tell dr immediately if swelling of the face, lips or tongue.
Women= Use effective contraception during and for 1 week after stopping treatment.
9
Q
Isosorbide mononitrate
A
- Nitrates
- Prevention of angina
- 30-120mg OD
The 60 mg tablets can be halved, but not the 120 mg tablets.
4. Nitrate-free period to avoid tolerance! C/I - hypovolaemia - raised intracranial pressure - tx w/PDE5Is - anaemia - aortic or mitral stenosis !
- tolerance to nitrates (with loss of effect) occurs with continuous exposure; avoid by ensuring a nitrate-free interval from long-acting nitrates.
- LABELS: 16, A*
Take this medicine once daily, at approximately the same time each day. Take
at the time of day when you most frequently experience angina.
This medicine can initially cause headaches. These generally stop as tx continues.
- hypotension (may be accompanied by paradoxical bradycardia and increased angina), fainting, tachycardia, loss of appetite, nausea, diarrhoea, rash.
10
Q
GTN patch
A
1, Nitrates 2. Prevention and tx of stable chronic angina. HF associated with acute MI (infusion) Accepted - Unstable angina (infusion) - Acute pulmonary oedema (infusion)
- 5 mg-15 mg/24hr patch once daily for approx. 12-14 hrs each day.
4. Nitrate-free period to avoid tolerance! C/I - hypovolaemia - raised intracranial pressure - tx w/PDE5Is - anaemia - aortic or mitral stenosis
- Remove before difibrillation-
- tolerance to nitrates (with loss of effect) occurs with continuous exposure; avoid by ensuring a nitrate-free interval from long-acting nitrates.
- LABELS: 13, 16, 21, K!!
Use patch once daily, at approximately the same time each day. Use at the time of day when you most frequently experience angina.
- Apply to clean, dry skin on the chest area or upper arm. Wear when symptoms of angina are most frequent, eg during the day for daytime angina. Make sure you know how to dispose of patches safely.
- To avoid nitrate tolerance with glyceryl trinitrate patch, ensure a patch-free period of at least 8 hours (ideally 10–12 hours) in each 24 hour period; patch-free period is usually overnight (unless nocturnal angina symptoms)
Remove the patch for 8–12 hours every 24 hours (usually at night).
Rotate the application site. To reduce skin irritation, avoid applying a patch to the same site for several days.
- S/Es: headache, flushing, palpitations, orthostatic hypotension, fainting, peripheral oedema, contact dermatitis
- Wear patch and take isosorbide mononitrate tablet at same time
11
Q
Nitrolingual spray and tablets
A
1, Nitrates
2. Acute angina.
Prevention of acute angina before a precipitating activity.
- Sublingual tablet= 300-600microg repeated every 3–4 minutes until pain is resolved, MAX 1800microg.
Sublingual spray= 400-800microg (1 or 2 sprays), repeat after 5mins if necessary to a maximum of 3 sprays.
400 micrograms=1 spray
4. ONLY TO BE USED FOR CHEST PAIN, NOT SOB. C/I - hypovolaemia - raised intracranial pressure - tx w/PDE5Is - anaemia - aortic or mitral stenosis
- tolerance to nitrates (with loss of effect) occurs with continuous exposure; avoid by ensuring a nitrate-free interval from long-acting nitrates.
- LABEL: 16
HOW TO USE Sublingual tablets and spray: - Use this medicine at the first sign of chest pain or discomfort (angina), or before physical activity that may bring on angina.
- Sit or lie down before use as it may cause dizziness.
- When ready to use, aim the spray under the tongue and press the nozzle once; do not inhale the spray.
- If the pain or discomfort is not relieved within 5 minutes, use a second dose.
- If this does not relieve the smxs within 10 minutes or smx get severe, call an ambulance immediately.
Sublingual tablets: place a tablet under the tongue or in your cheek, and allow it to dissolve. Once angina has been relieved, spit out what is left of the tablet (to avoid side effects such as headaches).
Do not swallow or inhale the spray.
Before using the spray for the first time, or if it has not been used for more than 4 months, prime it with 5 sprays into the air.
If it has not been used for 1 week, spray it into the air 1 time before use.
- S/Es: headache, flushing, palpitations, orthostatic hypotension, fainting, peripheral oedema
12
Q
Nicorandil (Ikorel, Ikotab)
A
- Anti-anginal
- Prevention and tx of stable angina
- 5mg BD, ↑ after 1 week to 10-20mg BD.
4. BP HR ULCERS and FISTULAE: GI and genital tracts, oral, perianal, OCULAR, cutaneous, peristomal. C/I: - PDE5Is - hypotension, acute MI Diverticular disease worsen
- LABELS: 9, 12, 13
H/aches should ↓/disappear w/continued use.
- nausea, dizziness, lack of energy, weakness, palpitations, flushing and muscle aches.
Tell dr if mouth ulcers, or sores or ulcers on other parts of your body including the EYES, tell your doctor.
ULCERS (particularly oral and perianal) and fistulae in the GI and genital tracts. Ocular, cutaneous and peristomal ulcers, as well as lesions at wounds or sites of surgical procedures (including ophthalmic), have also been reported. Misdiagnosis is common.
Healing occurs only after stopping nicorandil.
13
Q
Perhexiline
A
- Anti-anginal
- Refractory angina
- Poor metabolisers of Perhexiline:
- 6-10% of Caucasians
- 1-2% of Asians
GIVE very low doses (50mg) of perhexiline to avoid toxicity.
Ultrarapid metabolisers may require up to 600mg daily.
Dose △s during chronic tx= ↑by no more than 50 mg daily= disproportionate △s in plasma conc, as metabolism is saturable w/in the clinical dose range.
Initially 200mg OD until metaboliser status known (for rapid effect=400mg once daily for 3 days), followed by
100-250mg OD; adjust according to conc.
- TDM each month first, then every 3 months.
Blood sample in first 3-5 days of starting tx to identify poor/ultra-rapid metabolisers.
Liver fn- heptatotoxicity
Weight
BSL- can cause hypoglycaemia
Peripheral neuropathy- monitor clinical status
CYP2D6 inhibitors= toxicity - LABELS: 5, 12†
Regular blood tests.
Nausea and dizziness should ↓/disappear w/continued use.
Tell your doctor promptly if you have weakness, weight loss or feel pins and needles or numbness of fingers or toes.
EPSE RARE
14
Q
Hydrochlorothiazide, Indapamide
A
- Thiazide diuretic
- HTN, Oedema associated w/HF, cirrhosis or nephrotic syndrome.
- 12.5-100mg d.
Indapamide= 1.25-2.5mg OD mane. CR= 1.5mg mane. - Gout- may be aggravated by diuretic-induced hyperuraceamia.
Diabetes= ↑BSLs
Lipids= dyslipidaemia
Renal fn
BP
Electrolytes esp. diuretic induced hypokalaemia ↓K+, ↓Na+ and ↓Cl- - LABELS: 8, 16- orthostatic hypotension. Indapamide CR= A 16
Can take up to 4 weeks to ↓BP effectively.
H/aches, fatigue and muscle cramps.
Take a once-daily dose mane. If BD dose, take the first dose in the morning and the second dose before 6pm.
Tell dr if excessive thirst, weakness, drowsiness, confusion, muscle pains or cramps, or nausea and vomiting, tell your doctor.
Muscle cramps, , rarely blood dyscrasias, jaundice, hypersensitivity reactions (e.g. urticaria, toxic epidermal necrolysis, photosensitivity).
15
Q
Ramipril
A
- Angiotensin converting enzyme inhibitor
- HTN, Post-MI in pts w/HF, Prevention of MI, stroke, CV death/need for revascularisation procedures in patients >55 years with: CAD, stroke or PVD, or
diabetes and 1 or > risk factors (HTN, smoking, microalbuminuria, high total cholesterol, low HDL cholesterol, previous vascular disease), Prev of progressive renal failure in patients with persistent proteinuria (>1 g daily). - Captopril= 12.5-150mg daily in two or three doses.
Enalapril= 2.5-40mg daily in one or two doses.
Fosinopril= 5-40mg OD.
Lisinopril= 2.5-20mg OD. Max 40mg daily.
Perindopril= erbumine:2-8mg OD. arginine:2.5-10mg OD.
Quinapril= 5-40mg daily in one or two doses.
Ramipril= 1.25-10mg daily in one or two doses.
Trandolapril= 0.5-4mg OD. - BP
HR
Electrolytes esp K+ conc regularly.= tx w.drugs that ↑ K+ (trimethoprim, ciclosporin)
- Monitor dietary K+ intake (e.g. bananas, dried fruit, salt substitutes) and use of complementary medicines containing potassium (e.g. some glucosamine products) in patients at risk of hyperkalaemia.
- Renal fn
- Electrolytes
C/I:
- sacubitril with valsartan= ↑ risk of angioedema
mTOR, DPP4I, alteplase = ↑ risk of angioedema
- LABELS: 5, 11, 12†, 16†, 21, A
Takes 2-4 weeks to ↓ BP effectively.
Side effects:
Tell your doctor if persistent dry cough.
Immediate medical att if swelling of the face, lips or tongue; or abdo pain; or your skin or eyes become yellow.
Hypotension, hyperkalaemia, headache, fatigue, dizziness, nausea, diarrhoea, taste disturbances, rash, hypersensitivity reactions (e.g. anaphylaxis, angioedema, urticaria, Stevens–Johnson syndrome), and (rarely) blood dyscrasias, hepatitis, pancreatitis, photosensitivity.
Do not take NSAIDs.
16
Q
Amlodipine
A
- CCB
Dihydropyridines=arteriolar smooth muscle= amlodipine, felodipine, lercanidipine, nimodipine, nifedipine.
Non-dihydropyridines= cardiac and arteriolar smooth muscle= diltiazem and verapamil. - HTN, Angina, aneurysmal subarachnoid haemorrhage (nimodipine only)
- Amlo= 2.5-10mg OD.
Felodipine= CR 2.5-10mg OD. Max 20mg OD.
Lercanidipine= 10mg daily, ↑ to 20mg daily if necessary.
Nimodipine= Adult, oral 60 mg every 4 hours.
Hepatic impairment, 30 mg every 4 hours.
Nifedipine= CR 20mg or 30mg OD, ↑ to max of 90mg OD (angina) or 120mg OD (HTN). - BP
HR
Myasthenia-like neuromuscular disease= may ↑ risk of muscle weakness and resp depression (most case reports with verapamil).
Peritoneal dialysis—cloudy peritoneal fluid (w/no signs of infection) has been reported, mostly with lercanidipine; it is not clear if this is a class effect. - LABELS: 3b (lercan), 9, 16†, 18, A (felo,CR)
Can take up to 2 weeks to ↓ your BP effectively.
- h/aches, flushing, palpitations and nausea.
Tell dr if swollen ankles!
Can cause peripheral oedema due to vasodilation= does not respond to diuretics and may require dose ↓ or withdrawal.
Other (uncommon) adverse effects include paraesthesia, dyspnoea, tachycardia, myalgia and hypersensitivity reactions (e.g. rash, angioedema).
Felodipine= Gingival hyperplasia is a common adverse effect. It may be avoided or reversed with dental hygiene.
vasodilatory A/Es usually subside with continued treatment (may require dose reduction)- constipation, bradycardia
17
Q
Diltiazem and verapamil
A
- CCB
Dihydropyridines=arteriolar smooth muscle= amlodipine, felodipine, lercanidipine, nimodipine, nifedipine.
Non-dihydropyridines= cardiac and arteriolar smooth muscle= diltiazem and verapamil. - HTN, Angina
- Verapamil= Conventional tablet: 40-160mg 2-3 times daily.
MR: 120-240mg 1-2 times daily. Max. 480mg daily.
Diltiazem= Angina CR: 180mg OD, ↑ as required to 360mg OD.
Standard tab: 30mg 3-4 times daily, ↑ as required to 180-360mg daily in 3-4 DOSES.
HTN: CR: initially 180-240mg OD. Maintenance dose 240-360mg OD.
- HR- brady
BP
Verapamil=
Ileus
Tx w/antiarrhythmics ↑ risk of HF, bradycardia and proarrhythmic effect= avoid.
Tx w/b-blockers ↑ risk of severe bradycardia, heart block and left ventricular failure= avoid.
Manufacturer of dabigatran C/I combo w/verapamil in certain circumstances.
C/I:
- severe bradycardia, sick sinus syndrome, 2nd or 3rd-degree AV block (w/out pacemaker)
- hypotension (systolic BP <90 mm Hg)
- AF or atrial flutter associated with an accessory conduction pathway
Diltiazem may worsen first-degree atrioventricular block, but risk is less than with verapamil.
Tx w/drugs that slow cardiac conduction, cause bradycardia or arrhythmias may potentiate the adverse cardiac effects of diltiazem eg with beta-blockers; use combos carefully and monitor cardiac fn.
CYP3A4 substrate and inhibitor - LABELS: MR: 5, 9, 12, 13, 16†, 18, A, B. tablet: 5, 9, 12, 13, 16†, 18
Diltiazem= Capsule/tablet: 5, 9, 16†, 18; modified-release capsule: 5, 9, 16†, 18, A
-constipation, flushing, headaches, nausea and tiredness.
Verapamil can ↑ and prolong effects of alcohol. Limit your alcohol intake until you know how it is going to affect you.
vasodilatory adverse effects usually subside with continued treatment (may require dose reduction)- constipation, bradycardia
Diltiazem= Peripheral oedema, hypotension, depression, insomnia, gingival hyperplasia, and (rarely) hepatitis.
18
Q
Atenolol, Metoprolol ↑↓△
HEART FAILURE= carvedilol, CR metoprolol or bisoprolol (Evidence for nebivolol WEAK)
A
- Beta-blocker
- HTN, Angina, Tachyarrhythmias, MI, Accepted= Prev of migraine
Metoprolol/bisoprolol/carvedilol/nebivolol=
Chronic heart failure with reduced ejection fraction, as part of standard treatment (eg with ACE inhibitors and diuretics) - Atenolol= 25-50mg OD; ↑ if required to 100mg daily in 1 or 2 doses.
Metoprolol= HTN: 50-100mg OD-BD. Max 400mg daily. Angina: 25-100mg 2-3 times daily.
HEART FAILURE: (CR) 23.75-190mg OD daily for a minimum of 2 weeks. Double dose every 2 weeks.
Bisoprolol= 1.25-10mg max daily
4. BP HR= bradycardia Heart block Asthma Diabetes RENAL fn RENAL= atenolol, bisoprolol, nebivolol HEPATIC= bisoprolol, metoprolol, nebivolol, propranolol, carvedilol, labetalol C/I: - bradycardia (45–50 beats/min) - 2nd‑ or 3rd-degree AV block, sick sinus syndrome (without pacemaker), severe hypotension or uncontrolled HF failure. risk of worsening coronary artery spasm in vasospastic angina.
- LABELS: CR: 9, 12†, 16†, A; tablet: 9, 12†, 16†, I (atenolol)
You may feel tired or lack energy for a few days after starting this medicine or when the dose is increased.
This medicine can cause fatigue, nausea, diarrhoea, constipation and headaches. These may decrease or disappear with continued use.
cold extremities
nightmares
Controlled release tablets may be broken in half or swallowed whole; do not chew or crush them.
19
Q
Prazosin
A
- Selective alpha1 blocker
- HTN, BPH (symptom relief)
- HTN
Initially 0.5mg BD, ↑ to 1mg 2-3 times daily after 3–7 days. Maintenance, 3-20mg daily in 2 or 3 doses.
BPH
0.5mg BD for 3-7 days, then ↑ according to clinical response up to 2mg BD.
First-dose hypotension (↑elderly/fluid depletion/ diuretics)= start w/small dose @ bedtime, and increasing slowly over a few weeks, withhold diuretic for a few days before starting prazosin, ↓ dose of CCB or betaB before starting.
4. Monitor BP (lying and standing) and for symptoms of hypotension, particularly during dose titration. Heart failure Orthostatic hypotension Tachycardia Hallucinations
- LABELs: 12†, 16
Dizziness on standing= start of tx or when dose ↑. Get up gradually from sitting or lying to minimise this effect; sit or lie down if you become dizzy.
Take the first dose at bedtime, but be careful if you get up during the night as you may feel dizzy.
Tell your ophthalmologist you are taking, or have taken, this medicine if you are going to have cataract surgery.
first-dose hypotension, orthostatic hypotension, dizziness, drowsiness, headache, weakness, fatigue, palpitations, oedema, nausea, dry mouth, nasal congestion, blurred vision
Infrequent (0.1–1%)
tachycardia, fainting, urinary incontinence, vomiting, diarrhoea
Rare (<0.1%) hypersensitivity reactions (eg angioedema, urticaria, rash), paraesthesia, priapism, pancreatitis, depression, hallucinations
20
Q
Digoxin
tab, 62.5 mcg, 200, Lanoxin PG, Sigmaxin-PG
tab, 250 mcg (scored), 100, Lanoxin, Sigmaxin
A
- Cardiac glycoside
- AF and atrial flutter
Heart failure - LD(oral/IV)= 125-500microg Q4-6H. Max 1.5mg (500 microg in elderly).
Maintenance(oral)= 62.5-250microg OD. Max 500 microg daily (125microg in elderly). - PGP substrate!!
TDM= to guide dose adjustment and confirm toxicity.
BP
HR
RENAL FN=CLd (70%); ↓ dose in renal impair
ELECTROLYTES(below)
May worsen arrhythmia (proarrhythmic effect).Regularly assess patients for digoxin toxicity (including resting heart rate)
Monitor digoxin conc and alter dose as required for the following as they ↑ sensitivity to digoxin:
- Hyperthyroidism= may ↓ digoxin conc
- Hypothyroidism= may ↑ digoxin conc
- HyperCa, hyperK= risk of heart block.
- HypoK, hypoMg= ↑ risk of toxicity.
- Elderly
Heart block= C/I
Arrhythmias, CNS disturbances, rashes. Adverse effects are usually related to plasma conc. - LABELs: 5=otc, herbal
This medicine can cause nausea, vomiting, diarrhoea, visual disturbances, dizziness, headaches and loss of appetite. If these become severe or troublesome, tell your doctor as soon as possible.
21
Q
Flecainide
tab, 50 mg, 60, Tambocor
tab, 100 mg (scored), 60, Flecatab, Tambocor
A
- Anti-arrhythmic
- Ventricular Arrhythmias (eg: SVT)
Paroxysmal AF or atrial flutter associated with disabling symptoms - 50-100mg BD, max 400mg daily.
- Electrolyte disturbances= ↑ risk of arrhythmias
HR
BP
Heart block= C/I
May worsen arrhythmia (proarrhythmic effect).
TDM esp in renal and hepatic fn. - LABELs: 9, 12, 13
This medicine can cause dizziness, blurred vision, sensitivity to light, headaches and nausea, if you are affected, avoid driving or operating machinery.
22
Q
Sotalol
↑↓△
A
- non-selective beta-blocker, class III anti-arrhythmic
- Tx and prev of arrhythmias, including atrial, supraventricular and srs ventricular arrhythmias.
- 40-80mg BD, ↑ according to response to 160mg BD.
MAX= 640 mg daily. - BP
HR
Heart Block
Electrolyte disturbances= ↑ risk of arrhythmias
PVD/Raynaud’s= may ↓ peripheral circulation.
Diabetes=affects glucose metab and delay recovery from hypoglycaemia and mask signs of hypos (eg tachycardia).
Asthma= C/I
May worsen arrhythmia (proarrhythmic effect).
Monitoring of QT interval is used to guide dose adjustments. - LABELs: 4a, 9, 12†, 16
You may feel tired or lack energy for a few days after starting this medicine or when the dose is increased.
S/Es= SOB, fatigue, headaches, nausea and diarrhoea.
Sotalol may cause dizziness, drowsiness or visual disturbance; if you are affected, do not drive or operate machinery.
Don’t stop taking unless your doctor tells you to.
23
Q
Macitentan
tab, 10 mg, 30, Opsumit, PBS‑S1001
A
- Endothelin antagonists
- Pulmonary arterial hypertension (idiopathic, heritable, or associated with connective tissue disease or congenital heart disease)
- Adult, child >12 years and >40 kg, oral 10 mg once daily.
- Measure aminotransferase (ALT/AST) concs at baseline and each month during tx. If elevated >3 times ULN, stop tx; consider reintroducing when levels (incl bilirubin) return to pretx values unless pt had smx of hepatic injury.
Check Hb at baseline, at 1 and 3 months, then every 3 months. - Ensure effective contraception is used during, and for at least 3 months after stopping, treatment.
Tell dr immediately if you have nausea, vomiting, abdominal pain, fatigue, dark urine or jaundice.
S/Es= increased liver aminotransferases, cholelithiasis, hypotension, thrombocytopenia, influenza, itch, insomnia
reduced haemoglobin, flushing, peripheral oedema (may be less with macitentan), headache, nasal symptoms (eg congestion (may be dose related), nasopharyngitis or sinusitis), abdominal pain (uncommon with bosentan)
