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Pharmacy > HTN, HF, AF, Haem Drugs > Flashcards

HTN, HF, AF, Haem Drugs Flashcards

To know the various MOA, Class, Doses (100 cards)

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1
Q

class of peridopril

A

ACEi

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2
Q

Class of Diltiazem

A

Non-DHP CCB

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3
Q

Class of Verapamil

A

Non-DHP CCB

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4
Q

Class of methyldopa

A

Central-acting

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5
Q

Class of hydralazine

A

Direct Arterial Vasodilator

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6
Q

MOA of ACEi

A

Inhibits the Angiotensin Converting Enzyme which is responsible for conversion of biologically inert angiotensin I to angiontensin II

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7
Q

different packaging & Max dose for captopril

A

12.5mg & 25mg
max: 150mg (UTD), 450mg (NHG)

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8
Q

different packaging & Max dose for enalapril

A

5mg,10mg,20mg
max: 40mg/d

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9
Q

different packaging & Max dose for lisinopril

A

5mg,10mg,20mg
max: 40mg/d

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9
Q

different packaging & Max dose for peridopril

A

A - 20mg
E - 16mg

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10
Q

different salt forms of peridopril & their packaging

A

5mg - arginine
4mg - erbumine

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11
Q

how are the salt forms equivalent

A

4mg E = 5mg A

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12
Q

Side effects of ACEi

A
  • Persistent dry cough
  • Dizziness
  • increased potassium levels → Hyperkalemia
  • Angioedema
  • AKI → When used with NSAIDs or diuretics can lead to AKI
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13
Q

CI of ACEi

A
  • Pregnancy / Breastfeeding
  • History of angioedema
  • Bilateral renal artery stenosis (narrowing of arteries that bring blood to kidneys)
  • Hyperkalemia
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14
Q

MOA of ARBs

A

Selective inhibition of angiotensin II by competitive antagonism of the AT1 receptors (Angiotensin II type 1 receptors)

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15
Q

different packaging & Max dose for Losartan

A

50mg,100mg
max: 100mg/d

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16
Q

different packaging & Max dose for
candesartan

A

8mg tab
max: 32mg/d

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17
Q

different packaging & Max dose for
Irbesartan

A

100mg,300mg
max: 300mg/d

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18
Q

different packaging & Max dose for
Telmisartan

A

40mg, 80mg
Max: 80mg/d

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19
Q

different packaging & Max dose for
Valsartan

A

80mg,160mg
max: 320mg/d

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20
Q

which ARBs require a dose adjustment?

A

candesartan: initial 4mg OD
losartan: Crcl<20: initial 25mg OD
valsartan: Crcl<10: use with caution

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21
Q

MOA of ARNi

A

inhibits neprilysin (neutral endopeptidase) through the active metabolite LBQ657, leading to increased levels of peptides, including natriuretic peptides;

induces vasodilation and natriuresis (process of sodium excretion in the urine through the action of the kidneys)

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22
Q

different packaging & Max dose for
Entresto

A

49/51 & 97/103

Max: 97/103 BID

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23
Q

What is the ingredients in ARNI

A

Sacubitril / Valsartan

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24
SE of ARNi
Hyperkalemia (increase K+) Dizziness & light-headedness (will improve with time) Cough Angioedema
25
what to do if you are on an ACEi/ARB but want to switch to ARNi
washout period for ACEi - 36hr NO washout period for ARB
26
MOA of CCB
prevents calcium from entering the cells of the heart and arteries, which reduces contraction of arteries and allows vasodilation
27
different packaging & Max dose for amlodipine
5mg,10mg max dose: 10mg/d
28
different packaging & Max dose for Nifedipine
30mg,60mg max: 120mg
29
different packaging & Max dose for Diltiazem
normal Tab: 30,60mg SR tabs: 90,100,200mg max: 360mg/d
30
SE of DHP CCB
Peripheral Edema (leg swelling) - to lift up the legs Headache Hypotension
31
SE of non-DHP CCB
Peripheral Edema (leg swelling) - to lift up the legs Headache Hypotension (Bradycardia) (constipation)
32
CI for non-DHP CCB
Systolic HF, 2nd or 3rd degree AV block, pulmonary congestion, acuteMI Decompensated is an issue
33
what to counsel the patient to avoid when taking CCB
Avoid grapefruit juice
34
MOA of thiazide diuretics
Inhibit Na and H2O reabsorption in the proximal distal tubule
35
different packaging & Max dose for Hydrochlorothiazide
25mg max: 50mg/d
36
different packaging & Max dose for Indapamide
Tab: 2.5mg (max: 5mg/d) SR: 1.5mg (max: 1.5mg/d)
37
SE of thiazides
Hypotension Frequent urination Muscle cramps, tired (due to the electrolytes being lost) May cause a gout attack Light sensitivity → sunblock, avoid strong sun Electrolyte imbalance - K+ low, Na low DM - may cause hyperglycaemia
38
rare SE for hydrochlorothiazide
non-melanoma skin cancer - Consult a doctor if there are lumps or patches on the skin that does not heal or go away - To minimise exposure to sunlight
39
CI for diuretics
Sulfonamide allergy - cross reactivity is rare Pregnancy Persistent anuria/oliguria Advanced kidney failure Diabetes (caution) Hyperlipidemia
40
MOA of loops
Inhibits the Na/K/2Cl co-transporter, which transport Cl across the lining cells of the ascending limb of the loop of Henle
41
Max dose & packaging for frusemide
20mg max: 80mg/d
42
SE of Loops
Hypotension Frequent urination May cause some electrolyte imbalance - may have some muscle cramps etc but there will be constant monitoring to ensure
43
MOA of BBs
blocks the neurotransmitters norepinephrine and epinephrine from binding to receptors Mainly blocks the Beta-receptors Sometimes it may block the alpha receptors as well - mainly for those that are NOT cardio selective
44
Who are cardioselective?
Bisoprolol, Atenolol. Metoprolol (BAM)
45
Who are non-cardio selective
Carvedilol (has B blockade & alpha blockade), Propranolol
46
Which BB needs to be renally adjusted
1. atenolol (Crcl 15-35: max 50; crcl<15: max 25mg) 2. bisoprolol (Crcl<20; max: 10mg)
47
Max dose & packaging for Atenolol
50mg,100mg max: 100mg
48
Max dose & packaging for Bisoprolol
2.5mg, 5mg max: 20mg
49
Max dose & packaging for Carvedilol
6.25mg, 25mg max: 50mg/d
50
Max dose & packaging for Metoprolol
50mg,100mg max: 450mg/d
51
Max dose & packaging for Propanolol
10mg,40mg,80mg max: 320mg/d
52
SE of BB
Masking of hypoglycemia Bradycardia Heart block Hypotension bronchospasm (especially noncardioselective beta blockers)
53
CI of BB
asthma, 2nd or 3rd heart block, systolic HF, decompensated HF
54
MOA of MRA
Act on the distal tubule to inhibit Na/K exchange at the site of aldosterone action
55
Max dose & adjustment for Spironolactone
25-50 OD/BD GFR 30 to 50: Initial: 12.5 mg once daily or every other day; may double the dose every 4 weeks if serum potassium remains <5 mEq/L and kidney function is stable, up to a maximum target dose of 25 mg/day eGFR <30: Use not recommended
56
SE of MRA
Hirusutism Gynecomastia → generally on higher doses & longer durations Hyperkalemia Hyponatremia
57
MOA of Ivabradine
Slow down your HR
58
Dose of Ivabradine
7.5mg BD
59
SE of Ivabradine
symptomatic bradycardia: breathlessness, fatigue, syncope, dizziness; other side effects: luminous visual phenomena.
60
CI of ivabradine
AF unstable CVS condition (eg. ACS, TIA) pregnancy severe liver dysfunction
61
MOA Hydralazine
direct relaxation of peripheral smooth arteries, reducing peripheral resistance
62
Max dose & packaging for Hydralazine
10,25,50mg max: 300mg/d
63
SE of Hydralazine
palpitation flushing headache
64
CI of Hydralazine
Mitral Valve heart disease
65
Trimetazidine (MOA, SE, Monitoring)
Fatty acid oxidation inhibitors Manage symptoms of chest pain common side effects: nausea, diarrhoea, headaches Rarely, side effects some movement disturbances like tremors, uncontrolled body movement. \ Monitoring: Uncontrolled movements, BP, HR, renal panel (sCr)
66
MOA of Digoxin
Inhibition of the Na/K ATPase pump in myocardial cells results in a transient increase of intracellular sodium, which in turn promotes calcium influx via the sodium-calcium exchange pump leading to increased contractility. May improve baroreflex sensitivity
67
Dosing of Digoxin
62.5mg Daily Initial dose: <15mL/min: 50% dose Maintenance: <60mL/min for dose adjustment
68
SE of Digoxin
(normal) Diarrhoea, nausea and vomiting Some rare side effects can include: Blurring of vision. If this occurs do not drive or operate machinery Palpitations of slowed heart rate Should these symptoms occur, please let your healthcare provider know
69
What condition can affect digoxin levels
K+ levels due to pump
70
MOA of Amiodarone
It works by correcting the rhythm of your heartbeat and also by slowing your heartbeat if it is beating too fast.
71
SE of amiodarone
Need to see notes for more details
72
MOA of methyldopa
stimulate alpha 2 receptors
73
Max dose & packaging of methyldopa
250mg max: 3g/d
74
SE of methyldopa
Postural hypotension drowsiness headache
75
CI of methyldopa
MAOI therapy active liver disease
76
name of Renin Inhibitors
Aliskiren
77
MOA of aliskiren
direct inhibitor of renin, inhibit conversion of angiotensin to angiotensin I, cause vasodilation & reduce blood pressure
78
CI of aliskiren
co-commitant use with ACEi, ARB in DM, CKD patients pregnancy
79
Max dose & Packaging of prazosin
1mg,5mg max: 20mg
80
Max dose & packaging for terazosin
2mg,5mg max: 20mg
81
difference in MOA between clopidogrel & ticagrelor
Clopidogrel: Irreversibly binds to the ADP binding site on the P2Y12 receptor Ticagrelor: Reversibly bind at a allosteric site (not ADP binding site)
82
Patient is a CYP2C19 poor metaboliser, which antiplatelet to avoid & why
Clopidogrel Pro-drug → active metabolite Delayed onset (peak action 6-8hr) & interindividual variability due to CYP2C19-mediated metabolism. hence you cannot convert to the active form
83
Max dose of aspirin
100mg/d
84
SE of antiplatelets (Generally)
Minor Bleeding: - Unexplained nosebleed -Bleeding from gums when brushing teeth. Use a soft bristle toothbrush to avoid gum bleeds. -Bleeding from small cuts for 10-15 minutes even as you apply pressure on the wound. Check with your doctor if the bleeding does not stop within 15 minutes or if you feel unwell. Serious Bleeding (Seek help immediately!) - Blood in the urine - Black and sticky stools (if you are not using iron supplements at the same time) - Unexplained large bruises - Coughing up blood or coffee ground-like vomit - Sudden severe headache with nausea or loss of consciousness
85
Other SE of ticagrelor
Bradycardia Dyspnea → let pt know to seek doc if this happens
86
Who is more potent Ticagrelor or clopidogrel
Ticagrelor
87
Dose of clopidogrel & ticagrelor
Clopidogrel: a loading dose of 300 to 600 mg once, followed by 75 mg once daily Ticagrelor: Loading 180mg, followed by 90mg once daily
88
Which factors does warfarin inhibit
II, VII, ix,x
89
Which factors does NOAC inhibit
Xa
90
Which factor does dabigatran inhibit
II (thrombin)
91
Dosing for ampixaban & rivaroxaban (plus dose adjustment)
Apixaban: 5mg BD normally If: >80yo, <60kg, sCr > 133 (2 of the criteria met): to lower the dose to 2.5mg BD Dose adjustment in liver impairment & kidney impairment Rivaroxaban: CrCl 15 to 50 mL/minute: 15 mg once daily with the evening meal Crcl<15: avoid use
92
The saving agents for the anticoagulants
warfarin: vitamin K NOAC: aldenaxet alfa or PCC Dabigatran: Idarucizumab
93
Who is the antiplatelet - dabigatran or dypiradamole
dypiradamole
94
CI of NOAC
Mitral valve stenosis (mod-severe) Mitral valve replacement APS Left ventricular thrombosis Mechanical valve replacement Co-comittant use of AZOLES
95
INR > 3 means?
Increase risk of bleeding
96
IMPT counselling for warfarin
1. Avoid making any MAJOR CHANGES to your diet (e.g. becoming a vegetarian) without first consulting your doctor or pharmacist Leafy greens, green tea stuff, soy milk Vitamin K interacts with the warfarin, it can reduce efficacy of medications 2. Avoid excessive alcohol consumption. It is advisable not to take more than 5 cans of beer or 1 bottle of wine per week 3. Avoid any form of traditional or herbal remedies and over-the-counter supplements (e.g. gingko, garlic, cordyceps and ginseng) as their effect on warfarin is unpredictable (eg. green tea, chrysanthemum tea) 4. Avoid sports that increases your risk of bleeding/injury(eg. high contact sports) Inform doc if you are going for procedures that you are on blood thinners
97
What are the factors that will affect your INR range
INR can be raised in febrile states → increased turnover of clotting factors Repeat INR in 3-5d after starting therapies Sudden increase in physical activity: increase warfarin metabolism → decrease INR Smoking: CYP450 enzyme induction → increase warfarin metabolism → decrease INR Liver: Decreased clotting factor synthesis, Decrease warfarin metabolism → increase INR Fluid retention: Absorption from oedematous gut (red INR) VS liver (increase INR) congestion Thyroid disease: Hyperthyroidism increase clotting factor turnover → increase INR Hypothyroidism → reduce INR
98
Hypercoagulable state of warfarin
To load with LMWH
99
LWMH, Parenterals, changing of doses - to read guidelines & documents
to read guidelines & documents

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