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pre reg afsha > TLD > Flashcards

TLD Flashcards

1
Q

name the conventional thiazides

A
  • bendroflumethiazide
  • hydrochlorthiazide
  • chlorothiazide
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2
Q

name the TLD

A
  • indapamide
  • metolazone
  • chlortalidone
  • xipimide
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3
Q

contraindications of TLDs

A
  • refractory HYPOkalaemia
  • HYPOnatraemia
  • HYPERcalcaemia
  • Addison’s
  • sympatomtic HYPERuricaemia
  • severe liver disease
  • severe RI (CrCl <30)
  • pregnancy
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4
Q

why are TLDs contraindicated in pregnancy

A

risk of neonatal thrombocytopenia, bone marrow suppression, jaundice, electrolyte disturbances, hyperglycaemia, reduced parenteral perfusion

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5
Q

which 3 conditions can TLD exacerbate and therefore its use is cautioned

A

SLE
diabetes
gout

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6
Q

cautions for TLD

A
  • elderly
  • risk of exacerbation: diabetes, gout, SLE
  • severe CVD, or being treated with cardiac glycosides
  • mild to moderate HI
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7
Q

Why are TLDs cautioned in pt with severe CVD or being treated with cardiac glycosides

A

danger posed by hypokalaemia

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8
Q

adverse effects - electrolyte imbalances include the following…
when is it advisable to monitor

A
  • hyperglycaemia
  • hypokalaemia
  • hyponatraemia
  • hypomagnesemia
  • hypercalcaemia
  • monitor esp with high doses and long term use, and in people with RI
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9
Q

adverse effects of TLDs include

A
  • electrolyte imbalances
  • hypochloraemia alkalosis
  • mild GI disturbances
  • altered plasma lipid conc
  • cardiac arrhythmias
  • dizziness and headache
  • ED
  • choroidal effusion, acute transient myopia, acute secondary CAG
  • blood and lymphatic system disorders rarely occur
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10
Q

dose of indapamide for hypertension

A

2.5mg OD in the morning
or 1.5mg daily using MR prep

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11
Q

dose of xipimide for hypertension

A

20mg OD in morning

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12
Q

dose of chlortalidone for hypertension

A
  • starting: 25mg OD in morning
  • increase up to 50mg daily if necessary
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13
Q

dose of metolazone for hypertension

A
  • starting: 5mg OD in moring
  • maintenance: 5mg OD alternate days
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14
Q

monitoring requirements for all TLDs

A
  • electrolytes, esp if high dose or long term
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15
Q

TLD are ineffective in CrCl

A

under 30

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16
Q

interactions - drugs that concern blood pressure

A
  • ARBs/ACEi: can cause rapid fall in BP in a pt who is volume depleted
  • alpha blockers: enhanced hypotensive effect and increased risk of 1st dose hypotension
  • TCAs: increased risk of postural hypotension
17
Q

Use of lithium and TLDs

A

risk of increased levels and toxicity
monitor levels regularly if used together

18
Q

TLDs and aminoglycosides

A

increased risk of ototoxicity

19
Q

What monitoring is recommended if a pt is on high dose diuretic and an ACE/ARB is to be started

A
  • if dose of diuretic is >80mg furosemide or equivalent, ACEi/ARB should be initiated under close supervision, and in some cases diuretic dose may need to be reduced or discontinued at least 24h beforehand
  • if high dose diuretic cannot be stopped, close observation is recommended for at least 2h following 1st dose of ACE/ARB, or until BP is stable
20
Q

concomitant use of TLDs and NSAIDs

A

increased risk of nephrotoxicity and antagonism of diuretic effect

21
Q

Use of CCs and TLDs

A

may potentiate hypokalaemia effect

22
Q

use of insulin and oral anti-diabetics with TLDs

A

may require dose adjustment

23
Q

Use of alprostadil, CCBs, BBs, hydralazine, nitrates, anxiolytics, MAOIs, methyldomia, minoxidil with TLDs

A

enhances hypotensive effect

24
Q

amiodarone, disopyramide, fleicanide and TLDs

A

hypokalaemia caused by TLDs increases risk of cardiac toxicity of these drugs

25
Q

use of allopurinol with TLDs

A

concurrent use may increase incidence of hypersensitivity reactions to allopurinol

26
Q

monitoring requirements of TLDs

A

serum electrolytes esp if long term use or high dose or RI

27
Q

can digoxin be used with TLDs

A

caution as predicted to increase risk of digoxin toxicity

28
Q

how potent are the TLDs as diuretics

A

moderately potent

29
Q

MOA of TLDs

A

inhibit sodium reabsorption at beginning of distal convoluted tubule

30
Q

how soon after oral administration to TLDs work and what is their duration of action

A

typically within 1-2h oral admin, duration of action 12-24h

31
Q

what time of the day to administer

A

usually in a.m. to not disturb sleep

32
Q

in the management of hypertension, what dose of TLD would you expect and why

A
  • low dose TLD provides maximal or near maximal BP lowering effect with very little biochemical disturbance
  • higher doses cause more marked changes in plasma potassium, sodium, uric acid, glucose, lipids - with little or no advantage in BP control
33
Q

what are the 2 TLDs preferred in management of hypertension

A

chlortalidone and idapamide
(bendro also licensed but not 1st line anymore)

34
Q

characteristics of chlortalidone
- duration of action
- use in oedema
- useful in which pt?
- other indication

A
  • a TLD
  • longer duration of action than thiazides
  • can be given on alternate days to control oedema
  • useful if acute retention is likely to be precipitated by a more rapid diuresis or if pt dislikes the altered patter or micturition caused by other diuretics
  • can also be used under close supervision for treatment of ascites due to cirrhosis in stable pt
35
Q

characteristics of indapamide
- related to
- useful in which comorbid?

A
  • chemically related to chlortalidone
  • indapamide claimed to to lower BP with less metabolic disturbance
  • less aggravation of DM - use this diuretic in pt with DM
36
Q

characteristics of metolozone
- combination
- side effect

A
  • effective when combined with loop diuretic (even in renal failure)
  • profound diuresis can occur so monitor carefully
37
Q

which set of patients are particularly susceptible to adverse effects of TLDs?

A

elderly - caution

38
Q

why is regular monitoring of plasma sodium essential

A

fall in plasma sodium may be asymptomatic initially

pre reg afsha (51 decks)

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