Twynsta Flashcards
(28 cards)
In what patients should Twynsta be used?
Patients who already receive telmisartan and amlodipine separately can instead receive the fixed-combination TWYNSTA.
List the contraindications for Twynsta?
- Hypersensitivity to the active ingredients or to any of the excipients.
- Hypersensitive to dihydropyridine derivatives
- Breastfeeding
- Lactation
- Biliary obstructive disorder
- Severe hepatic impairment
- Cardiogenic shock
What are the storage conditions for Twynsta?
- Below 30
- Away from light and moisture
- Tablets should not be removed from their packaging till required
How many repeats are on a script of Micardis plus?
5
What is volume of distribution of Micardis?
6.6L/kg
How is Telmisartan excreted?
Almost exclusively hepatically, only <1% is excreted in renal.
Explain why Twynsta has a reduced incidence of peripheral oedema compared to CCB mono therapy?
The presence of Telmisartan results in both arterial and venous dilation, helping to balance the pressure between the blood vessels in the peripheral capillaries; reducing the pressure, reduces the fluid leakage and result in reduced peripheral oedema.
How would you describe Micardis’ side effect profile?
Mild and transient.
Similar side effect to that of placebo.
What is the half life of Micardis?
18.3-23 hrs
How is HCTZ excreted?
HCTZ is not metabolized in the body and almost exclusively excreted through renal.
What is the indication for Twynsta?
Hypertension
Treatment should not be initiated with this fixed dose combination.
What is the trough-peak ratio for Micardis according to PI?
> 70%
Is Micardis metabolised by the cytochrome P450 system?
No
Based on National Heart Foundation Guidelines, based on available evidence, what is the most effective combination therapy?
ARB (AIIRA) or ACEi with CCB
According to national health foundation guidelines, what percentage of patients will require combination therapy to reach BP?
50-75%
What are two most common side effect for Twynsta?
Dizziness
Peripheral oedema
How many tablet in a pack of Micardis/Micardis plus?
28
List the contraindications for Micardis plus?
- Hypersensitivity to any of the compounds or sulphonamide derived substances
- Pregnancy or lactation
- Cholestasis
- Biliary obstructive disorder
- Severe hepatic impairment
- Severe renal impairment
- Refractory hypokalaemia, hypercalcaemia
Name 3 competitors of AIIRA / ACEi + CCB combination currently available on the Australian market.
Coveram (perindopril + amlodipine)
Ex-forge (Diovan + amlodipine)
Sevikar (Olmetec + amlodipine)
Is Twynsta metabolised in cytochrome P450 system?
Partially, Telmisartan is not metabolised but amlodipine is.
What is the pregnancy category for Twynsta?
Category D
Briefly outline the main features of the accomplish trial.
- Compare the cardiovascular outcome of an ACEi/CCB and ACEi/HCTZ
- 11,506 pts with hypertension and high risk of CV events
- History of coronary events, MI, revascularization or stroke, impaired renal function, peripheral arterial disease, LVH, diabetes.
List 4 advantages of combination therapy.
- Additive BP lowering
- Reduction in side effect
- Improved patient compliance
- Reduced cost
Onset antihypertensive occurs gradually within how many hours of taking Telmisartan ?
3 hours
