একজন Male Pt আসলো তার Face, Lips or hands ফুলে আছে! আপনি দেখলেন Non pitting Oedema or Periorbital swelling in left eye…& local temp Is Raised!!!

Dx_Angioedema

Angioedema হলো Episodic,Localized,Non pitting swelling of Submucous or Subcutaneous tissue ___এটি Type 1 hypersensitivity রিয়েকশন।

Angioedema Types!

Acquired & Hereditary

𝐀𝐜𝐪𝐮𝐢𝐫𝐞𝐝 𝐚𝐧𝐠𝐢𝐨𝐞𝐝𝐞𝐦𝐚

এটি মুলত Allargic reaction এর জন্য বা Allergy এর জন্য হয়ে থাকে।যেখানে Type_1 Hypersensitivity reaction হয়। মুখ,ঠোঁট,হাত ,Periorbital এর localised swelling হয়।

Severe কেস এর ক্ষেত্রে____

• Wheezing

•Shortness of breath

• Nausea

•Abdominal pain দেখা যায়

তবে Mouth & Laryngeal involvement হলে Severe suffocation হয় & Life threatening পযন্ত হতে পার

Mild to moderate এ আমরা

2nd Gen Antihistamine

Tablet 1. Fexo 180 stat*

+ Avoid of triggering factr

In_case_of_Severe case

Inj Adrenaline ( IM)

Inj( Cotson/ Decason) IV

Inj Avil এগুলো দিতে পারি

Keep it in ur mind__Hereditory angioedema তে Effective নয়

𝐇𝐞𝐫𝐞𝐝𝐢𝐭𝐚𝐫𝐲 𝐀𝐧𝐠𝐢𝐨𝐞𝐝𝐞𝐦𝐚

এটি inherited Disorder as Autosomal dominant due to C1 Esterase Inhibitor Deficiency (C1_INH) এর জন্য হয়ে থাকে। এখানে Blood vessel involvement হয়ে থাকে।Family হিস্ট্রি থাকবেAttact is usually Recurrent হয়।Face, Limbs,mucosa of larynx এ Edema হয়। # Laryngeal Edema হলে লাইফ Threatening হতে পারে। Recurrent Abdominal pain হতে পারে।

Non hereditary form may occur in Lymphoma or SLE

তাহলে Hereditary angioedma তে কি inv দিবো?কিভাবে Dx করবো

Diagnosis is clinical

• Serum C2 & C4 (both low)

• Measurement of C1 estarase Inhivitor ( C1-INH, low থাকবে)

Rx plan

Acute attack এ C1 Esterase inhibitor (C1-INH) Conc & Fresh frozen plasma should be given!! এভাইলেবল থাক্লে

• new Drug Icatibant & Ecallantide __Severe Attack এ use হয়

Reccurnt attack প্রিভেন্ট করার জন্য Tab Danamet( Danazol) ***

Capsule 1: Danamet 100 mg As a Danazol As a Drugs affecting inhibiting gonadotrophin.

Indications of Capsule : Danamet 100 mg As a Danazol As a Drugs affecting inhibiting gonadotrophin.

Danamet is indicated for the following treatment-

• Endometriosis
• Benign breast disease
• Menorrhagia
• Gynecomastia
• Preoperative thinning of the endometrium before hysteroscopic endometrial ablation.

Pharmacology of Capsule : Danamet 100 mg As a Danazol As a Drugs affecting inhibiting gonadotrophin.

As a gonadotropin inhibitor, danazol suppresses the pituitary-ovarian axis possibly by inhibiting the output of pituitary gonadotropins. Danazol also depresses the preovulatory surge in output of follicle-stimulating hormone (FSH) and luteinizing hormone (LH), thereby reducing ovarian estrogen production. Danazol may also directly inhibits ovarian steroidogenesis; bind to androgen, progesterone, and glucocorticoid receptors; bind to sex-hormone-binding globulin and corticosteroid-binding globulin; and increases the metabolic clearance rate of progesterone. Another mechanism of action by which danazol may use to facilitate regression of endometriosis is by decreasing IgG, IgM, and IgA concentrations, as well as phospholipid and IgG isotope autoantibodies. In the treatment of endometriosis, as a consequence of suppression of ovarian function, danazol causes both normal and ectopic endometrial tissues to become inactive and atrophic. This leads to anovulation and associated amenorrhea. In fibrocystic breast disease, the exact mechanism of action of danazol is unknown, but may be related to suppressed estrogenic stimulation as a result of decreased ovarian production of estrogen. A direct effect on steroid receptor sites in breast tissue is also possible. This leads to a disappearance of nodularity, relief of pain and tenderness, and possibly changes in the menstrual pattern. In terms of hereditary angioedema, danazol corrects the underlying biochemical deficiency by increasing serum concentrations of the deficient C1 esterase inhibitor, resulting in increased serum concentrations of the C4 component of the complement system.

Dosage & Administration of Capsule : Danamet 100 mg As a Danazol As a Drugs affecting inhibiting gonadotrophin.

Usually given in up to 4 divided doses; in women of child-bearing potential, treatment should start during menstruation, preferably on first day.

Endometriosis: 200-800 mg daily in up to 4 divided doses, adjusted to achieve amenorrhoea, usually for 6 months (up to 9 months in some cases).

Menorrhagia: In menorrhagia daily doses of 100-200 mg have been found effective but 200 mg daily for 3 months is usually sufficient to reduce menstrual blood flow to acceptable levels.

Severe cyclical mastalgia: 100-400 mg daily usually for 3-6 months.

Benign breast cysts: 300 mg daily usually for 3-6 months.

Gynaecomastia: 400 mg daily in up to 4 divided doses for 6 months (adolescents 200 mg daily, increased to 400 mg daily if no response after 2 months).

For pre-operative thinning of endometrium: 400 mg-800 mg daily in up to 4 divided doses for 3-6 weeks.

Children: Danazol is not used in children.

Interaction of Capsule : Danamet 100 mg As a Danazol As a Drugs affecting inhibiting gonadotrophin.

Insulin: Patients taking Danamet may show increased insulin resistance. The significance of this is not known but such patients should be carefully monitored.

Estrogens and progestogens: Theoretically Danamet may interact with exogenous estrogens and/or progestogens. It has been suggested that Danamet acts by binding to estrogen, progesterone or androgen receptors at various levels in the hypothalamic pituitary-ovarian axis. Therefore, women of child bearing age should use effective, non hormonal methods of contraception.

Anticonvulsant therapy: Danamet may affect the plasma concentration of carbamazepin and possibly the patient’s response to this agent and to phenytoin. A similar interaction is possible for phenobarbital.

Antihypertensive therapy: Danamet can oppose the action of antihypertensive agents, possibly through effects on fluid retention.

Cyclosporine: Danamet can increase the plasma concentration of cyclosporine.

Migraine therapy: Danamet itself may provoke migraine and it may possibly reduce the effectiveness of medication to prevent the condition.

Contraindications of Capsule : Danamet 100 mg As a Danazol As a Drugs affecting inhibiting gonadotrophin.

• Pregnancy and breast-feeding
• Impaired hepatic, renal, or cardiac function
• Porphyria
• Thromboembolic disease
• Androgen-dependent tumor
• Abnormal vaginal bleeding that has not been fully investigated.
• Hypersensitivity to danazol.

Side Effects of Capsule : Danamet 100 mg As a Danazol As a Drugs affecting inhibiting gonadotrophin.

Nausea, dizziness, skin reactions including rashes, photosensitivity and exfoliative dermatitis, fever, backache, nervousness, mood changes, anxiety, changes in libido, vertigo, fatigue, epigastric and pleuritic pain, headache, weight gain; menstrual disturbances, vaginal dryness and irritation, flushing and reduction in breast size; musculo-skeletal spasm, joint pain and swelling, hair loss; androgenic effects including acne, oily skin, oedema, hirsutism, voice changes and rarely clitoral hypertrophy; temporary alteration in lipoproteins and other metabolic changes, insulin resistance; thrombotic events; leucopenia, thrombocytopenia, eosinophilia, reversible erythrocytosis or polycythaemia reported; headache and visual disturbances may indicate benign intracranial hypertension.

Pregnancy & Lactation

The drug should not be given to pregnant women, because of risk of virilization of a female fetus, particularly when high doses are given for several weeks. Patients taking the drug should not breast-feed.

Precautions & Warnings

Cardiac, hepatic or renal impairment, elderly, polycythaemia, epilepsy, diabetes mellitus, hypertension, migraine, lipoprotein disorder, history of thrombosis or thromboembolic disease. If signs of virilization occur, e.g. voice changes or hirsutism, therapy should be stopped immediately.

Therapeutic Class of Capsule : Danamet 100 mg As a Danazol As a Drugs affecting inhibiting gonadotrophin.

Drugs affecting (inhibiting) gonadotrophin

OR

Stanozol দেয়া হয়ে থাকে

এই ড্রাগ গুলো Fluid retention,Menstrual irregularities, obesity& androgenic effect করতে পারেবাচ্চার Should be avoided

Stanozol:-

Tablet 2.Cortan 10mg (AS A Prednisolone AS A Glucocorticoids).

Indications of Tablet:-Cortan 10mg (AS A Prednisolone AS A Glucocorticoids).

Cortan is indicated in:

Rheumatic Disorders: Psoriatic arthritis, rheumatoid arthritis, juvenile rheumatoid arthritis, ankylosing spondylitis, acute and subacute bursitis, acute nonspecific tenosynovitis, acute gouty arthritis, post-traumatic osteoarthritis.

Endocrine Disorders: Primary or secondary adrenocortical insufficiency, congenital adrenal hyperplasia, nonsuppurative thyroiditis, hypercalcemia associated with cancer.

Dermatologic Diseases: Pemphigus, bullous dermatitis herpetiformis, severe erythema multiforme, exfoliative dermatitis, mycosis fungoides, severe psoriasis.

Allergic States: Seasonal or perennial allergic rhinitis, bronchial asthma, contact dermatitis, atopic dermatitis, serum sickness, drug hypersensitivity reactions.

Respiratory Diseases: Symptomatic sarcoidosis, berylliosis, fulminating, aspiration pneumonitis.

Hematologic Disorders: Idiopathic thrombocytopenic purpura, secondary thrombocytopenia, acquired (autoimmune) hemolytic anemia, erythroblastopenia (RBC anemia).

Edematous States: To induce a diuresis or remission of proteinuria in the nephrotic syndrome, without uremia, of the idiopathic type or that due to lupus erythematosus.

Gastrointestinal Diseases: Ulcerative colitis, regional enteritis.

Pharmacology of Tablet:-Cortan 10mg (AS A Prednisolone AS A Glucocorticoids).

Prednisolone is a synthetic adrenocortical drug with predominantly glucocorticoid properties. Prednisolone directly inhibits the action of the Phospholipase A2 enzyme which is responsible for the production of different inflammatory mediators like Leukotrienes, SRS-A, Prostaglandins etc. Prednisolone is rapidly and well absorbed from the Gl tract following oral administration. Prednisolone is 70- 90% protein-bound in the plasma and it is eliminated from the plasma with a half-life of 2 to 4 hours. It is metabolized mainly in the liver and excreted in the urine.

Dosage & Administration of Tablet:-Cortan 10mg (AS A Prednisolone AS A Glucocorticoids).

Adult-
Nephrotic Syndrome:

• Initial: 2 mg/kg/day (maximum 80 mg/day) in divided doses 3 to 4 times/day until urine is protein free for 3 consecutive days (maximum: 28 days); followed by 1 to 1.5 mg/kg/dose given every other day for 4 weeks.
• Maintenance dose: 0.5 to 1 mg/kg/ dose given every other day for 3 to 6 months.

Anti-inflammatory: 5 to 60 mg per day in divided doses 1 to 4 times/day.

Acute Asthma: 40-60 mg/day PO in single daily dose or divided q12 hr for 3-10 days.

Allergic Conditions:

• Day 1: 10 mg PO before breakfast, 5 mg after lunch and after dinner, and 10 mg at bedtime.
• Day 2: 5 mg PO before breakfast, after lunch, and after dinner and 10 mg at bedtime.
• Day 3: 5 mg PO before breakfast, after lunch, after dinner, and at bedtime.
• Day 4: 5 mg PO before breakfast, after lunch, and at bedtime.
• Day 5: 5 mg PO before breakfast and at bedtime.
• Day 6: 5 mg PO before breakfast.

Pediatric-
Asthma:

• 1 year: Acute: 10 mg orally every 12 hours. Maintenance: 10 mg orally every other day.
• 1 to 4 years: Acute: 20 mg orally every 12 hours. Maintenance: 20 mg orally every other day.
• 5 to 12 years: Acute: 30 mg orally every 12 hours. Maintenance: 30 mg orally every other day.
• 12 years: Acute: 40 mg orally every 12 hours. Maintenance: 40 mg orally every other day.

Anti-inflammatory: 0.05 to 2 mg/kg/day divided 1 to 4 times/day.

Immunosuppression: 0.05 to 2 mg/kg/day divided 1 to 4 times/day.

Interaction of Tablet:-Cortan 10mg (AS A Prednisolone AS A Glucocorticoids).

The efficacy of Cortan is reduced by Aminoglutethimide, Antacids, Barbiturates, Carbamazepine, Griseofulvin, Mitotane, Phenylbutazone, Phenytoin, Primidone and Rifampin. Cortan reduces the amount of potassium in the blood. Digitalis can cause Cardiac arrhythmias if hypokalemia occurs. Immunization should be done very carefully.

Contraindications of Tablet:-Cortan 10mg (AS A Prednisolone AS A Glucocorticoids).

Systemic infections unless specific anti-infective therapy is employed. Hypersensitivity to any ingredient. Ocular herpes simplex because of possible perforation.

Side Effects of Tablet:-Cortan 10mg (AS A Prednisolone AS A Glucocorticoids).

Fluid and Electrolyte Disturbances: Sodium retention, fluid retention, congestive heart failure in susceptible patients, potassium loss, hypokalemic alkalosis, hypertension.

Musculoskeletal: Muscle weakness, steroid myopathy, loss of muscle mass, osteoporosis, vertebral compression fractures, aseptic necrosis of femoral and humeral heads, pathologic fracture of long bones.

Gastrointestinal: Peptic ulcer with possible perforation and hemorrhage, pancreatitis, abdominal distention, ulcerative esophagitis.

Dermatologic: lmpaired wound healing, thin fragile skin, petechiae and ecchymoses, facial erythema, increased
sweating, may suppress reactions to skin tests.

Neurological: Convulsions, increased intracranial pressure with papilledema (cerebral pseudo-tumor) usually after treatment, vertigo, headache.

Endocrine: Menstrual irregularities, development of Cushingoid state, suppression of growth in children, secondary adrenocortical and pituitary unresponsiveness, particularly in times of stress as in trauma surgery or illness, decreased carbohydrate tolerance, manifestations of latent diabetes mellitus, increased requirements for insulin or oral hypoglycemic agents in diabetics.

Ophthalmic: Posterior subcapsular cataracts, increased intraocular pressure, glaucoma, exophthalmos.

Metabolic: Negative nitrogen balance due to protein catabolism.

Pregnancy & Lactation of Tablet:-Cortan 10mg (AS A Prednisolone AS A Glucocorticoids).

This medicine is not recommended for use during pregnancy unless considered essential by your doctor. It should only be used if the expected benefit to the mother is greater than any possible risk to the foetus. Corticosteroids appear in breast milk and could suppress growth, interfere with endogenous corticosteroid production or cause other unwanted effects.

Precautions & Warnings of Tablet:-Cortan 10mg (AS A Prednisolone AS A Glucocorticoids).

Patients who are on immunosuppressant doses of corticosteroids should be warned to avoid exposure to chickenpox or measles. Patients should also be advised that if they are exposed, medical advice should be sought without delay.

ln patients on corticosteroid therapy subjected to unusual stress, increased dosage of rapidly acting corticosteroids before, during and after the stressful situation is indicated. Corticosteroids may mask some signs of infection, and new infections may appear during their use. There may be decreased resistance and inability to localize infection when corticosteroids are used. Prolonged use of corticosteroids may produce posterior subcapsular cataracts, glaucoma with possible damage to the optic nerves, and may enhance the establishment of secondary ocular infections due to fungi or viruses.

Average and large doses of hydrocortisone or cortisone can cause elevation of blood pressure, salt and water retention, and increased excretion of potassium.

While on corticosteroid therapy, patient should not be vaccinated against smallpox. Other immunization procedures should not be undertaken in patients who are on corticosteroids, specially on high dose, because of possible hazards of neurological complications and a lack antibody response.

Children who are on drugs, which suppress the immune system, are more susceptible to infections than healthy children.

Chickenpox and measles, for example, can have more serious or even fatal course in non-immune children or adults on corticosteroids.

Use in Special Populations

Pediatric use: ln the treatment of endocrine disorders such as primary and secondary adrenocortical insufficiency in infancy, mineralocorticoid supplementation is of particular importance. lnfants born to mothers who have received substantial doses of corticosteroids during pregnancy should be carefully observed for signs of hypoadrenalism. lmmunization procedures should not be undertaken in patients who are on corticosteroids. Pediatric patients who are on drugs which suppress the immune system are more susceptible to infections than healthy pediatric patients. Chickenpox and measles, for example, can have more serious or even fatal course in non-immune patients on corticosteroids. Growth and development in pediatric population on prolonged corticosteroid therapy should be carefully observed. See contraindications and warnings for complete information.

Overdose Effects of Tablet:-Cortan 10mg (AS A Prednisolone AS A Glucocorticoids).

Adverse effects related to prednisone normally develop only after prolonged use of doses in excess of the normal physiological requirement. Treatment is symptomatic and where possible the prednisone dose should be reduced gradually.

Therapeutic Class of Tablet:-Cortan 10mg (AS A Prednisolone AS A Glucocorticoids).

Glucocorticoids

Drug causing Angioedema

Ace inhibitors

Tablet 3.Ramace 5mg (AS A Ramipril AS A Angiotensin-converting enzyme (ACE) inhibitors).

Indications of Tablet:-Ramace 5mg (AS A Ramipril AS A Angiotensin-converting enzyme (ACE) inhibitors).

Ramace tablet indicated in the following cases:

• Hypertension; to lower blood pressure, as single-drug therapy or in combination with other antihypertensive agents.
• Congestive heart failure; also in combination with diuretics.
• Treatment of patients who- within the first few days after an acute myocardial infarction- have demonstrated clinical signs of congestive heart failure.
• Treatment of non-diabetic or diabetic overt glomerular or incipient nephropathy.
• Reduction in the risk of myocardial infarction, stroke, or cardiovascular death in patients with an increased cardiovascular risk, such as manifest coronary heart disease (with or without a history of myocardial infarction), a history of stroke, a history of peripheral vascular disease, or diabetes mellitus that is accompanied by at least one other cardiovascular risk factor (microalbuminuria, hypertension, elevated total cholesterol levels, low high-density lipoprotein cholesterol levels, smoking).

Pharmacology of Tablet:-Ramace 5mg (AS A Ramipril AS A Angiotensin-converting enzyme (ACE) inhibitors).

Ramipril is an angiotensin converting enzyme (ACE) inhibitor, which after hydrolysis to ramiprilat, blocks the conversion of angiotensin I to the vasoconstrictor substance, angiotensin II. So, inhibition of ACE by ramipril results in decreased plasma angiotensin II, which leads to decreased vasopressor activity and decreased aldosterone secretion. Thus ramipril exerts its antihypertensive activity. It is also effective in the management of heart failure and reduction of the risk of stroke, myocardial infarction and death from cardiovascular events. It is long acting and well tolerated; so, can be used in long term therapy.

Dosage of Tablet:-Ramace 5mg (AS A Ramipril AS A Angiotensin-converting enzyme (ACE) inhibitors).

Dosage of Ramipril must be adjusted according to the patient tolerance and response.

Hypertension: For the management of hypertension in adults not receiving a diuretic, the usual initial dose of Ramipril is 1.25-2.5 mg once daily. Dosage generally is adjusted no more rapidly than at 2 week intervals. The usual maintenance dosage in adults is 2.5-20 mg daily given as a single dose or in 2 divided doses daily. If BP is not controlled with Ramipril alone, a diuretic may be added.

Congestive heart failure after myocardial infarction: In this case, Ramipril therapy may be initiated as early as 2 days after myocardial infarction. An initial dose of 2.5 mg twice daily is recommended, but if hypotension occurs, dose should be reduced to 1.25 mg twice daily. Therapy is then titrated to a target daily dose of 5 mg twice daily.

Prevention of major cardiovascular events: In this case, the recommended dose is 2.5 mg once daily for the first week of therapy and 5 mg once daily for the following 3 weeks; dosage then may be increased, as tolerated, to a maintenance dosage of 10 mg once daily.

Dosage in renal impairment:

• For patients with hypertension and renal impairment: The recommended initial dose is 1.25 mg Ramipril once daily. Subsequent dosage should be titrated according to individual tolerance and BP response, up to a maximum of 5 mg daily.
• For patients with heart failure and renal impairment: The recommended dose is 1.25 mg once daily. The dose may be increased to 1.25 mg twice daily and up to a maximum dose of 2.5 mg twice daily depending upon clinical response and tolerability.

Administration

Ramipril tablets have to be swallowed with sufficient amounts of liquid. The tablets must not be chewed or crushed. Absorption of Ramipril is not significantly affected by food. Ramipril may, therefore, be taken before, during or after a meal.

Interaction of Tablet:-Ramace 5mg (AS A Ramipril AS A Angiotensin-converting enzyme (ACE) inhibitors).

Concomitant administration with diuretics may lead to serious hypotension and in addition dangerous hyperkalemia with potassium sparing diuretics. Concomitant therapy with lithium may increase the serum lithium concentration. Reduction in BP may affect the ability to drive and operate machinery and this may be exacerbated by alcohol. NSAIDs may reduce the antihypertensive effect of Ramace and cause deterioration of renal function.

Contraindications of Tablet:-Ramace 5mg (AS A Ramipril AS A Angiotensin-converting enzyme (ACE) inhibitors).

Ramipril must not be used

• in patients with hypersensitivity to ramipril, to any other ACE inhibitor, or any of the excipients of Ramipril.
• in patients with a history of angioedema.
• concomitantly with sacubitril/valsartan therapy. Do not initiate Ramipril until sacubitril/valsartan is eliminated from the body. In case of switch from Ramipril to sacubitril/valsartan, do not start sacubitril/valsartan until Ramipril is eliminated from the body.
• in patients with haemodynamically relevant renal artery stenosis, bilateral or unilateral in the single kidney.
• in patients with hypotensive or haemodynamically unstable states.
• with aliskiren-containing medicines in patients with diabetes or with moderate to severe renal impairment (creatinine clearance <60 ml/min).
• with angiotensin II receptor antagonists (AIIRAs) in patients with diabetic nephropathy.
• during pregnancy.

Concomitant use of ACE inhibitors and extracorporeal treatments leading to contact of blood with negatively charged surfaces must be avoided, since such use may lead to severe anaphylactoid reactions. Such extracorporeal treatments include dialysis or haemofiltration with certain high-fux (e.g. polyacrylonitril) membranes and low-density lipoprotein apheresis with dextran sulfate.

Side Effects of Tablet:-Ramace 5mg (AS A Ramipril AS A Angiotensin-converting enzyme (ACE) inhibitors).

Ramace is generally well tolerated. Dizziness, headache, fatigue and asthenia are commonly reported side effects. Other side effects occurring less frequently include symptomatic hypotension, cough, nausea, vomiting, diarrhoea, rash, urticaria, oliguria, anxiety, amnesia etc. Angioneurotic oedema, anaphylactic reactions and hyperkalaemia have also been reported rarely.

Pregnancy & Lactation of Tablet:-Ramace 5mg (AS A Ramipril AS A Angiotensin-converting enzyme (ACE) inhibitors).

Ramipril must not be taken during pregnancy. Therefore, pregnancy must be excluded before starting treatment. Pregnancy must be avoided in cases where treatment with ACE inhibitors is indispensable. If the patient intends to become pregnant, treatment with ACE inhibitors must be discontinued, i.e. replaced by another form of treatment. If the patient becomes pregnant during treatment, medication with Ramipril must be replaced as soon as possible by a treatment regimen without ACE inhibitors. Otherwise, there is a risk of harm to the fetus. Ramipril is not recommended during breastfeeding.

Precautions & Warnings of Tablet:-Ramace 5mg (AS A Ramipril AS A Angiotensin-converting enzyme (ACE) inhibitors).

Ramace should be used with caution in patients with impaired renal function, hyperkalaemia, hypotension, and impaired hepatic function.

Use in Special Populations of Tablet:-Ramace 5mg (AS A Ramipril AS A Angiotensin-converting enzyme (ACE) inhibitors).

Elderly: A reduced initial dose of 1.25 mg Ramace daily must be considered.

Hepatic impairment: Treatment in these patients must therefore be initiated only under close medical supervision. The maximum permitted daily dose in such cases is 2.5 mg Ramace.

Renal impairment: With a creatinine clearance between 50 and 20 ml/min per 1.73 m2 body surface area, the initial daily dose is generally 1.25 mg Ramace. The maximum permitted daily dose, in this case, is 5 mg Ramace. Patients with incompletely corrected fuid or salt depletion, in patients with severe hypertension, as well as in patients in whom a hypotensive reaction would constitute a particular risk, (e.g., with relevant stenoses of the coronary vessels or those supplying the brain) A reduced initial dose of 1.25 mg Ramace daily must be considered.

Patients pretreated with a diuretic: Consideration must be given to discontinuing the diuretic for at least 2 to 3 days or- depending on the duration of action of the diuretic- longer before starting treatment with Ramace, or at least to reducing the diuretic dose. The initial daily dose in patients previously treated with a diuretic is generally 1.25 mg Ramace.

Overdose Effects of Tablet:-Ramace 5mg (AS A Ramipril AS A Angiotensin-converting enzyme (ACE) inhibitors).

Sign and symptom: Overdosage may cause excessive peripheral vasodilatation (with marked hypotension, shock), bradycardia, electrolyte disturbances, and renal failure.

Management: Primary detoxifcation by, for example, gastric lavage, administration of adsorbents, sodium sulfate; (if possible during the frst 30 minutes). In the event of hypotension administration of α1-adrenergic agonists (e.g. norepinephrine, dopamine) or angiotensin II (angiotensinamide), which is usually available only in scattered research laboratories, must be considered in addition to volume and salt substitution.

Therapeutic Class of Tablet:-Ramace 5mg (AS A Ramipril AS A Angiotensin-converting enzyme (ACE) inhibitors).

Angiotensin-converting enzyme (ACE) inhibitors

Arbs

Some Nsaid( Aspirin)

Raiyyan Tahsan Date:27-01-2025 Monday Time:9-55-45 Pm

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