from pptx import Presentation
from pptx.util import Inches, Pt, Emu
from pptx.dml.color import RGBColor
from pptx.enum.text import PP_ALIGN
from pptx.util import Inches, Pt
import copy

prs = Presentation()
prs.slide_width = Inches(13.33)
prs.slide_height = Inches(7.5)

# Color scheme
DARK_BLUE = RGBColor(0x0D, 0x47, 0xA1)    # Deep blue
MED_BLUE  = RGBColor(0x15, 0x65, 0xC0)    # Medium blue
LIGHT_BLUE= RGBColor(0xE3, 0xF2, 0xFD)    # Light blue bg
ACCENT    = RGBColor(0x1E, 0x88, 0xE5)    # Accent blue
GREEN     = RGBColor(0x2E, 0x7D, 0x32)    # Dark green
ORANGE    = RGBColor(0xE6, 0x51, 0x00)    # Orange highlight
WHITE     = RGBColor(0xFF, 0xFF, 0xFF)
DARK_GRAY = RGBColor(0x21, 0x21, 0x21)
LIGHT_GRAY= RGBColor(0xF5, 0xF5, 0xF5)
RED       = RGBColor(0xC6, 0x28, 0x28)

def blank_layout(prs):
    return prs.slide_layouts[6]  # completely blank

def add_rect(slide, l, t, w, h, fill_color, line_color=None):
    shape = slide.shapes.add_shape(1, Inches(l), Inches(t), Inches(w), Inches(h))
    shape.fill.solid()
    shape.fill.fore_color.rgb = fill_color
    if line_color:
        shape.line.color.rgb = line_color
        shape.line.width = Pt(0.75)
    else:
        shape.line.fill.background()
    return shape

def add_textbox(slide, text, l, t, w, h, font_size=12, bold=False, color=DARK_GRAY,
                align=PP_ALIGN.LEFT, wrap=True, italic=False):
    txBox = slide.shapes.add_textbox(Inches(l), Inches(t), Inches(w), Inches(h))
    txBox.word_wrap = wrap
    tf = txBox.text_frame
    tf.word_wrap = wrap
    p = tf.paragraphs[0]
    p.alignment = align
    run = p.add_run()
    run.text = text
    run.font.size = Pt(font_size)
    run.font.bold = bold
    run.font.italic = italic
    run.font.color.rgb = color
    return txBox

def add_slide_header(slide, title, subtitle=None):
    """Dark blue header bar at top"""
    add_rect(slide, 0, 0, 13.33, 1.1, DARK_BLUE)
    add_textbox(slide, title, 0.3, 0.08, 12.5, 0.7, font_size=28, bold=True,
                color=WHITE, align=PP_ALIGN.LEFT)
    if subtitle:
        add_textbox(slide, subtitle, 0.3, 0.72, 12.5, 0.35, font_size=13,
                    color=RGBColor(0xBB, 0xDE, 0xFF), align=PP_ALIGN.LEFT, italic=True)

def add_section_box(slide, title, l, t, w, h, title_color=MED_BLUE, bg=LIGHT_BLUE):
    """Colored section box with title"""
    add_rect(slide, l, t, w, 0.35, title_color)
    add_textbox(slide, title, l+0.1, t+0.02, w-0.2, 0.3,
                font_size=12, bold=True, color=WHITE)
    add_rect(slide, l, t+0.35, w, h-0.35, bg, line_color=MED_BLUE)

def bullet_text(slide, bullets, l, t, w, h, font_size=10.5, color=DARK_GRAY, spacing=0.02):
    """Add bulleted list"""
    txBox = slide.shapes.add_textbox(Inches(l), Inches(t), Inches(w), Inches(h))
    txBox.word_wrap = True
    tf = txBox.text_frame
    tf.word_wrap = True
    first = True
    for item in bullets:
        if first:
            p = tf.paragraphs[0]
            first = False
        else:
            p = tf.add_paragraph()
        p.space_before = Pt(2)
        if isinstance(item, tuple):
            text, is_bold, indent = item
        else:
            text, is_bold, indent = item, False, False
        if indent:
            p.level = 1
        run = p.add_run()
        run.text = ("  • " if indent else "• ") + text
        run.font.size = Pt(font_size)
        run.font.bold = is_bold
        run.font.color.rgb = color

def key_value_box(slide, items, l, t, w, h, font_size=10.5):
    """Two-column key:value text"""
    txBox = slide.shapes.add_textbox(Inches(l), Inches(t), Inches(w), Inches(h))
    txBox.word_wrap = True
    tf = txBox.text_frame
    tf.word_wrap = True
    first = True
    for key, val in items:
        if first:
            p = tf.paragraphs[0]; first = False
        else:
            p = tf.add_paragraph()
        p.space_before = Pt(3)
        run1 = p.add_run()
        run1.text = f"{key}: "
        run1.font.size = Pt(font_size)
        run1.font.bold = True
        run1.font.color.rgb = MED_BLUE
        run2 = p.add_run()
        run2.text = val
        run2.font.size = Pt(font_size)
        run2.font.bold = False
        run2.font.color.rgb = DARK_GRAY

# ─────────────────────────────────────────────────────────────
# SLIDE 1: TITLE SLIDE
# ─────────────────────────────────────────────────────────────
slide = prs.slides.add_slide(blank_layout(prs))
add_rect(slide, 0, 0, 13.33, 7.5, DARK_BLUE)
add_rect(slide, 0, 2.6, 13.33, 2.3, MED_BLUE)
add_rect(slide, 0, 4.9, 13.33, 0.05, ACCENT)

add_textbox(slide, "DRUGS AFFECTING THE", 1.5, 1.1, 10.3, 0.8,
            font_size=24, bold=False, color=RGBColor(0xBB,0xDE,0xFF), align=PP_ALIGN.CENTER)
add_textbox(slide, "RENIN-ANGIOTENSIN SYSTEM", 1.0, 1.7, 11.3, 1.0,
            font_size=36, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
add_textbox(slide, "ACE Inhibitors  |  ARBs  |  Direct Renin Inhibitors", 1.5, 2.75, 10.3, 0.65,
            font_size=18, bold=False, color=LIGHT_BLUE, align=PP_ALIGN.CENTER)
add_textbox(slide, "Cardiovascular Pharmacology", 1.5, 3.35, 10.3, 0.45,
            font_size=13, bold=False, color=RGBColor(0xBB,0xDE,0xFF), align=PP_ALIGN.CENTER, italic=True)

# Drug class tags
tags = [("ACE Inhibitors", 1.5), ("ARBs", 4.5), ("Direct Renin Inhibitors", 7.5), ("Aldosterone Antagonists", 10.3)]
for tag, x in [("ACE Inhibitors", 1.2), ("ARBs", 4.2), ("Direct Renin Inhibitors", 6.8), ("Aldost. Antagonists", 10.0)]:
    add_rect(slide, x, 5.5, 2.5, 0.5, ACCENT)
    add_textbox(slide, tag, x+0.05, 5.52, 2.4, 0.45, font_size=11, bold=True,
                color=WHITE, align=PP_ALIGN.CENTER)

add_textbox(slide, "Chapter 36 — Cardiovascular Drugs", 0.5, 6.9, 12.3, 0.4,
            font_size=10, italic=True, color=RGBColor(0x90,0xCA,0xF9), align=PP_ALIGN.CENTER)

# ─────────────────────────────────────────────────────────────
# SLIDE 2: RAS OVERVIEW — How the System Works
# ─────────────────────────────────────────────────────────────
slide = prs.slides.add_slide(blank_layout(prs))
add_rect(slide, 0, 0, 13.33, 7.5, LIGHT_GRAY)
add_slide_header(slide, "Renin-Angiotensin System (RAS)", "Overview & Sites of Drug Action")

# 5 drug classes boxes
classes = [
    ("1. Sympathetic Blockers", "β-blockers, central sympatholytics,\nadrenergic neurone blockers\n→ Decrease renin release", MED_BLUE),
    ("2. Direct Renin Inhibitors", "e.g. Aliskiren\n→ Block renin action\n→ Prevent Ang I generation\n(rate-limiting step)", GREEN),
    ("3. ACE Inhibitors", "e.g. Captopril, Enalapril\n→ Prevent Ang II generation\n→ ↑ Bradykinin, Ang(1-7)", DARK_BLUE),
    ("4. ARBs", "e.g. Losartan, Valsartan\n→ Block AT₁ receptors\n→ Antagonize Ang II at target cells", ACCENT),
    ("5. Aldosterone Antagonists", "e.g. Spironolactone\n→ Block mineralocorticoid\nreceptors", ORANGE),
]
col_w = 2.4
for i, (title, body, color) in enumerate(classes):
    x = 0.2 + i * 2.6
    add_rect(slide, x, 1.3, col_w, 0.4, color)
    add_textbox(slide, title, x+0.05, 1.3, col_w-0.1, 0.38,
                font_size=11, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
    add_rect(slide, x, 1.7, col_w, 2.3, WHITE, line_color=color)
    add_textbox(slide, body, x+0.1, 1.75, col_w-0.2, 2.2,
                font_size=10.5, color=DARK_GRAY)

# Bottom note
add_rect(slide, 0.2, 4.2, 12.9, 1.1, RGBColor(0xE8,0xF5,0xE9), line_color=GREEN)
add_textbox(slide, "KEY CONCEPT", 0.35, 4.25, 2.0, 0.35, font_size=11, bold=True, color=GREEN)
add_textbox(slide,
    "Hyperuricemia → Ang II→ Vasoconstriction + Aldosterone release + Na⁺ retention + Sympathetic activation → Hypertension\n"
    "All RAS drugs interrupt this cascade at different points. Combination strategies target multiple points for superior BP control.",
    0.35, 4.55, 12.6, 0.7, font_size=10.5, color=DARK_GRAY)

# ─────────────────────────────────────────────────────────────
# SLIDE 3: ACE INHIBITORS — Mechanism & Captopril Prototype
# ─────────────────────────────────────────────────────────────
slide = prs.slides.add_slide(blank_layout(prs))
add_rect(slide, 0, 0, 13.33, 7.5, LIGHT_GRAY)
add_slide_header(slide, "ACE Inhibitors — Mechanism of Action", "Prototype: Captopril")

# Left column — Mechanism
add_section_box(slide, "Mechanism of Action", 0.2, 1.2, 6.3, 5.1, DARK_BLUE, RGBColor(0xE3,0xF2,0xFD))
bullet_text(slide, [
    ("Sulfhydryl-containing dipeptide surrogate of proline", False, False),
    ("Abolishes pressor action of Ang I (NOT Ang II)", True, False),
    ("Does NOT block AT₁ or AT₂ receptors directly", False, False),
    ("ACE is nonspecific — also cleaves bradykinin, substance P, enkephalins", False, False),
    ("Inhibiting ACE → ↑ plasma kinins → ↑ vasodilation", True, False),
    ("Blocks Ang I→Ang II conversion → Ang I diverted to Ang(1-7) → vasodilation", False, False),
    ("Reflex feedback: ↓Ang II → ↑ renin release → ↑ Ang I (but cannot convert to Ang II)", False, False),
], 0.35, 1.6, 6.0, 3.5, font_size=10.5)

add_section_box(slide, "Hemodynamic Effects", 0.2, 4.8, 6.3, 1.5, MED_BLUE, WHITE)
bullet_text(slide, [
    ("↓ Total peripheral resistance → ↓ systolic & diastolic BP", False, False),
    ("Cardiac output unchanged; cardiovascular reflexes intact", False, False),
    ("Renal, cerebral, and coronary blood flow maintained", True, False),
    ("Postural hypotension NOT a problem", True, False),
], 0.35, 5.2, 6.0, 1.0, font_size=10.5)

# Right column — Captopril details
add_section_box(slide, "Captopril — Pharmacokinetics", 6.7, 1.2, 6.4, 2.2, DARK_BLUE, WHITE)
kv = [
    ("Absorption", "~70% oral; food reduces bioavailability"),
    ("Distribution", "Poor CNS penetration; 98% protein bound"),
    ("Metabolism", "Partly metabolized; partly excreted unchanged in urine"),
    ("Half-life (t½)", "~2 hours; action lasts 6–12 hrs"),
    ("Dose", "25 mg BD, gradually up to 50 mg TDS"),
]
key_value_box(slide, kv, 6.85, 1.6, 6.1, 1.7, font_size=10.5)

add_section_box(slide, "Adverse Effects of Captopril / All ACE Inhibitors", 6.7, 3.5, 6.4, 2.8, RED, RGBColor(0xFF,0xEB,0xEE))
bullet_text(slide, [
    ("Hypotension — first dose; worse in diuretic-treated/CHF patients", True, False),
    ("Hyperkalaemia — with K⁺-sparing diuretics, NSAIDs, β-blockers", False, False),
    ("Dry persistent cough — 10–16%; due to ↑ bradykinin/substance P breakdown inhibition", True, False),
    ("Rashes & urticaria — 1–4% (don't usually require drug stoppage)", False, False),
    ("Angioedema — rare but serious", True, False),
    ("Dysgeusia — reversible taste alteration (more common with captopril)", False, False),
    ("Foetotoxicity — contraindicated in pregnancy (stop when woman conceives)", True, False),
    ("Acute renal failure — in bilateral renal artery stenosis", False, False),
    ("Granulocytopenia & proteinuria — rare; warrant withdrawal", False, False),
], 6.85, 3.9, 6.1, 2.3, font_size=10)

# ─────────────────────────────────────────────────────────────
# SLIDE 4: ACE Inhibitors Comparative Table
# ─────────────────────────────────────────────────────────────
slide = prs.slides.add_slide(blank_layout(prs))
add_rect(slide, 0, 0, 13.33, 7.5, LIGHT_GRAY)
add_slide_header(slide, "ACE Inhibitors — Comparative Features", "Table 36.1")

# Table header
headers = ["Feature", "Captopril", "Enalapril", "Lisinopril", "Fosinopril", "Perindopril", "Ramipril"]
col_widths = [2.1, 1.6, 1.6, 1.6, 1.6, 1.65, 1.58]
x_starts = [0.2]
for w in col_widths[:-1]:
    x_starts.append(x_starts[-1] + w)

for i, (h, x, w) in enumerate(zip(headers, x_starts, col_widths)):
    add_rect(slide, x, 1.2, w, 0.4, DARK_BLUE)
    add_textbox(slide, h, x+0.05, 1.22, w-0.1, 0.36,
                font_size=10, bold=True, color=WHITE, align=PP_ALIGN.CENTER)

rows = [
    ["Chemical nature", "Sulfhydryl", "Carboxyl", "Carboxyl", "Phosphinate\nCarboxyl", "Carboxyl", "Carboxyl"],
    ["Activity status", "Active", "Prodrug", "Active", "Prodrug", "Prodrug", "Prodrug"],
    ["Bioavailability", "70%", "50%", "25%", "30%", "30–60%", "60%"],
    ["Time to peak", "1 hr", "4–6 hr", "6–8 hr", "3–5 hr", "6 hr", "3–6 hr"],
    ["Elimination t½", "2 hr", "11 hr", "12 hr", "12 hr", "25–30 hr", "8–18 hr"],
    ["Mode of excretion", "Renal", "Renal", "Renal", "Renal/\nHepatic", "Renal", "Renal"],
    ["Duration of action", "6–12 hr", "24 hr", ">24 hr", "24 hr", ">24 hr", ">24 hr"],
    ["Daily dose (mg)", "25–150", "2.5–40", "5–40", "10–40", "2–8", "1.25–10"],
]

for r_idx, row in enumerate(rows):
    bg = WHITE if r_idx % 2 == 0 else RGBColor(0xE8,0xEA,0xF6)
    y = 1.6 + r_idx * 0.52
    for i, (cell, x, w) in enumerate(zip(row, x_starts, col_widths)):
        add_rect(slide, x, y, w, 0.5, bg, line_color=RGBColor(0xC5,0xCA,0xE9))
        add_textbox(slide, cell, x+0.05, y+0.03, w-0.1, 0.44,
                    font_size=9.5, align=PP_ALIGN.CENTER, color=DARK_GRAY,
                    bold=(i==0))

# Note at bottom
add_rect(slide, 0.2, 5.9, 12.9, 0.5, RGBColor(0xFF,0xF9,0xC4), line_color=ORANGE)
add_textbox(slide, "⚑  No single ACE inhibitor is superior to others. Differences are primarily pharmacokinetic (time course). "
            "All share the same pharmacological actions, therapeutic uses, adverse effects, and contraindications.",
            0.35, 5.95, 12.6, 0.4, font_size=10, italic=True, color=RGBColor(0x5D,0x40,0x37))

# ─────────────────────────────────────────────────────────────
# SLIDE 5: ACE Inhibitors — Clinical Uses
# ─────────────────────────────────────────────────────────────
slide = prs.slides.add_slide(blank_layout(prs))
add_rect(slide, 0, 0, 13.33, 7.5, LIGHT_GRAY)
add_slide_header(slide, "ACE Inhibitors — Clinical Uses & Indications", "First-line drugs in multiple cardiovascular and renal conditions")

uses = [
    ("1. Hypertension", [
        "First-choice in all grades: essential, renovascular, malignant, accelerated HTN",
        "Control BP in ~50% as monotherapy; ~90% with added diuretic/β-blocker",
        "Low-dose diuretic (HCZ 12.5 mg) sufficient due to supra-additive synergism",
        "More effective in younger (<55 yr) and white patients",
        "Preferred in: Diabetes, CKD, LVH, CHF, angina, post-MI",
        "Confirmed by AIRE, HOPE, ALLHAT trials",
    ], MED_BLUE),
    ("2. Congestive Heart Failure (CHF)", [
        "Cause both arteriolar and venodilation → reduce preload & afterload",
        "↑ Cardiac output, ↑ exercise capacity, improve NYHA functional class",
        "Retard progression of LV systolic dysfunction",
        "Reduce mortality by ~20% in symptomatic CHF",
        "Reduce episodes of decompensation, MI, and sudden death",
        "Supported by CONSENSUS, SOLVD, AIRE trials",
    ], GREEN),
    ("3. Myocardial Infarction (MI)", [
        "Initiated within 24 hrs of evolving MI, continued for ≥6 weeks",
        "Reduce early + long-term mortality regardless of EF",
        "In high-risk/NSTEMI: long-term therapy reduces re-MI & need for CABG/PTCA (SAVE, SOLVD)",
        "Sustained survival benefit extends over years",
    ], ORANGE),
    ("4. Diabetic Nephropathy", [
        "Prevent/delay end-stage renal disease in Type 1 & 2 diabetes",
        "Stabilize albuminuria (index of glomerulopathy)",
        "Reduce intraglomerular pressure and hyperfiltration",
        "Also retard retinopathy progression",
        "Non-diabetic renal failure also benefits (reduce proteinuria)",
    ], RED),
    ("5. Prophylaxis — High CV Risk", [
        "Ramipril (HOPE study, 9297 post-MI patients): reduced cardiac death + MI + stroke by 22% over 4.5 yr",
        "Protect even without LV dysfunction or heart failure",
        "Protective effect via improved endothelial function independent of BP lowering",
    ], DARK_BLUE),
    ("6. Scleroderma Crisis", [
        "ACE inhibitors produce dramatic improvement",
        "Are life-saving in this condition",
        "Marked rise in BP and deterioration of renal function mediated by Ang II",
    ], MED_BLUE),
]

box_w = 4.1
box_h = 2.75
positions = [(0.2,1.25),(4.4,1.25),(8.6,1.25),(0.2,4.1),(4.4,4.1),(8.6,4.1)]

for (title, bullets, color), (x, y) in zip(uses, positions):
    add_rect(slide, x, y, box_w, 0.35, color)
    add_textbox(slide, title, x+0.08, y+0.02, box_w-0.15, 0.32,
                font_size=11, bold=True, color=WHITE)
    add_rect(slide, x, y+0.35, box_w, box_h-0.35, WHITE, line_color=color)
    bullet_text(slide, bullets, x+0.12, y+0.4, box_w-0.18, box_h-0.45, font_size=9.5)

# ─────────────────────────────────────────────────────────────
# SLIDE 6: ARBs — Introduction, Mechanism, Differences from ACEi
# ─────────────────────────────────────────────────────────────
slide = prs.slides.add_slide(blank_layout(prs))
add_rect(slide, 0, 0, 13.33, 7.5, LIGHT_GRAY)
add_slide_header(slide, "Angiotensin Receptor Blockers (ARBs)", "Angiotensin AT₁ Receptor Antagonists — Overview")

# Left: Introduction & Mechanism
add_section_box(slide, "Introduction & Mechanism", 0.2, 1.2, 6.4, 3.8, MED_BLUE, WHITE)
bullet_text(slide, [
    ("Orally active, nonpeptide AT₁ receptor blockers (ARBs) developed as alternatives to ACE inhibitors over 25 years", False, False),
    ("Drugs: Losartan, candesartan, valsartan, telmisartan, olmesartan, irbesartan, eprosartan", True, False),
    ("Selective antagonists of AT₁ receptors; AT₂ receptors remain intact", False, False),
    ("Block all actions of Ang II: vasoconstriction, sympathetic stimulation, aldosterone release, Na⁺ reabsorption, vasopressin release, growth-promoting actions on heart & vessels", False, False),
    ("Blocking AT₁ → feedback ↑ Ang II → stimulates unblocked AT₂ receptors (vasodilator, antiproliferative) → indirect benefit", False, False),
    ("Unlike ACE inhibitors — do NOT increase bradykinin (no cough, no angioedema)", True, False),
    ("Result in more complete inhibition of AT₁ activation (Ang II generated by non-ACE pathways also blocked)", True, False),
], 0.35, 1.6, 6.1, 3.25, font_size=10.5)

# Middle/Right: Key Differences from ACEi
add_section_box(slide, "ARBs vs ACE Inhibitors — Key Differences", 6.8, 1.2, 6.3, 3.8, DARK_BLUE, RGBColor(0xE8,0xEA,0xF6))
diff_table = [
    ("Feature", "ACE Inhibitors", "ARBs"),
    ("Bradykinin", "↑ (inhibit breakdown)", "No effect"),
    ("Cough", "10–16% (persistent)", "Rare / absent"),
    ("Ang II blockade", "Partial (non-ACE paths escape)", "Complete AT₁ block"),
    ("AT₂ stimulation", "No direct effect", "↑ (indirect via ↑ Ang II)"),
    ("Angioedema", "Uncommon (~0.1–0.3%)", "Very rare"),
    ("Uricosuric effect", "No", "Losartan: mild uricosuric"),
    ("Foetotoxicity", "Yes (contraindicated)", "Yes (contraindicated)"),
    ("First-line status", "Yes", "Yes (preferred in black race)"),
]
col_ws = [2.8, 1.7, 1.7]
x_pos = [6.9, 9.75, 11.5]
for i, (feat, ace, arb) in enumerate(diff_table):
    bg = DARK_BLUE if i == 0 else (WHITE if i%2==1 else RGBColor(0xE3,0xF2,0xFD))
    txt_color = WHITE if i == 0 else DARK_GRAY
    y = 1.6 + i * 0.38
    for j, (txt, x, w) in enumerate(zip([feat, ace, arb], x_pos, col_ws)):
        add_rect(slide, x, y, w, 0.37, bg, line_color=RGBColor(0xBB,0xDE,0xFF))
        add_textbox(slide, txt, x+0.05, y+0.02, w-0.1, 0.33,
                    font_size=9.5, bold=(i==0 or j==0), color=txt_color,
                    align=PP_ALIGN.CENTER)

# Bottom — ARBs adverse effects
add_section_box(slide, "Adverse Effects of ARBs", 0.2, 5.1, 6.4, 1.5, RED, RGBColor(0xFF,0xEB,0xEE))
bullet_text(slide, [
    ("Remarkably free of side effects", True, False),
    ("Hypotension and hyperkalemia — possible but less common than ACEi first-dose hypotension", False, False),
    ("No ACE inhibitor-related cough (do not increase kinin levels)", True, False),
    ("Angioedema, urticaria, taste disturbance — rare", False, False),
    ("CONTRAINDICATED in pregnancy — fetopathic potential similar to ACE inhibitors", True, False),
], 0.35, 5.5, 6.1, 1.0, font_size=10.5)

add_section_box(slide, "Important Guideline Notes", 6.8, 5.1, 6.3, 1.5, ORANGE, RGBColor(0xFF,0xF3,0xE0))
bullet_text(slide, [
    ("JNC8 & NICE: Do NOT combine ACE inhibitors + ARBs for hypertension", True, False),
    ("NICE (2011): ARBs preferred over ACEi for black races", False, False),
    ("For CHF/diabetic nephropathy: combination may offer added benefit but risk ↑ hyperkalemia, hypotension, renal impairment", False, False),
    ("COOPERATE (2003): ARB + ACEi retards non-diabetic renal disease progression more than monotherapy", False, False),
], 6.95, 5.5, 6.1, 1.05, font_size=10)

# ─────────────────────────────────────────────────────────────
# SLIDE 7: Individual ARBs — Drug Profiles
# ─────────────────────────────────────────────────────────────
slide = prs.slides.add_slide(blank_layout(prs))
add_rect(slide, 0, 0, 13.33, 7.5, LIGHT_GRAY)
add_slide_header(slide, "Individual ARBs — Drug Profiles", "Dosing, Pharmacokinetics & Special Features")

arb_data = [
    ("Losartan", "50 mg OD (rarely BD)\n25 mg in liver disease\n+ HCZ 12.5–25 mg enhances effect",
     "t½: 2 hr (metabolite E3174: 6–9 hr)\nActive metabolite E3174: 10–30× more potent\nMild uricosuric (probenecid-like)\nBrands: LOSACAR, LOSAR, TOZAAR"),
    ("Candesartan", "8 mg OD (max 8 mg BD)\n4 mg OD in liver/renal impairment",
     "Highest AT₁ affinity\nInsurrmountable antagonism\n(slow receptor dissociation)\nBrands: CANDESAR, CANDILONG"),
    ("Irbesartan", "150–300 mg OD",
     "High oral bioavailability\nt½ ~12 hr\nMetabolized + excreted in bile\nBrands: IROVEL, IRBEST"),
    ("Valsartan", "80–160 mg OD\n(1 hr before meal)\n40 mg initial in liver disease",
     "Bioavailability ~23%\nFood reduces absorption\nt½: 6–9 hr; action 24 hr\nBrands: DIOVAN, STARVAL, VALZAAR"),
    ("Olmesartan", "20–40 mg OD",
     "Ester prodrug → completely hydrolyzed in gut\nt½ ~12 hr\nEliminated in urine + bile\nSprue-like symptoms (rare)\nBrands: OLMAT, OLSAR"),
    ("Telmisartan", "20–80 mg OD\nReduce dose in liver disease",
     "No active metabolite\nPeak action at 3 hrs\nAction >24 hr\nExcreted mainly in bile\nBrands: TELMA, TELSAR, TELVAS"),
    ("Eprosartan", "600 mg OD (400–800 mg OD)",
     "Newer AT₁ blocker\nAlso blocks prejunctional AT₁ → ↓ NA release\nBioavailability ~13%\nt½ 20 hr; excreted in faeces\nBrands: TEVETEN, EPROZAR"),
]

col_w = 1.82
for i, (name, dose, features) in enumerate(arb_data):
    x = 0.2 + i * 1.87
    add_rect(slide, x, 1.2, col_w, 0.38, ACCENT)
    add_textbox(slide, name, x+0.04, 1.22, col_w-0.08, 0.34,
                font_size=11, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
    add_rect(slide, x, 1.58, col_w, 1.6, RGBColor(0xE3,0xF2,0xFD), line_color=ACCENT)
    add_textbox(slide, "Dose:", x+0.06, 1.62, col_w-0.12, 0.25,
                font_size=9.5, bold=True, color=MED_BLUE)
    add_textbox(slide, dose, x+0.06, 1.85, col_w-0.12, 1.25,
                font_size=9.5, color=DARK_GRAY)
    add_rect(slide, x, 3.2, col_w, 3.1, WHITE, line_color=MED_BLUE)
    add_textbox(slide, "Key Features:", x+0.06, 3.24, col_w-0.12, 0.25,
                font_size=9.5, bold=True, color=DARK_BLUE)
    add_textbox(slide, features, x+0.06, 3.48, col_w-0.12, 2.7,
                font_size=9, color=DARK_GRAY)

# ─────────────────────────────────────────────────────────────
# SLIDE 8: Uses of ARBs — Clinical Applications
# ─────────────────────────────────────────────────────────────
slide = prs.slides.add_slide(blank_layout(prs))
add_rect(slide, 0, 0, 13.33, 7.5, LIGHT_GRAY)
add_slide_header(slide, "Clinical Uses of ARBs", "Same overall range as ACE Inhibitors — Better tolerated")

uses_arbs = [
    ("Hypertension", [
        "First-line drugs: comparable to ACE inhibitors",
        "Advantage: no cough, lower angioedema, rash, dysgeusia",
        "Maximum effect: 2–4 weeks",
        "Reverse vascular/ventricular hypertrophy similarly to ACEi",
        "Preferred by NICE (2011) for black races over ACEi",
        "Evidence: LIFE, VALUE, SCOPE, JLIGHT trials",
        "Losartan: also controls portal hypertension in cirrhosis",
    ], MED_BLUE),
    ("Congestive Heart Failure (CHF)", [
        "ARBs afford clear-cut symptomatic relief + survival benefit",
        "Reserved for patients intolerant to ACEi (cough, angioedema)",
        "Relative value vs ACEi for long-term survival: still uncertain",
        "Candesartan + valsartan showed superior benefit vs losartan/irbesartan in trials",
        "For CHF: prefer specific ARBs (candesartan, valsartan) over losartan/irbesartan",
    ], DARK_BLUE),
    ("Myocardial Infarction", [
        "Utility in MI comparable to ACEi including long-term survival",
        "ACEi generally used first due to greater clinical experience",
        "Valsartan in acute MI (VAL-HEFT, VALIANT): non-inferior to captopril",
    ], ORANGE),
    ("Diabetic Nephropathy", [
        "ARBs are renoprotective in Type 2 DM, independent of BP lowering",
        "Magnitude of benefit comparable to ACEi",
        "Better tolerability profile → many consider ARBs first choice now",
        "Reduce proteinuria, slow CKD progression",
    ], GREEN),
    ("Combination with ACE Inhibitors", [
        "NOT recommended for hypertension (JNC8, NICE)",
        "Rationale in CHF/CKD: more complete RAS suppression",
        "Short-term CHF benefit with ACEi + ARB combination",
        "COOPERATE trial: ARB + ACEi retards non-diabetic renal disease",
        "Risks: ↑ hyperkalemia, ↑ hypotension, ↑ renal impairment",
        "ACEi adds bradykinin benefit; ARBs add non-ACE Ang II blockade",
    ], RED),
]

box_w = 2.42
box_h = 5.1
for i, (title, bullets, color) in enumerate(uses_arbs):
    x = 0.2 + i * 2.58
    add_rect(slide, x, 1.2, box_w, 0.38, color)
    add_textbox(slide, title, x+0.06, 1.22, box_w-0.1, 0.34,
                font_size=11, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
    add_rect(slide, x, 1.58, box_w, box_h-0.38, WHITE, line_color=color)
    bullet_text(slide, bullets, x+0.1, 1.62, box_w-0.18, box_h-0.55, font_size=10)

# ─────────────────────────────────────────────────────────────
# SLIDE 9: Direct Renin Inhibitor — Aliskiren
# ─────────────────────────────────────────────────────────────
slide = prs.slides.add_slide(blank_layout(prs))
add_rect(slide, 0, 0, 13.33, 7.5, LIGHT_GRAY)
add_slide_header(slide, "Direct Renin Inhibitor — Aliskiren", "Latest class of RAS inhibitory drugs | Only available member of class")

# Left column
add_section_box(slide, "Mechanism of Action", 0.2, 1.2, 6.3, 2.3, DARK_BLUE, WHITE)
bullet_text(slide, [
    ("Nonpeptide; binds to catalytic site of renin → competitive blockade", False, False),
    ("Blocks access of angiotensinogen to renin → no Ang I generated", True, False),
    ("Interrupts entire RAS effector chain (no Ang I → no Ang II)", False, False),
    ("Plasma renin activity (PRA) decreases despite ↑ renin concentration (feedback)", False, False),
    ("Ang I and Ang II levels fall in dose-dependent manner", True, False),
    ("Aldosterone levels lowered; mild natriuresis; tendency to K⁺ retention", False, False),
    ("Pattern of hemodynamic effect resembles ACE inhibitors", False, False),
    ("Postural hypotension NOT a problem", True, False),
], 0.35, 1.6, 6.0, 1.85, font_size=10.5)

add_section_box(slide, "Pharmacokinetics", 0.2, 3.6, 6.3, 1.8, MED_BLUE, RGBColor(0xE3,0xF2,0xFD))
kv = [
    ("Route", "Oral; bioavailability very low (active extrusion by P-glycoprotein)"),
    ("Elimination", "Mainly in faeces; small amount in urine"),
    ("Half-life (t½)", ">24 hours; BP lowering persists days after regular intake"),
    ("Dose", "150–300 mg OD | Brands: RASILEZ 150 mg; RASILEZ-HCT (+ HCZ)"),
]
key_value_box(slide, kv, 0.35, 3.95, 6.0, 1.35, font_size=10.5)

add_section_box(slide, "Adverse Effects", 0.2, 5.5, 6.3, 1.6, RED, RGBColor(0xFF,0xEB,0xEE))
bullet_text(slide, [
    ("Few and mild: dyspepsia, abdominal pain, loose motions, headache, dizziness", False, False),
    ("Acute hypotension, hyperkalemia, cough, angioedema, rashes — less frequent than with ACEi", False, False),
    ("CONTRAINDICATED in pregnancy", True, False),
    ("Do NOT combine with ACEi/ARBs in Type 2 diabetics — no benefit, may worsen outcome", True, False),
], 0.35, 5.9, 6.0, 1.1, font_size=10.5)

# Right column
add_section_box(slide, "Clinical Uses & Efficacy", 6.7, 1.2, 6.4, 2.4, GREEN, WHITE)
bullet_text(slide, [
    ("Antihypertensive efficacy nearly equivalent to ACEi/ARBs", True, False),
    ("Reduces hypertensive left ventricular hypertrophy", False, False),
    ("Benefits CHF patients", False, False),
    ("Reduces albuminuria; renoprotective in hypertension and DM", True, False),
    ("Combination with ACEi/ARB: greater BP fall (blocks PRA rise caused by ACEi/ARBs)", False, False),
], 6.85, 1.6, 6.1, 1.9, font_size=10.5)

add_section_box(slide, "Current Recommendations (Guideline Status)", 6.7, 3.7, 6.4, 2.0, ORANGE, RGBColor(0xFF,0xF3,0xE0))
bullet_text(slide, [
    ("Alternative antihypertensive for those who don't respond/tolerate 1st-line drugs (ACEi/ARBs)", False, False),
    ("Can combine with ACEi/ARB for more complete RAS blockade and cardioprotection", False, False),
    ("Adding to ACEi/ARB in Type 2 diabetes: NOT beneficial, may worsen outcome — NOT advised", True, False),
    ("Experience limited; employed only when established ACEi/ARBs cannot be used", False, False),
    ("Value as additional drug vs ACEi/ARBs monotherapy: needs more outcome data", False, False),
], 6.85, 4.05, 6.1, 1.55, font_size=10.5)

add_section_box(slide, "Combination Strategies — Key Points", 6.7, 5.8, 6.4, 1.35, DARK_BLUE, RGBColor(0xE8,0xEA,0xF6))
bullet_text(slide, [
    ("Aliskiren + ACEi/ARB: greater BP fall; more complete RAS blockade", False, False),
    ("Hemodynamic pattern resembles ACEi (no postural hypotension)", False, False),
    ("Evidence for outcome benefit beyond BP: still being established", False, False),
], 6.85, 6.15, 6.1, 0.9, font_size=10.5)

# ─────────────────────────────────────────────────────────────
# SLIDE 10: Summary — RAS Drug Classes at a Glance
# ─────────────────────────────────────────────────────────────
slide = prs.slides.add_slide(blank_layout(prs))
add_rect(slide, 0, 0, 13.33, 7.5, LIGHT_GRAY)
add_slide_header(slide, "Summary — RAS Drugs at a Glance", "Quick Reference Comparison")

headers2 = ["Drug Class", "Representative Drugs", "Target", "Cough?", "Key Use", "Avoid In"]
col_ws2 = [1.9, 2.5, 2.2, 0.85, 3.0, 2.7]
x_pos2 = [0.15]
for w in col_ws2[:-1]:
    x_pos2.append(x_pos2[-1] + w)

for h, x, w in zip(headers2, x_pos2, col_ws2):
    add_rect(slide, x, 1.2, w, 0.4, DARK_BLUE)
    add_textbox(slide, h, x+0.05, 1.22, w-0.1, 0.36,
                font_size=10.5, bold=True, color=WHITE, align=PP_ALIGN.CENTER)

summary_rows = [
    ("ACE Inhibitors", "Captopril, Enalapril,\nLisinopril, Ramipril", "ACE enzyme\n(prevents Ang II)", "Yes\n(10–16%)", "HTN, CHF, MI,\nDiabetic nephropathy,\nScleroderma crisis", "Bilateral renal artery\nstenosis, Pregnancy,\nHyperkalemia"),
    ("ARBs", "Losartan, Valsartan,\nCandesartan, Telmisartan,\nOlmesartan, Irbesartan", "AT₁ receptor\n(blocks Ang II effect)", "Rarely", "HTN, CHF, MI,\nDiabetic nephropathy\n(Type 2 preferred)", "Pregnancy; Not combined\nwith ACEi for HTN\n(JNC8, NICE)"),
    ("Direct Renin Inhibitors", "Aliskiren", "Renin enzyme\n(rate-limiting step)", "Rare", "HTN (alternative);\nCHF; renoprotection", "Pregnancy; Type 2 DM\non ACEi/ARB combo"),
    ("Aldosterone Antagonists", "Spironolactone,\nEplerenone", "Mineralocorticoid\nreceptors", "No", "Add-on for resistant\nHTN (ACEi+ARB+CCB+\nthiazide not sufficient)", "Hyperkalemia;\nMonitor K⁺ closely\nwith ACEi/ARBs"),
]

colors_rows = [DARK_BLUE, ACCENT, GREEN, ORANGE]
for r_idx, (row_data, color) in enumerate(zip(summary_rows, colors_rows)):
    y = 1.65 + r_idx * 1.35
    row_vals = list(row_data)
    # first cell gets colored bg
    add_rect(slide, x_pos2[0], y, col_ws2[0], 1.3, color)
    add_textbox(slide, row_vals[0], x_pos2[0]+0.05, y+0.02, col_ws2[0]-0.1, 1.25,
                font_size=10.5, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
    for j, (val, x, w) in enumerate(zip(row_vals[1:], x_pos2[1:], col_ws2[1:])):
        bg = WHITE if r_idx % 2 == 0 else RGBColor(0xF3,0xF4,0xF7)
        add_rect(slide, x, y, w, 1.3, bg, line_color=RGBColor(0xC5,0xCA,0xE9))
        add_textbox(slide, val, x+0.06, y+0.03, w-0.12, 1.22,
                    font_size=9.5, color=DARK_GRAY, align=PP_ALIGN.CENTER)

# ─────────────────────────────────────────────────────────────
# Save
out_path = "/tmp/workspace/RAS_Drugs_Pharmacology.pptx"
prs.save(out_path)
print(f"Saved: {out_path}")

from pptx import Presentation
from pptx.util import Inches, Pt, Emu
from pptx.dml.color import RGBColor
from pptx.enum.text import PP_ALIGN
from pptx.oxml.ns import qn
from lxml import etree
import copy

prs = Presentation()
prs.slide_width  = Inches(13.33)
prs.slide_height = Inches(7.5)

# ── Palette ────────────────────────────────────────────────
C_BG       = RGBColor(0xF7, 0xF9, 0xFF)
C_NAVY     = RGBColor(0x0D, 0x2B, 0x55)
C_BLUE     = RGBColor(0x15, 0x65, 0xC0)
C_LBLUE    = RGBColor(0xBB, 0xDE, 0xFF)
C_TEAL     = RGBColor(0x00, 0x69, 0x7A)
C_GREEN    = RGBColor(0x1B, 0x7A, 0x3E)
C_ORANGE   = RGBColor(0xD8, 0x55, 0x00)
C_RED      = RGBColor(0xB7, 0x1C, 0x1C)
C_PURPLE   = RGBColor(0x4A, 0x14, 0x8C)
C_GOLD     = RGBColor(0xF9, 0xA8, 0x25)
C_WHITE    = RGBColor(0xFF, 0xFF, 0xFF)
C_DGRAY    = RGBColor(0x21, 0x21, 0x21)
C_LGRAY    = RGBColor(0xEC, 0xEF, 0xF5)
C_ARROW    = RGBColor(0x55, 0x55, 0x55)

BLANK = prs.slide_layouts[6]

# ── Helpers ────────────────────────────────────────────────

def rgb(r, g, b): return RGBColor(r, g, b)

def rect(slide, l, t, w, h, fill, line=None, lw=0.75, radius=False):
    from pptx.util import Inches, Pt
    shp = slide.shapes.add_shape(1, Inches(l), Inches(t), Inches(w), Inches(h))
    shp.fill.solid(); shp.fill.fore_color.rgb = fill
    if line:
        shp.line.color.rgb = line; shp.line.width = Pt(lw)
    else:
        shp.line.fill.background()
    return shp

def textbox(slide, text, l, t, w, h, fs=11, bold=False, color=C_DGRAY,
            align=PP_ALIGN.LEFT, italic=False, wrap=True):
    tb = slide.shapes.add_textbox(Inches(l), Inches(t), Inches(w), Inches(h))
    tb.word_wrap = wrap
    tf = tb.text_frame; tf.word_wrap = wrap
    p = tf.paragraphs[0]; p.alignment = align
    r = p.add_run(); r.text = text
    r.font.size = Pt(fs); r.font.bold = bold
    r.font.italic = italic; r.font.color.rgb = color
    return tb

def label(slide, text, l, t, w, h, fs=11, bold=False, color=C_WHITE,
          fill=C_BLUE, line=None, align=PP_ALIGN.CENTER, italic=False):
    rect(slide, l, t, w, h, fill, line)
    textbox(slide, text, l+0.06, t+0.04, w-0.12, h-0.08,
            fs=fs, bold=bold, color=color, align=align, italic=italic)

def arrow_h(slide, x1, y, x2, color=C_ARROW, text=''):
    """Horizontal arrow x1→x2 at height y"""
    from pptx.util import Inches, Pt, Emu
    cx, cy = Inches((x1+x2)/2), Inches(y)
    cw = Inches(abs(x2-x1))
    ch = Inches(0.03)
    connector = slide.shapes.add_connector(1, Inches(x1), Inches(y), Inches(x2), Inches(y))
    connector.line.color.rgb = color
    connector.line.width = Pt(1.5)
    if text:
        textbox(slide, text, (x1+x2)/2-0.5, y-0.22, 1.0, 0.2,
                fs=9, italic=True, color=color, align=PP_ALIGN.CENTER)

def arrow_v(slide, x, y1, y2, color=C_ARROW, text='', text_side='right'):
    connector = slide.shapes.add_connector(1, Inches(x), Inches(y1), Inches(x), Inches(y2))
    connector.line.color.rgb = color
    connector.line.width = Pt(1.5)
    if text:
        tx = x+0.06 if text_side == 'right' else x-0.6
        textbox(slide, text, tx, (y1+y2)/2-0.12, 0.55, 0.25,
                fs=9, italic=True, color=color)

def diamond(slide, text, l, t, w, h, fill=C_GOLD, line=C_ORANGE, fs=10, bold=True):
    """Draw a diamond shape using freeform"""
    from pptx.util import Inches
    cx = Inches(l + w/2); cy = Inches(t + h/2)
    hw = Inches(w/2);     hh = Inches(h/2)
    # Use a rotated rectangle as diamond proxy via MSO_AUTO_SHAPE_TYPE = 4
    shp = slide.shapes.add_shape(4, Inches(l), Inches(t), Inches(w), Inches(h))
    shp.fill.solid(); shp.fill.fore_color.rgb = fill
    shp.line.color.rgb = line; shp.line.width = Pt(1.5)
    tf = shp.text_frame; tf.word_wrap = True
    p = tf.paragraphs[0]; p.alignment = PP_ALIGN.CENTER
    r = p.add_run(); r.text = text
    r.font.size = Pt(fs); r.font.bold = bold; r.font.color.rgb = C_DGRAY
    return shp

def pill(slide, text, l, t, w, h, fill=C_BLUE, fs=10, bold=True, color=C_WHITE, line=None):
    """Rounded rectangle (pill shape = MSO type 5)"""
    shp = slide.shapes.add_shape(5, Inches(l), Inches(t), Inches(w), Inches(h))
    shp.fill.solid(); shp.fill.fore_color.rgb = fill
    if line:
        shp.line.color.rgb = line; shp.line.width = Pt(1.2)
    else:
        shp.line.fill.background()
    tf = shp.text_frame; tf.word_wrap = True
    p = tf.paragraphs[0]; p.alignment = PP_ALIGN.CENTER
    r = p.add_run(); r.text = text
    r.font.size = Pt(fs); r.font.bold = bold; r.font.color.rgb = color
    return shp

def header(slide, title, sub=''):
    rect(slide, 0, 0, 13.33, 0.95, C_NAVY)
    rect(slide, 0, 0.95, 13.33, 0.04, C_BLUE)
    textbox(slide, title, 0.3, 0.05, 12.5, 0.6,
            fs=26, bold=True, color=C_WHITE, align=PP_ALIGN.LEFT)
    if sub:
        textbox(slide, sub, 0.32, 0.62, 12.5, 0.3,
                fs=11, italic=True, color=C_LBLUE, align=PP_ALIGN.LEFT)

def footer(slide, text):
    rect(slide, 0, 7.18, 13.33, 0.32, C_NAVY)
    textbox(slide, text, 0.3, 7.2, 12.7, 0.28,
            fs=8.5, color=C_LBLUE, align=PP_ALIGN.CENTER, italic=True)

# ══════════════════════════════════════════════════════════════
#  SLIDE 1 — TITLE
# ══════════════════════════════════════════════════════════════
sl = prs.slides.add_slide(BLANK)
rect(sl, 0, 0, 13.33, 7.5, C_NAVY)
rect(sl, 0, 2.8,  13.33, 2.0, C_BLUE)
rect(sl, 0, 4.8,  13.33, 0.06, C_GOLD)

textbox(sl, "CLINICAL DECISION TREE", 1.0, 1.0, 11.3, 0.7,
        fs=20, bold=False, color=C_LBLUE, align=PP_ALIGN.CENTER)
textbox(sl, "RAAS Inhibitor Selection", 0.5, 1.6, 12.3, 1.1,
        fs=38, bold=True, color=C_WHITE, align=PP_ALIGN.CENTER)
textbox(sl, "ACE Inhibitors  ·  Angiotensin Receptor Blockers (ARBs)  ·  Direct Renin Inhibitors (DRI)", 0.8, 2.95, 11.7, 0.6,
        fs=15, bold=False, color=C_WHITE, align=PP_ALIGN.CENTER)
textbox(sl, "Evidence-based guidance per JNC8, ACC/AHA, NICE & ESC Guidelines", 1.0, 3.52, 11.3, 0.45,
        fs=12, italic=True, color=C_GOLD, align=PP_ALIGN.CENTER)

# 4 badge boxes
badges = [("ACE\nInhibitors", C_TEAL), ("ARBs", C_GREEN),
          ("DRI\n(Aliskiren)", C_PURPLE), ("Combination\nStrategies", C_ORANGE)]
bx = 1.8
for name, col in badges:
    pill(sl, name, bx, 5.2, 2.2, 0.9, fill=col, fs=12, bold=True)
    bx += 2.5

textbox(sl, "Cardiovascular Pharmacology  |  Chapter 36", 0.5, 7.0, 12.3, 0.35,
        fs=10, italic=True, color=C_LBLUE, align=PP_ALIGN.CENTER)

# ══════════════════════════════════════════════════════════════
#  SLIDE 2 — MASTER DECISION TREE  (main algorithm)
# ══════════════════════════════════════════════════════════════
sl = prs.slides.add_slide(BLANK)
rect(sl, 0, 0, 13.33, 7.5, C_BG)
header(sl, "Master Decision Tree — RAAS Inhibitor Selection",
       "Step-by-step clinical algorithm for choosing the right drug class")

# ── Level 0: START ──
pill(sl, "PATIENT REQUIRES\nRAAS INHIBITION", 4.9, 1.08, 3.5, 0.7,
     fill=C_NAVY, fs=11, bold=True)

arrow_v(sl, 6.65, 1.78, 2.28)

# ── Level 1: Contraindication check ──
diamond(sl, "Bilateral Renal\nArtery Stenosis?", 4.9, 2.28, 3.5, 0.9,
        fill=C_GOLD, line=C_ORANGE, fs=10)

# YES → avoid all RAS
arrow_h(sl, 8.4, 2.73, 9.6, color=C_RED, text='YES')
pill(sl, "⚠ AVOID ALL\nRAAS Inhibitors\n(risk of acute renal failure)", 9.6, 2.38, 3.5, 0.8,
     fill=C_RED, fs=9.5, bold=True)

# NO → continue
arrow_v(sl, 6.65, 3.18, 3.65, text='NO')

# ── Level 2: Pregnancy check ──
diamond(sl, "Pregnant /\nPlanning Pregnancy?", 4.9, 3.65, 3.5, 0.9,
        fill=C_GOLD, line=C_ORANGE, fs=10)

# YES → avoid
arrow_h(sl, 8.4, 4.1, 9.6, color=C_RED, text='YES')
pill(sl, "⚠ AVOID ACEi / ARBs / DRI\n(Fetotoxic — all three classes)\nUse methyldopa / labetalol", 9.6, 3.75, 3.5, 0.8,
     fill=C_RED, fs=9.5, bold=True)

# NO → continue
arrow_v(sl, 6.65, 4.55, 5.05, text='NO')

# ── Level 3: Hyperkalaemia check ──
diamond(sl, "Significant\nHyperkalemia\n(K⁺ > 5.5 mEq/L)?", 4.9, 5.05, 3.5, 1.0,
        fill=C_GOLD, line=C_ORANGE, fs=10)

# YES → caution
arrow_h(sl, 8.4, 5.55, 9.6, color=C_ORANGE, text='YES')
pill(sl, "⚠ CAUTION\nAll RAAS Inhibitors raise K⁺\nCorrect K⁺ first; use lowest dose;\nmonitor closely", 9.6, 5.18, 3.5, 0.85,
     fill=C_ORANGE, fs=9, bold=False)

# NO → go to slide 3
arrow_v(sl, 6.65, 6.05, 6.6, text='NO')
pill(sl, "➜  Proceed to Drug Class\n     Selection Algorithm  (Slide 3)", 4.9, 6.62, 3.5, 0.65,
     fill=C_NAVY, fs=10, bold=True)

# Left side legend
rect(sl, 0.15, 1.1, 4.5, 5.5, C_LGRAY, line=C_BLUE, lw=0.5)
textbox(sl, "LEGEND", 0.3, 1.15, 4.2, 0.3, fs=10, bold=True, color=C_NAVY)
legends = [
    (C_GOLD, "Decision node (diamond)"),
    (C_NAVY, "Action / drug choice (pill)"),
    (C_RED,  "Contraindication / stop"),
    (C_ORANGE, "Caution / monitor"),
    (C_GREEN, "Preferred drug choice"),
]
for i, (col, desc) in enumerate(legends):
    y = 1.55 + i*0.42
    rect(sl, 0.3, y, 0.4, 0.28, col)
    textbox(sl, desc, 0.8, y, 3.6, 0.28, fs=10, color=C_DGRAY)

footer(sl, "Decision nodes reflect absolute contraindications. Proceed left-to-right at each diamond: YES = branch right, NO = continue downward.")

# ══════════════════════════════════════════════════════════════
#  SLIDE 3 — DRUG CLASS SELECTION BY CLINICAL CONDITION
# ══════════════════════════════════════════════════════════════
sl = prs.slides.add_slide(BLANK)
rect(sl, 0, 0, 13.33, 7.5, C_BG)
header(sl, "Drug Class Selection — By Clinical Condition",
       "Which RAAS inhibitor to start? Match condition to preferred class")

# Central question
pill(sl, "SELECT BASED ON PRIMARY CONDITION", 3.7, 1.1, 5.9, 0.55,
     fill=C_NAVY, fs=13, bold=True)

# 6 condition boxes in two rows
conditions = [
    # (condition, first_choice, second_choice, avoid/note, fill_top, fill_body)
    ("Hypertension\n(Uncomplicated)", "ACEi  OR  ARB\n(equally effective)", "DRI (if ACEi/ARB\nnot tolerated)", "Not: ACEi+ARB combo\n(JNC8, NICE)", C_BLUE, RGBColor(0xE3,0xF2,0xFD)),
    ("Hypertension\n+ Diabetes", "ACEi  (1st line)\nARB  (if cough)", "DRI added if target\nnot achieved", "Not: ACEi+ARB in DM\n(worsen outcomes)", C_TEAL, RGBColor(0xE0,0xF2,0xF1)),
    ("Hypertension\n+ CKD / Proteinuria", "ACEi  OR  ARB\n(renoprotective)", "ARB preferred in\nType 2 DM + CKD", "Avoid in bilateral\nrenal artery stenosis", C_GREEN, RGBColor(0xE8,0xF5,0xE9)),
    ("Heart Failure\n(Reduced EF)", "ACEi  (CONSENSUS,\nSOLVD, SAVE evidence)", "ARB if ACEi\nnot tolerated", "Not: DRI routine\n(limited evidence)", C_PURPLE, RGBColor(0xED,0xE7,0xF6)),
    ("Post-MI /\nHigh CV Risk", "ACEi  (within 24 hrs;\nHOPE, AIRE, EUROPA)", "ARB if ACEi\nnot tolerated", "ARB non-inferior\n(VALIANT, OPTIMAAL)", C_ORANGE, RGBColor(0xFF,0xF3,0xE0)),
    ("Black Race\nHypertension", "ARB  preferred\n(NICE 2011)", "ACEi  acceptable\n(less effective solo)", "Combine with thiazide\nor CCB for added effect", C_RED, RGBColor(0xFF,0xEB,0xEE)),
]

box_w = 4.1; box_h = 2.6
positions = [(0.15, 1.8), (4.5, 1.8), (8.9, 1.8),
             (0.15, 4.5), (4.5, 4.5), (8.9, 4.5)]

for (cond, first, second, avoid, top_col, body_col), (bx, by) in zip(conditions, positions):
    # top band
    rect(sl, bx, by, box_w, 0.45, top_col)
    textbox(sl, cond, bx+0.08, by+0.03, box_w-0.14, 0.4,
            fs=11, bold=True, color=C_WHITE, align=PP_ALIGN.CENTER)
    # body
    rect(sl, bx, by+0.45, box_w, box_h-0.45, body_col, line=top_col, lw=0.8)
    # 1st choice
    textbox(sl, "1st Choice:", bx+0.1, by+0.52, 1.1, 0.22, fs=9, bold=True, color=top_col)
    textbox(sl, first, bx+0.1, by+0.72, box_w-0.18, 0.6, fs=10, bold=True, color=C_DGRAY)
    # 2nd choice
    textbox(sl, "Alternative:", bx+0.1, by+1.32, 1.2, 0.22, fs=9, bold=True, color=top_col)
    textbox(sl, second, bx+0.1, by+1.52, box_w-0.18, 0.5, fs=9.5, color=C_DGRAY)
    # avoid / note
    rect(sl, bx+0.08, by+2.12, box_w-0.16, 0.35, RGBColor(0xFF,0xF9,0xC4), line=C_ORANGE, lw=0.5)
    textbox(sl, "⚑ " + avoid, bx+0.12, by+2.14, box_w-0.22, 0.3, fs=8.5, italic=True,
            color=RGBColor(0x5D,0x40,0x37))

footer(sl, "ACEi = ACE Inhibitor  |  ARB = Angiotensin Receptor Blocker  |  DRI = Direct Renin Inhibitor (Aliskiren)  |  Based on JNC8, ACC/AHA, NICE, ESC guidelines")

# ══════════════════════════════════════════════════════════════
#  SLIDE 4 — ACEi vs ARB DECISION BRANCH
# ══════════════════════════════════════════════════════════════
sl = prs.slides.add_slide(BLANK)
rect(sl, 0, 0, 13.33, 7.5, C_BG)
header(sl, "ACE Inhibitor vs ARB — Which One to Choose?",
       "Detailed decision branch once RAAS inhibition is confirmed appropriate")

# Start pill
pill(sl, "RAAS Inhibition Indicated\n(no absolute contraindications)", 4.65, 1.08, 4.0, 0.65,
     fill=C_NAVY, fs=11, bold=True)

arrow_v(sl, 6.65, 1.73, 2.2)

# Q1: Cough on ACEi?
diamond(sl, "Dry Cough\non ACE Inhibitor?", 4.9, 2.2, 3.5, 0.88, fill=C_GOLD, line=C_ORANGE)

# YES → switch to ARB
arrow_h(sl, 8.4, 2.64, 9.5, color=C_GREEN, text='YES')
rect(sl, 9.5, 2.25, 3.6, 1.15, C_GREEN)
textbox(sl, "✔ SWITCH TO ARB", 9.6, 2.28, 3.4, 0.3, fs=11, bold=True, color=C_WHITE)
textbox(sl, "ARBs do NOT raise bradykinin → no cough.\nLosar tan / Valsartan / Telmisartan / Candesartan",
        9.6, 2.58, 3.4, 0.75, fs=9.5, color=C_WHITE)

# NO → continue
arrow_v(sl, 6.65, 3.08, 3.55, text='NO')

# Q2: Race
diamond(sl, "Patient is\nBlack Race?", 4.9, 3.55, 3.5, 0.88, fill=C_GOLD, line=C_ORANGE)

# YES → prefer ARB
arrow_h(sl, 8.4, 4.0, 9.5, color=C_GREEN, text='YES')
rect(sl, 9.5, 3.6, 3.6, 1.1, C_GREEN)
textbox(sl, "✔ PREFER ARB", 9.6, 3.63, 3.4, 0.3, fs=11, bold=True, color=C_WHITE)
textbox(sl, "NICE (2011): ARBs preferred over ACEi\nfor black races. Add thiazide or CCB.",
        9.6, 3.93, 3.4, 0.7, fs=9.5, color=C_WHITE)

# NO → continue
arrow_v(sl, 6.65, 4.43, 4.9, text='NO')

# Q3: Type 2 DM?
diamond(sl, "Type 2 Diabetes\nMellitus?", 4.9, 4.9, 3.5, 0.88, fill=C_GOLD, line=C_ORANGE)

# YES → ARB preferred
arrow_h(sl, 8.4, 5.34, 9.5, color=C_TEAL, text='YES')
rect(sl, 9.5, 4.95, 3.6, 1.1, C_TEAL)
textbox(sl, "✔ ARB PREFERRED", 9.6, 4.98, 3.4, 0.3, fs=11, bold=True, color=C_WHITE)
textbox(sl, "ARBs renoprotective in T2DM independent of BP.\nBetter tolerability → now first choice by many.",
        9.6, 5.28, 3.4, 0.7, fs=9.5, color=C_WHITE)

# NO → ACEi
arrow_v(sl, 6.65, 5.78, 6.28, text='NO')
rect(sl, 4.65, 6.28, 4.0, 0.85, C_BLUE)
textbox(sl, "✔ START ACE INHIBITOR", 4.75, 6.31, 3.8, 0.3, fs=11, bold=True, color=C_WHITE, align=PP_ALIGN.CENTER)
textbox(sl, "Enalapril / Ramipril / Lisinopril / Perindopril\nStart low; uptitrate; monitor BP, K⁺, Cr",
        4.75, 6.61, 3.8, 0.45, fs=9.5, color=C_WHITE, align=PP_ALIGN.CENTER)

# Left panel — quick notes
rect(sl, 0.15, 1.1, 4.35, 6.0, C_LGRAY, line=C_BLUE, lw=0.5)
textbox(sl, "KEY NOTES", 0.28, 1.15, 4.0, 0.3, fs=10, bold=True, color=C_NAVY)
notes = [
    ("ACEi cough:", "10–16% patients; brassy, persistent;\ncaused by ↑ bradykinin / substance P"),
    ("ARB advantage:", "No kinin effect → no cough;\nlower angioedema, rash, dysgeusia"),
    ("Equivalence:", "ACEi = ARB efficacy in HTN, CHF, MI,\ndiabetic nephropathy"),
    ("Do NOT combine:", "ACEi + ARB for HTN (JNC8, NICE);\n↑ hyperkalemia, ↑ hypotension, ↑ renal risk"),
    ("ARB options:", "Losartan, Valsartan, Candesartan,\nTelmisartan, Olmesartan, Irbesartan"),
]
for i, (k, v) in enumerate(notes):
    y = 1.55 + i * 1.05
    textbox(sl, k, 0.28, y, 1.4, 0.25, fs=9.5, bold=True, color=C_BLUE)
    textbox(sl, v, 0.28, y+0.22, 4.0, 0.7, fs=9.5, color=C_DGRAY)

footer(sl, "All decision nodes assume no absolute contraindications (bilateral RAS, pregnancy, severe hyperkalemia) — these screened out in Slide 2.")

# ══════════════════════════════════════════════════════════════
#  SLIDE 5 — DRI (ALISKIREN) DECISION BRANCH
# ══════════════════════════════════════════════════════════════
sl = prs.slides.add_slide(BLANK)
rect(sl, 0, 0, 13.33, 7.5, C_BG)
header(sl, "When to Use Direct Renin Inhibitor (Aliskiren)?",
       "DRI is a third-line option — specific indications and combinations")

# Start
pill(sl, "RAAS Inhibition Needed\n(ACEi & ARB considered first)", 4.65, 1.1, 4.0, 0.65,
     fill=C_NAVY, fs=11, bold=True)
arrow_v(sl, 6.65, 1.75, 2.22)

# Q1: ACEi/ARB failed?
diamond(sl, "ACEi AND ARB\nfailed / not tolerated?", 4.75, 2.22, 3.8, 0.95,
        fill=C_GOLD, line=C_ORANGE, fs=10)
arrow_h(sl, 8.55, 2.7, 9.55, color=C_PURPLE, text='YES')
rect(sl, 9.55, 2.25, 3.55, 1.15, C_PURPLE)
textbox(sl, "✔ ALISKIREN MONOTHERAPY", 9.65, 2.28, 3.35, 0.3, fs=10, bold=True, color=C_WHITE)
textbox(sl, "150–300 mg OD. Alternative for those who\ncannot tolerate 1st-line RAAS drugs.",
        9.65, 2.58, 3.35, 0.75, fs=9.5, color=C_WHITE)

arrow_v(sl, 6.65, 3.17, 3.62, text='NO')

# Q2: BP target not achieved on ACEi/ARB?
diamond(sl, "BP target NOT achieved\non ACEi or ARB alone?", 4.75, 3.62, 3.8, 0.95,
        fill=C_GOLD, line=C_ORANGE, fs=10)
arrow_h(sl, 8.55, 4.1, 9.55, color=C_PURPLE, text='YES')
rect(sl, 9.55, 3.65, 3.55, 1.15, C_PURPLE)
textbox(sl, "✔ ADD ALISKIREN", 9.65, 3.68, 3.35, 0.3, fs=10, bold=True, color=C_WHITE)
textbox(sl, "Combination ACEi+DRI or ARB+DRI:\ngreater BP fall; more complete RAS blockade.\nMonitor K⁺ and renal function.",
        9.65, 3.98, 3.35, 0.75, fs=9.5, color=C_WHITE)

arrow_v(sl, 6.65, 4.57, 5.02, text='NO')

# Q3: Type 2 DM on ACEi or ARB?
diamond(sl, "Type 2 Diabetes?\n(already on ACEi or ARB)", 4.75, 5.02, 3.8, 0.95,
        fill=C_GOLD, line=C_ORANGE, fs=10)
arrow_h(sl, 8.55, 5.5, 9.55, color=C_RED, text='YES')
rect(sl, 9.55, 5.05, 3.55, 1.15, C_RED)
textbox(sl, "✘ DO NOT ADD ALISKIREN", 9.65, 5.08, 3.35, 0.3, fs=10, bold=True, color=C_WHITE)
textbox(sl, "Adding DRI to ACEi/ARB in Type 2 DM:\nNo benefit; may worsen outcomes.\n(ALTITUDE trial evidence)", 9.65, 5.38, 3.35, 0.75, fs=9.5, color=C_WHITE)

arrow_v(sl, 6.65, 5.97, 6.45, text='NO')
rect(sl, 4.65, 6.45, 4.0, 0.75, C_TEAL)
textbox(sl, "✔ ALISKIREN CAN BE ADDED\nfor more complete cardioprotection",
        4.75, 6.48, 3.8, 0.65, fs=10, bold=True, color=C_WHITE, align=PP_ALIGN.CENTER)

# Left panel
rect(sl, 0.15, 1.1, 4.35, 6.0, C_LGRAY, line=C_PURPLE, lw=0.5)
textbox(sl, "ALISKIREN PROFILE", 0.28, 1.15, 4.0, 0.3, fs=10, bold=True, color=C_PURPLE)
alisk = [
    ("Mechanism:", "Nonpeptide; blocks catalytic site of\nrenin → no Ang I production"),
    ("Dose:", "150–300 mg OD\nBrands: RASILEZ, RASILEZ-HCT"),
    ("PK:", "Bioavailability low (P-gp efflux);\nt½ >24 hrs; excreted in faeces"),
    ("ADRs:", "Dyspepsia, dizziness, loose stools;\nhypotension, hyperkalemia (rare)"),
    ("Contraindicated:", "Pregnancy; T2DM + ACEi/ARB combo"),
    ("Evidence:", "LVH regression; reduces albuminuria;\nrenoprotective in HTN + DM"),
]
for i, (k, v) in enumerate(alisk):
    y = 1.55 + i * 0.87
    textbox(sl, k, 0.28, y, 1.4, 0.25, fs=9.5, bold=True, color=C_PURPLE)
    textbox(sl, v, 0.28, y+0.22, 4.0, 0.58, fs=9.5, color=C_DGRAY)

footer(sl, "DRI = Direct Renin Inhibitor (Aliskiren) | ALTITUDE trial showed harm with aliskiren + ACEi/ARB in T2DM — combination must be avoided.")

# ══════════════════════════════════════════════════════════════
#  SLIDE 6 — SPECIAL POPULATIONS DECISION TREE
# ══════════════════════════════════════════════════════════════
sl = prs.slides.add_slide(BLANK)
rect(sl, 0, 0, 13.33, 7.5, C_BG)
header(sl, "Special Populations — Tailored RAAS Drug Selection",
       "Adjust choice based on patient-specific comorbidities and characteristics")

# Title question block
pill(sl, "PATIENT HAS SPECIAL CONDITION — Select Below", 3.5, 1.1, 6.3, 0.5,
     fill=C_NAVY, fs=12, bold=True)

special = [
    # (condition, recommended, avoid, extra note, color)
    ("CHF + Sinus\nRhythm", "ACEi 1st line\n(CONSENSUS, SOLVD)\nARB if ACEi intolerant\n(valsartan, candesartan)", "DRI: limited evidence\nAldosterone antag: add\nif still symptomatic", "Target: NYHA class improvement;\n↓ mortality ~20%", C_BLUE),
    ("Post-MI\n(STEMI/NSTEMI)", "ACEi within 24 hrs\n(AIRE, TRACE, SAVE)\nContinue long-term", "ARB: non-inferior\n(VALIANT for captopril)\nUse if ACEi not tolerated", "High-risk: benefit greatest with\nassociated HTN or DM", C_ORANGE),
    ("Diabetic\nNephropathy\nType 1", "ACEi\n(slow end-stage\nrenal disease)", "ARB: alternative\nif ACEi not tolerated", "Albumin uria stabilizes;\n↓ dialysis requirement", C_TEAL),
    ("Diabetic\nNephropathy\nType 2", "ARB preferred\n(Losartan, Irbesartan\nINDEX, RENAAL trials)", "ACEi: acceptable\nalternative", "ARBs renoprotective\nindependent of BP effect", C_GREEN),
    ("Scleroderma\nRenal Crisis", "ACEi — LIFE-SAVING\n(dramatic improvement)", "ARB: less evidence\nbut acceptable", "ACEi dramatically\n↓ renovascular crisis\nrisk in scleroderma", C_RED),
    ("Hypertension\n+ LVH", "ACEi or ARB\n(reverse hypertrophy\nwithin weeks)", "Not: β-blocker alone\n(less LVH regression)", "LIFE trial: losartan\nsuperior to atenolol\nfor LVH + CV events", C_PURPLE),
    ("Resistant\nHypertension\n(3 drugs failing)", "Add DRI (Aliskiren)\nto ACEi or ARB +\nCCB + thiazide", "Not: ACEi + ARB\nalone (JNC8)", "NICE: add aldosterone\nantagonist 4th drug\nbefore DRI", C_NAVY),
    ("Non-Diabetic\nCKD / Proteinuria", "ACEi or ARB\n(reduce proteinuria,\nslow progression)", "Avoid combo ACEi+ARB\n(↑ renal risk, hyperK)", "COOPERATE: ARB+ACEi\nbetter than mono in\nnon-DM CKD (caution)", C_TEAL),
]

bw = 3.15; bh = 2.5
positions_sp = [
    (0.12, 1.75), (3.37, 1.75), (6.62, 1.75), (9.87, 1.75),
    (0.12, 4.35), (3.37, 4.35), (6.62, 4.35), (9.87, 4.35),
]

for (cond, rec, avoid, note, col), (bx, by) in zip(special, positions_sp):
    rect(sl, bx, by, bw, 0.42, col)
    textbox(sl, cond, bx+0.06, by+0.02, bw-0.1, 0.38,
            fs=10, bold=True, color=C_WHITE, align=PP_ALIGN.CENTER)
    rect(sl, bx, by+0.42, bw, bh-0.42, C_WHITE, line=col, lw=0.7)
    textbox(sl, "✔ " + rec, bx+0.08, by+0.46, bw-0.14, 0.85, fs=9.5, bold=True, color=col)
    rect(sl, bx+0.06, by+1.35, bw-0.12, 0.55, RGBColor(0xFF,0xEB,0xEE), line=C_RED, lw=0.4)
    textbox(sl, "✘ " + avoid, bx+0.1, by+1.38, bw-0.18, 0.5, fs=8.5, color=C_RED)
    rect(sl, bx+0.06, by+1.95, bw-0.12, 0.46, RGBColor(0xFF,0xF9,0xC4), line=C_ORANGE, lw=0.4)
    textbox(sl, "⚑ " + note, bx+0.1, by+1.97, bw-0.18, 0.42, fs=8, italic=True,
            color=RGBColor(0x5D,0x40,0x37))

footer(sl, "ACEi = ACE Inhibitor  |  ARB = Angiotensin Receptor Blocker  |  DRI = Aliskiren  |  LVH = Left Ventricular Hypertrophy  |  CKD = Chronic Kidney Disease")

# ══════════════════════════════════════════════════════════════
#  SLIDE 7 — ADVERSE EFFECTS & SWITCHING DECISION TREE
# ══════════════════════════════════════════════════════════════
sl = prs.slides.add_slide(BLANK)
rect(sl, 0, 0, 13.33, 7.5, C_BG)
header(sl, "Adverse Effect Management — When & How to Switch",
       "Practical algorithm for managing drug-induced problems")

pill(sl, "PATIENT ON RAAS INHIBITOR\nDevelops an Adverse Effect", 4.65, 1.1, 4.0, 0.65,
     fill=C_NAVY, fs=11, bold=True)

ae_tree = [
    # (y_start, question, yes_action, yes_color, no_text)
    (1.9,  "Dry Persistent Cough\n(on ACEi)?",
     "Switch to ARB\nSame efficacy, no kinin effect\n→ cough resolves in 4–6 days",
     C_GREEN, "NO ↓"),
    (3.1,  "Angioedema\n(on ACEi)?",
     "STOP ACEi immediately\nSwitch to ARB (angioedema\nrare with ARBs) or DRI",
     C_RED, "NO ↓"),
    (4.3,  "Hyperkalemia\n(K⁺ > 5.5 mEq/L)?",
     "REDUCE dose or STOP\nCorrect K⁺; avoid K⁺ sparing\ndiuretics, NSAIDs, β-blockers",
     C_ORANGE, "NO ↓"),
    (5.5,  "Rising Creatinine\n(>30% increase)?",
     "STOP; investigate for bilateral\nrenal artery stenosis\nMay restart at lower dose if <30%",
     C_RED, "NO ↓"),
]

for y, q, yes_act, yes_col, no_txt in ae_tree:
    diamond(sl, q, 4.85, y, 3.3, 0.9, fill=C_GOLD, line=C_ORANGE, fs=10)
    arrow_h(sl, 8.15, y+0.45, 9.2, color=yes_col, text='YES')
    rect(sl, 9.2, y+0.05, 3.9, 0.9, yes_col)
    textbox(sl, yes_act, 9.3, y+0.08, 3.7, 0.82, fs=9.5, color=C_WHITE)
    if no_txt == "NO ↓":
        arrow_v(sl, 6.5, y+0.9, y+1.1)

# Final: all well
rect(sl, 4.65, 6.52, 4.0, 0.68, C_GREEN)
textbox(sl, "✔ CONTINUE CURRENT THERAPY\nMonitor BP, K⁺, Cr every 3–6 months",
        4.75, 6.55, 3.8, 0.6, fs=10.5, bold=True, color=C_WHITE, align=PP_ALIGN.CENTER)
arrow_v(sl, 6.65, 6.4, 6.52)

# Left panel
rect(sl, 0.15, 1.1, 4.35, 5.85, C_LGRAY, line=C_RED, lw=0.5)
textbox(sl, "MONITORING CHECKLIST", 0.28, 1.15, 4.0, 0.3, fs=10, bold=True, color=C_RED)
checks = [
    "Baseline: BP, K⁺, serum Cr/eGFR before starting",
    "Recheck: 1–2 weeks after initiation",
    "Then: every 3–6 months when stable",
    "K⁺ >5.5 mEq/L → reduce dose or stop",
    "Cr rise >30% → investigate bilateral RAS",
    "Cr rise <30% → acceptable; continue",
    "Cough: confirm not cardiac / other cause first",
    "Angioedema: STOP immediately; airway risk",
    "Pregnancy test if reproductive-age women",
    "Avoid NSAIDs — reduce efficacy + raise K⁺",
]
for i, c in enumerate(checks):
    y = 1.55 + i * 0.5
    rect(sl, 0.28, y+0.02, 0.22, 0.22, C_RED if i in (3,4,7,8) else C_BLUE)
    textbox(sl, c, 0.58, y, 3.85, 0.45, fs=9.5, color=C_DGRAY)

footer(sl, "ACEi = ACE Inhibitor  |  ARB = Angiotensin Receptor Blocker  |  Cr = Creatinine  |  eGFR = estimated GFR  |  RAS = Renal Artery Stenosis")

# ══════════════════════════════════════════════════════════════
#  SLIDE 8 — COMBINATION STRATEGY & DOSE QUICK REFERENCE
# ══════════════════════════════════════════════════════════════
sl = prs.slides.add_slide(BLANK)
rect(sl, 0, 0, 13.33, 7.5, C_BG)
header(sl, "Combination Strategies & Quick Dose Reference",
       "When to combine, when to avoid, and recommended starting doses")

# Left: Combination decision boxes
rect(sl, 0.15, 1.1, 6.2, 5.9, C_LGRAY, line=C_NAVY, lw=0.5)
textbox(sl, "COMBINATION STRATEGIES", 0.28, 1.15, 5.8, 0.3, fs=11, bold=True, color=C_NAVY)

combos = [
    ("ACEi + Thiazide Diuretic", "✔ RECOMMENDED",
     "Supra-additive synergy; only 12.5 mg HCZ needed.\nExtends efficacy from ~50% to ~90%.", C_GREEN),
    ("ACEi + ARB", "✘ NOT for HTN (JNC8/NICE)",
     "↑ hyperkalemia, ↑ hypotension, ↑ renal failure.\nOnly consider in CHF/CKD under specialist guidance.", C_RED),
    ("ACEi/ARB + DRI (Aliskiren)", "✔ CONDITIONAL",
     "Greater BP fall + more complete RAS blockade.\nAVOID in Type 2 DM (worsens outcomes — ALTITUDE).", C_ORANGE),
    ("ACEi + CCB (Amlodipine)", "✔ RECOMMENDED",
     "Excellent combination; CCB offsets ACEi ankle edema\n(CCBs cause edema; ACEi reduces it). First-line combo.", C_GREEN),
    ("ACEi/ARB + Aldosterone\nAntagonist", "✔ FOR RESISTANT HTN",
     "Add when ACEi/ARB+CCB+thiazide fails.\nNICE/JNC8 recommend as 4th drug. Watch K⁺.", C_TEAL),
]

for i, (combo, verdict, detail, vcol) in enumerate(combos):
    y = 1.55 + i * 1.07
    rect(sl, 0.25, y, 6.0, 0.95, C_WHITE, line=vcol, lw=0.8)
    textbox(sl, combo, 0.35, y+0.03, 3.5, 0.3, fs=10, bold=True, color=C_NAVY)
    rect(sl, 3.9, y+0.03, 2.2, 0.28, vcol)
    textbox(sl, verdict, 3.95, y+0.04, 2.1, 0.25, fs=9, bold=True, color=C_WHITE, align=PP_ALIGN.CENTER)
    textbox(sl, detail, 0.35, y+0.35, 5.9, 0.55, fs=9.5, color=C_DGRAY)

# Right: Dose Quick Reference
rect(sl, 6.55, 1.1, 6.6, 5.9, C_LGRAY, line=C_BLUE, lw=0.5)
textbox(sl, "DOSE QUICK REFERENCE", 6.68, 1.15, 6.2, 0.3, fs=11, bold=True, color=C_BLUE)

dose_data = [
    # (class, drug, start_dose, usual_dose, max)
    ("ACEi", "Captopril",   "6.25–12.5 mg BD",  "25–50 mg BD",    "150 mg/day"),
    ("ACEi", "Enalapril",   "2.5–5 mg OD",       "10–20 mg OD",    "40 mg/day"),
    ("ACEi", "Lisinopril",  "5 mg OD",            "10–40 mg OD",    "40 mg/day"),
    ("ACEi", "Ramipril",    "1.25–2.5 mg OD",    "5–10 mg OD",     "10 mg/day"),
    ("ACEi", "Perindopril", "2–4 mg OD",          "4–8 mg OD",      "8 mg/day"),
    ("ARB",  "Losartan",    "25–50 mg OD",        "50–100 mg OD",   "100 mg/day"),
    ("ARB",  "Valsartan",   "40–80 mg OD",        "80–160 mg OD",   "320 mg/day"),
    ("ARB",  "Candesartan", "4–8 mg OD",          "8–16 mg OD",     "32 mg/day"),
    ("ARB",  "Telmisartan", "20–40 mg OD",        "40–80 mg OD",    "80 mg/day"),
    ("ARB",  "Irbesartan",  "75–150 mg OD",       "150–300 mg OD",  "300 mg/day"),
    ("DRI",  "Aliskiren",   "150 mg OD",          "150–300 mg OD",  "300 mg/day"),
]

# Table header
hdr_cols = ["Class", "Drug", "Start", "Usual", "Max"]
hdr_ws   = [0.7, 1.6, 1.6, 1.65, 1.0]
hdr_x    = [6.65]
for w in hdr_ws[:-1]: hdr_x.append(hdr_x[-1]+w)
for h, x, w in zip(hdr_cols, hdr_x, hdr_ws):
    rect(sl, x, 1.55, w, 0.32, C_NAVY)
    textbox(sl, h, x+0.03, 1.56, w-0.05, 0.29, fs=9, bold=True, color=C_WHITE, align=PP_ALIGN.CENTER)

class_colors = {"ACEi": C_BLUE, "ARB": C_GREEN, "DRI": C_PURPLE}
for r, (cls, drug, start, usual, mx) in enumerate(dose_data):
    y = 1.87 + r * 0.44
    bg = C_WHITE if r%2==0 else RGBColor(0xF0,0xF4,0xFF)
    for vals, x, w, bold_ in zip([cls, drug, start, usual, mx], hdr_x, hdr_ws,
                                   [True, True, False, False, False]):
        rect(sl, x, y, w, 0.42, bg if vals != cls else class_colors[cls], line=RGBColor(0xD0,0xD0,0xE0), lw=0.3)
        textbox(sl, vals, x+0.03, y+0.02, w-0.05, 0.38, fs=8.5,
                bold=bold_, align=PP_ALIGN.CENTER,
                color=C_WHITE if vals == cls else C_DGRAY)

footer(sl, "OD = once daily  |  BD = twice daily  |  Doses shown for hypertension; CHF/post-MI dosing may differ  |  Always start low, uptitrate, monitor renal function + K⁺")

# ══════════════════════════════════════════════════════════════
#  SLIDE 9 — ONE-PAGE SUMMARY FLOWCHART
# ══════════════════════════════════════════════════════════════
sl = prs.slides.add_slide(BLANK)
rect(sl, 0, 0, 13.33, 7.5, C_BG)
header(sl, "One-Page Clinical Summary — RAAS Inhibitor Algorithm",
       "Quick reference card for clinical use")

# Summary table
rect(sl, 0.15, 1.08, 13.0, 5.85, C_WHITE, line=C_NAVY, lw=0.7)

cols = ["Criterion", "Prefer ACEi", "Prefer ARB", "Consider DRI", "AVOID / Caution"]
col_ws = [2.4, 2.5, 2.5, 2.5, 3.1]
col_xs = [0.2]
for w in col_ws[:-1]: col_xs.append(col_xs[-1]+w)
col_fills = [C_NAVY, C_BLUE, C_GREEN, C_PURPLE, C_RED]

for h, x, w, f in zip(cols, col_xs, col_ws, col_fills):
    rect(sl, x, 1.12, w, 0.42, f)
    textbox(sl, h, x+0.06, 1.14, w-0.1, 0.38, fs=11, bold=True, color=C_WHITE, align=PP_ALIGN.CENTER)

rows_sum = [
    ("Race", "White / Asian", "Black race (NICE)", "Any (3rd line)", "—"),
    ("Cough on ACEi", "—", "✔ Switch to ARB", "Alternative", "ACEi causes cough"),
    ("Type 1 DM + nephropathy", "✔ First line", "Alternative", "—", "—"),
    ("Type 2 DM + nephropathy", "Acceptable", "✔ Preferred", "NOT with ACEi/ARB", "DRI+ACEi/ARB in T2DM"),
    ("CHF (reduced EF)", "✔ First line (RCT evidence)", "If ACEi intolerant", "Limited evidence", "ACEi + ARB (high risk)"),
    ("Post-MI", "✔ Within 24 hrs", "Non-inferior (VALIANT)", "—", "—"),
    ("LVH", "✔ Effective", "✔ Equally effective", "—", "β-blocker alone"),
    ("Scleroderma crisis", "✔ Life-saving", "Less evidence", "—", "—"),
    ("Pregnancy", "✘ Contraindicated", "✘ Contraindicated", "✘ Contraindicated", "ALL RAAS — stop immediately"),
    ("Bilateral RAS", "✘ Contraindicated", "✘ Contraindicated", "✘ Contraindicated", "All RAAS inhibitors"),
]

row_fills = [C_WHITE, RGBColor(0xF3,0xF5,0xFF)] * 5
for r, (row, rf) in enumerate(zip(rows_sum, row_fills)):
    y = 1.54 + r * 0.51
    for val, x, w in zip(row, col_xs, col_ws):
        is_contra = "✘" in val
        is_check  = "✔" in val
        bg = RGBColor(0xFF,0xEB,0xEE) if is_contra else (RGBColor(0xE8,0xF5,0xE9) if is_check else rf)
        tc = C_RED if is_contra else (C_GREEN if is_check else C_DGRAY)
        rect(sl, x, y, w, 0.49, bg, line=RGBColor(0xC0,0xC8,0xE0), lw=0.3)
        textbox(sl, val, x+0.06, y+0.02, w-0.1, 0.44, fs=9.5, color=tc,
                bold=(is_contra or is_check), align=PP_ALIGN.CENTER)

footer(sl, "ACEi = ACE Inhibitor  |  ARB = Angiotensin Receptor Blocker  |  DRI = Aliskiren  |  RAS = Renal Artery Stenosis  |  T1/T2 DM = Type 1/2 Diabetes  |  LVH = Left Ventricular Hypertrophy")

# ── SAVE ────────────────────────────────────────────────────
out = "/tmp/workspace/RAAS_Clinical_Decision_Tree.pptx"
prs.save(out)
print(f"Saved: {out}")
print(f"Slides: {len(prs.slides)}")