CKD Flashcards
How do statins work?
- They are competitive inhibitors of HMG-CoA reductase, which is the enzyme responsible for converting HMG-CoA to mevalonate in the cholesterol synthesis pathway.
- ⬇️ hepatic cholesterol synthesis
- Upregulation of LDL-receptors and increased hepatic uptake of LDL-cholesterol from the circulation occurs
What do statins target?
HMG-CoA reductase
What are the main side effects of statins?
- Muscle toxicity -> pain
- Constipation or diarrhoea
Name some statins
- Simvastatin
- artorvastatin
When are statins prescribed?
- hypercholesterolaemia
- if >10% risk of CVD within 10yrs
How do you calculate risk of CVD within 10yrs?
QRISK3 calculator
Can Aspirin be given to someone with CKD?
We tend to avoid aspirin because it is an NSAID.
However, if person is at a high risk of stroke/ MI, it could be considered.
How does Aspirin work?
- Irreversible inactivation of COX enzyme.
- Prevents oxidation of arachidonic acid to produce prostaglandins.
- Reduction of thromboxane A2 in platelets reduces aggregation -> prevents clotting.
How does aspirin help to alleviate pain?
Reduction of PGE2 (prostaglandin) at sensory pain neurones…
- reduces pain and sensation in the brain
- decreases fever
What does aspirin target?
COX enzyme
What are the side effects of aspirin?
- Dyspepsia
- Haemorrhage
- increased risk of bleeding in the elderly
- co-administer PPI if past history of peptic ulcer.
Why does a PPI need to be administered with aspirin if past history of ulcers?
Blockade of COX1 in gastric mucosal cells reduces mucus/bicarbonate production which can expose the stomach lining to acid.
What can Trimethoprim be used for?
To treat bacterial infections like UTIs
How does trimethoprim work?
It inhibits the reduction of dihydrofolic acid to tetrahydrofolic acid (active form) which is a necessary component for synthesising purines required for DNA and protein production.
What does trimethoprim target/ compete with?
Dihydrofolate reductase
