Common drugs and side effects - blood thinners, NSAIDs, ACEis, diuretics, Beta blockers, CCBs, PPIs Flashcards
what are DOACs?
Direct oral anticoagulants
name 2 DOACs
apixaban
Rivaroxaban
how to DOACs work
they inhibit clotting factor 10a
how does warfarin work?
inhibits 10,9,7,2
ie. the vitamin K dependent factors (1972)
what are LMWHs?
Low-molecular-weight heparins
type of anticoagulants
how do LMWHs work?
inhibits clotting factor 10 and thrombin
name a LMWH
dalteparin,
enoxaparin
name the class of anticoagulant (blood thinners) that are fibrinolytic drugs
alteplase (IV)
how to Alteplase drugs work?
activating plasminogen to form plasmin, which degrades the fibrin mesh
and so breaks up thrombi.
ie. this is the fibrinolysis stage to prevent clot from growing too big
therefore alteplases are essentially tissue plasminogen activatosr, tPa
how do antiplatlet drugs work?
inhibit P2Y12
stops platelets from sticking together to form the primary platelet plug
name an antiplatlet drug
clopidogrel
summarise the 5 groups of blood thinners you need to be aware of
DOACs
warfarin
LMWH
alteplase (VI)
antiplatlets
list some conditions in which you would need to prescribe blood thinners
AF
DVT/PE
prosthetic valves
bleeding disorders
ischemic stroke
myocardial infarction
what are NSAIDs?
Non-steroidal anti-inflammatory drugs (NSAIDs)
medicines that are widely used to relieve pain, reduce inflammation, and bring down a high temperature
they are weak analgesics for mild pain
give an example of a NSAID
Ibuprofen,
naproxen
aspirin
what enzymes do NSAIDs inhibit?
Cox-1 and Cox-2
what do COX enzymes do? (in general)
involved in synthesis of prostaglandins from arachidonic acid
why does NSAIDs inhibiting COX enzymes produce an anti-inflammatory effect?
results in inhibition of synthesis of prostaglandins from arachidonic acid,
prostaglandin= proinflammatory
Therefore preventing synthesis of prostaglandins reduces inflammation
what do COX-1 enzymes specifically do? relate this to the common side effect on NSAIDs
involved in synthesis of particular prostaglandins that are important for preserving gastric mucosa.
Therefore inhibition of COX-1 has a side effect of causing gastric ulcers
what do COX-2 enzymes specifically do? why were selective-Cox 2 NSAIDs created?
stimulates production of prostaglandins in response to inflammatory stimuli.
this is a more targeted pathway with less side effects
name a selective-Cox 2 NSAID
Celecoxib
list examples of when NSAIDs are needed
post operative pain
pericarditis
Rheumatoid arthritis
gout
headache
acute injury
should NSAIDs be taken in pregnancy and breast feeding?
Avoid in pregnancy. Are associated with increased risk of miscarriage (in first trimester), and a whole host of cardiovascular adverse events in the foetus in the third trimester
Safe in breastfeeding
aside from GI symptoms, what other adverse effects can NSAIDs have?
Renal impairment
Increased risk of cardiovascular events
in short what are diuretics?
drugs that promote increased production of urine
aka. water tablets
what are the 3 main types of diuretic?
which is very potent, moderalty potent and mildly potent?
loop diuretics, = very potent
thiazide diuretics = moderately
potassium-sparing diuretics. = mildly
Each works by affecting a different part of the kidneys.
how do loop diuretics work ?
acts on ascending limb of loop of Henle
inhibits the NKCC2 channels
cause an increase in the excretion of sodium and water
give an example of a loop diuretic
furosemide
give an example of when you would prescribe a loop diuretic
to treat fluid retention eg. a large oedema in the heart
renal impairment
how do thiazide diuretics work?
act on the distal convoluted tubule of nephron
inhibits Na-Cl co transporter
they inhibit reabsorption of sodium and water
give an example of a thiazide diuretic
bendroflumethiazide
give an example of when you would prescribe a thiazide diuretic
to treat hypertension (low dose)
mild oedema
how do potassium-sparing diuretics work?
aldosterone antagonist
acts on aldosterone receptors in the collecting duct (blocks the effects of aldosterone)
increases Na and water excretion and retain K+
relatively weak effect
name a potassium-sparing diuretics
spironolactone
give an example of when you would prescribe a potassium-sparing diuretic
when you want to increase output of water but prevent too much potassium loss
eg. resistant hypertension
what is a risk of taking diuretics?
can cause hypokalaemia (low potassium)
greatest risk in thiazide diuretics
how can you reduce the risk of hypokalaemia when taking loop or thiazide diuretics ?
reduce risk by taking potassium sparing diuretics or KCl supplements
which diuretic is slow acting and long lasting?
which is fast acting but short lasting?
slow acting and long duration of action = thiazide
fast acting but shorter duration of action = loop
what are ACE inhibitors and what are they used for?
Angiotensin-converting-enzyme inhibitors
used to treat hypertension (ie. are anti hypertensive) and heart failure and early renal failure
name an ACE inhibitor
Ramipiril
how do ACE inhibitors work ?
reduce the generation of angiotensin-II, and consequently aldosterone.
leads to reduced na and water retention
reduce blood volume, cause vasodilation, decrease peripheral vascular resistance
inhibits bradykinin breakdown by ACE
why is a side effect of ACE inhibitors a dry cough?
brandykinin accumualtion
what is an unwanted affect of ACE inhibitors?
persistent dry cough
hypotension - rare
renal impairment
what are calcium channel blockers used for?
treat hypertension
they disrupt calcium movement
what is the main side effect of calcium channel blockers (CCBs) and what can this be mistaken for ?
ankle swelling
may be mistaken for heart failure
name a calcium channel blocker
amplodopine
what are PPIs? what do they do?
proton pump inhibitors
prevent H⁺/K⁺ ATPase proton pump
therefore reduce stomach acid production
this reduced acidity in GI lumen
give an example of when you would prescribe a PPI
name the PPI
to relieve symptoms of acid reflux, or gastroesophageal reflux disease (GERD).
eg. Lanzoprazole
what are corticosteroids?
synthetic steroid hormones
anti-inflammatory drugs
name a corticosteroid drug
Prednisolone
give a use of corticosteroids
use inhaled corticosteroids to treat asthma
