Common drugs to explain Flashcards
What is the mechanism of action of warfarin?
Thins the blood
by blocking vitamin K
Which is used by the body to make proteins that cause the blood to clot
How do statins work?
Statins stop the liver making cholesterol
cholesterol is ONE OF the things that predisposes to artery problems causing heart disease, stroke and kidney disease
its also important to address other risk factors…
How does metformin work?
Metformin increases the sensitivity of cells to insulin
So allows the body to make better use of lower insulin levels
How do iron tablets work?
They replace your bodys store of iron - a mineral needed to make red blood cells (which is deficient)
How do bisphosphonates work?
Prevent the bone from being broken down and by helping to rebuild new bone lifestyle factors can also help with this, including: no smoking (we can help) and eating a well balanced diet
When should warfarin be taken?
Once daily - usually in the evening
When should statins be taken?
once daily in evening
When should metformin be taken?
once daily - with breakfast
may be increased to 2x daily
When should iron tablets be taken?
1-3x daily depending on brand [will ask the consultant for the specifics for your care]
When should bisphosphonates be taken?
once weekly or smaller dose daily
How should you take warfarin?
Tablet(s)
How should you take a statin?
tablet
How should you take metformin?
take tablet with or immediately after a meal at the same time each day
How should you take iron tablets?
Work best if taken on an empty stomach because iron can irritate the stomach
How should bisphosphonates be taken?
swallow tablet with full glass of water
take at least 30 mins before food or anything other than water
be upright for 30mins after swallowing (no sitting)
What is the length of treatment for warfarin?
3 months for DVT
6 months for PE
lifelong for AF
What is the length of treatment for statin?
Lifelong
What is the length of treatment for metformin?
lifelong if it works
What is the length of treatment for iron tablets?
Usually ~4 months
3-4 weeks
–> for Hb to normalise
then take for 3 months after that
–> to replenish stores
What is the length of treatment for bisphosphonates?
Long term
What is the length of time before warfarins effect?
2-3 days
What is the length of time before the effect of statins?
decreases risk over many years
What is the length of time before effect of iron tablets?
3-4 weeks (hb stabilise)
What is the length of effect of bisphosphonates?
long term
What are the tests needed for warfarin??
INR test on day 5 and 8 then adjust dose accordingly
started concomitantly w/ LMWH if immediate effect if required
then, regular INR checks by anticoagulation clinic. Regularity determined by INR stability
What are the tests needed for statins?
review in 4w then every 6 months
LFTs before starting, @3months and 12months (as statins cause altered LFTs)
What are the tests needed for metformin?
U&Es before starting then annually
What are the tests needed for iron?
Hb in 3-4 weeks (to see repletion)
What are the tests needed for bisphosphonates?
Dental checkups
before starting - then regularly
- risk of osteonecrosis of jaw
What are the important side effects of warfarin?
Bleeding (1-2%)
tell dr if any unusual bleeding e.g. bruises, dark stools, cuts take longer to heal
diarrhoea, rash, hair loss, nausea
Many drug interactions
mainly with cytochrome p450 inhibitors/inducers, steroids
What are the important side effects of statins?
Muscle pains
hair loss
itching
also nausea, sickness diarrhoea, abdo pain
What are the important side effects of metformin?
nausea
diarrhoea
abdo pain
weight loss
What are the important side effects of iron tablets?
GI irritation
(nausea, sickness, dia, abdo pain)
coloured stools
taste bad
What are the important side effects of bisphosphonates?
headache
heartburn
bloating
indigestion (GI: dia/const, black stools, abdo pain)
What are the contraindications of warfarin?
pregnancy
haemorrhagic stroke
significant bleeding
caution: patients at high falls risk
What are the complications and contraindications of statins?
comp: rhabdomylosis
contra: pregnancy
What are the complications contraindications of metformin?
Comp: lactic acidosis
Contra: renal impairment, Ketoacidosis, low BMI and not have with GA or x ray contrast (inc lactic acidosis risk)
What are the complications and contraindications of bisphosphonates?
Comp: osteonecrosis of jaw
contra: pregnancy, dysphagia, stomach ulcers, severe renal impairment
What is the supplementary advice for warfarin takers?
Avoid liver, spinach, cranberry juice, no alcohol binges
no nsaids/aspirin
give anticoagulant book
What is the supplementary advice for statins?
Avoid grapefruit
What is the supplementary advice for metformin?
if miss a dose, take ASAP as remember unless its close to next dose time
What is the action of levothyroxine?
A synthetic version of the normal hormone produced by the thyroid gland called thyroxine
its given to bring thyroxine levels back up to normal
What is the timeline of thyroxine?
once daily before breakfast
How do you take thyroxine?
tablet
What is the length of treatment with thyroxine?
lifelong
What is the amount of time before effects of levothyroxine?
a few weeks
What tests need to be done for levothyroxine?
start test dose then review in 2-3 weeks
TSH test every 2-3 months until stable
when TSH stable = check annually
what are the important side effects of levothyroxine?
rare when thyroxine level is stable as its replacing a normal hormone
there may be hyperthyroid symptoms if the level is too high - vomiting, diarroea, headache, palpitations, heat intolerance
or hypo thyroid is the level is too low
What supplementary advice is there for those taking levothyroxine?
you get free prescriptions for everything if you take levothyroxine!
