drug of the day Flashcards
losartan
TREAT: high blood pressure and heart failure, diabetic neuropathy
CLASS: DIURETIC; angiotensin II receptor blocker (ARB) in collecting duct
**MECHANISM: ** it prevents angiotensin II actions (vasoconstriction, water retention) so more blood flow
ADVERSE drug effects: hypotension, hyperkalaemia (decreased Na to distal tubule, so more K intake), angioedema
people to avoid: pregnant women, hepatic issues, renal impairments
DRUG - DRUG interactions K sparing diuretics (hyperkalaemia), lithim, NSAIDs
Indapamide
**TREAT: ** Treat high blood pressure (type 2 diabetes), heart failure, odema
**CLASS: **: thiazide loop diuretic that works in the distal tubule
MECHANISM: inhibits NA/cl transporter, cant enter epithelium and water follows
**ADVERSE drug effects: ** hyperuricaemia (high uric acid levels), hypokalemia, hyperglycemia (reduces insulin production due to reduced K levels), hypercalcemia (increase in Na/Ca channels
people to avoid: addisons (no aldosterone so very little Na reabsorbed), hyponatremia, hypercalcemia, hypokalemia
DRUG-DRUG interactions : alcohol, amlodipine (Ca channel blocker)
why is it recommeded to take in the morning? so you dont have to urinate in the night
Amlodipine
CLASS: di hydropyridine calcium channel blocker
ROLE: lowers the blood pressure, relaxing blood vessels, used in coronary heart diseases, has a long half life
**ADVERSE SIDE EFFECTS: **peripheral oedema, flushing and headaches (vasodilation), palpitations (compensatory tachycardia)
**PEOPLE to AVOID: **unstable angina, severe aortic stenosis
DRUG reactions: avoid giving with simvastatin as it enhances the statin
non centrally as it works on the blood vessels
atorvostatin
CLASS: HMG-CoA reductase inhibitor prevents cholesterol production.
ROLE: treats hyperlipdaemia, high cholesterol, prevent heart disease
**ADVERSE side reactions: ** GI disruption, nausea, myalgia, rhabdomyolysis (rare)
People to avoid: pregnancy (cholestrol needed in baby), breastfeeding
DRUG interactions macrolides (antibiotics) inhibit the breakdown of statins, amlodipine (increases plasma statin)
-> normally first line defence
spirinolactone
CLASS: mineralcorticoid (aldosterone) receptor antagonist (3rd line use) potassium sparing
MOA: acts on the DC, Acts on the NA/K pump reducing reabsorption of NA
ROLE: treats hypertension, oedema
**ADVERSE side reactions: ** hyperkalemia, gynaecomastia (reduces testosterone production, testosterone -> estradiol)
PEOPLE to avoid: hyperkalemia, addisions
ADVERSE DRUG REACTIONS : high K drugs, pregnancy (effect male foetus)
A and B blockers would be considered instead if high K
Verampil
CLASS: IV anti-arrhythmic agent (arrhythmia, angina, hypertenison) L type Ca channel blocker
ROLE: atrial fib, flutter, supraventricular tachycardia, hypertension and angina
MOA: binds to a1 receptors instead of Ca channels, negative inotropic and chonotropic effects, prolongs AP and ERP
ADVERSE effects: constipation, bradycardia, heartblock, cardiac failure
PEOPLE to avoid: poor LV function (due to reduced contractility), AV conduction delay
DRUG-DRUG interactions: B-blockers, antihypertensives, antiarrhythmic
-> mainly acts on the heart
-> NON DIHYDROPYRADINE (less of an effect on vasodilation, more of an effect on the heart)
amiodarone
**CLASS: **class 3 antiarrhythmic drug
ROLE: arrhythmia, decrease blood pressure
**MECHANISM OF ACTION: **Blocks K channels, delays repolarisation and elongates ERP and AP, reducing excitability
**ADVERSE EFFECTS: **pulmonary fibrosis, hepatic injury, increased LDL, thyroid disease
PEOPLE to avoid: pregnant, people allergic to iodine, AV block, 2/3rd degree heartblock without pacemaker
DRUG-DRUG interactions: inhibit hepatic metabolism, reduces plasma conc of warfarin and digoxin (class 1 antiarrythmic drugs), B blockers and ca blockers
**contradicted in thyroid disease: ** has high iodine effect, directly toxic to thyroid
ezetimibe
CLASS: inhibits NPC1L1 transporters at brush border of the small intestine
**MECHANISM: **reduces the absorption
of cholesterol by 50% (apposed to statin that prevent the synthesis)
ADVERSE EFFECTS: gi upset, angioedema
**PEOPLE to avoid: **hepatic failure -> pro drug that requires hepatic metabolism, enterohepatic circulation
DRUG-DRUG intercations: statin (rhabdomyolsis)
can be cmbined with statin (use a lower dose of statin)
taken as a pill
dapagliflozin
CLASS: Gliflozins (SGLT-2 inhibitors)
TREAT: add on therapy for T11DM, HFrEF, heart failure (reduce amount of blood)
MECHANISM: reduce glucose reabsorption in proximal tubule and increase glucose excretion
ADVERSE EFFECTS: UTI, genital infection, (more glucose leaving = more food for bacteria to grow) thirst and polyuria, pancreatitis, hypovolemia
DRUG-DRUG interactions: antihypertensive meds and hypoglycemic agents
clopidogrel
CLASS: ADP receptor antagonist
ROLE: anti-platelet medication, heart attack, stroke
MECHANISM OF ACTION: irreversible inhibitor prevents binding of ADP to P2Y12 receptor, preventing action of glycoprotien receptors GPIIb/IIIa on platelet, inhibiting platelt aggregation. Pro-drug so requires liver to activate
ADVERSE EFFECTS: bleeding, Gi upset, dyspepsia and diarrohea
PEOPLE to avoid: hepatic and renal impairments
DRUG-DRUG interaction: requires CYPs for activation so cant give CYP inhibiting drugs (omeprazole, ciprofloaxacin) Trigrelor can intercat with some CYPs, NSAIDS
If having a surgery it is better to stop this medication a week before to avoid heammorage
semaglutide
CLASS: GLP-1 (glucagon like peptide) receptor agonist (incretin mimetics)
MECHANISM OF ACTION: increase glucose dependent synthesis of insulin from B Cells/ More insulin produced and reduce amount of glucose being produced by liver when its not needed
**ROLE: **anti-diabetic medication, weightloss
ADVERSE EFFECTS: GI upset, reduced appetite
PEOPLE to avoid: renal impairment
**DRUG-DRUG interactions: **hypoglycaemic agents
given subcutaneously;- protein so will get digested
how does semaglutide reduce apetite
GLP-1 also slows down the rate at which food moves through your stomach, which helps you feel full and reduces your appetite.
it also slows down the rate at which food moves through the stomach, which can help to reduce appetite and promote weight loss.
flecainide
CLASS: 1c antiarrhythmetic drug
MECHANISM of action: it blocks Na channels so substantially slows down phase 0, increasing action potential duration and refactory period
ROLE: atrial fibrillation and paroxysmal supraventricular tachycardia, Wolff parkinson-White syndrome
ADVERSE EFFECTS: flecainide flutter (can convery Afib to Aflutter, GI upset, chronic use = pro-arrhythmia
**PEOPLE to avoid: ** (reduces inoptropic effects) so: Coronary artery disease, reduced EJFR
DRUG-DRUG interactions given with atenolol can increase bradycardia
aspirin as a blood thinner
CLASS: irreversible COX-1 inhibitor, antiplatelet
MOA: blocks arachidonic acid and thromboxane forming platelets
ROLE: blood thinner (AF, 2nd prevention of stoke, TIA, ACS), analgesic, N/STEMI
ADVERSE EFFECTS: GI ulcer, haemmorage, GI irritation
PEOPLE to avoid: reyes syndrome, 3rd trimester ( premature close of ductus arteriosus -> Pa-aorta)
DRUG-DRUG interactions: antiplatlets and anticoagulants
-> has the lifespan of a platelet (7days)
celecoxib
CLASS: NSAID, Cox2 inhibitor, to avoid homeostatic adverse effects with cox-1 inhibitors
MOA: inhibits Cox2 so prevents formation of PGI2 -> inhibits: platelet aggregation, vasodialation. only supresses prostaglandin without thromboxane A2
ROLE: relieve pain (arthritis), reduce swelling and stiffness
PEOPLE TO AVOID: people in need of vasodialation (CKD, hert failure, renal perfusion)
ADVERSE effects: increase risk of MI, anaphylaxis
DRUG-DRUG interactions: avoid with sterioids, blood thinners
