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2a- pharmacology lectures > Common drugs and side effects - blood thinners, NSAIDs, ACEis, diuretics, Beta blockers, CCBs, PPIs > Flashcards

Common drugs and side effects - blood thinners, NSAIDs, ACEis, diuretics, Beta blockers, CCBs, PPIs Flashcards

1
Q

what are DOACs?

A

Direct oral anticoagulants

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2
Q

name 2 DOACs

A

apixaban

Rivaroxaban

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3
Q

how to DOACs work

A

they inhibit clotting factor 10a

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4
Q

how does warfarin work?

A

inhibits 10,9,7,2

ie. the vitamin K dependent factors (1972)

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5
Q

what are LMWHs?

A

Low-molecular-weight heparins

type of anticoagulants

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6
Q

how do LMWHs work?

A

inhibits clotting factor 10 and thrombin

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7
Q

name a LMWH

A

dalteparin,

enoxaparin

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8
Q

name the class of anticoagulant (blood thinners) that are fibrinolytic drugs

A

alteplase (IV)

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9
Q

how to Alteplase drugs work?

A

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

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10
Q

how do antiplatlet drugs work?

A

inhibit P2Y12

stops platelets from sticking together to form the primary platelet plug

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11
Q

name an antiplatlet drug

A

clopidogrel

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12
Q

summarise the 5 groups of blood thinners you need to be aware of

A

DOACs

warfarin

LMWH

alteplase (VI)

antiplatlets

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13
Q

list some conditions in which you would need to prescribe blood thinners

A

AF

DVT/PE

prosthetic valves

bleeding disorders

ischemic stroke

myocardial infarction

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14
Q

what are NSAIDs?

A

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

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15
Q

give an example of a NSAID

A

Ibuprofen,

naproxen

aspirin

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16
Q

what enzymes do NSAIDs inhibit?

A

Cox-1 and Cox-2

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17
Q

what do COX enzymes do? (in general)

A

involved in synthesis of prostaglandins from arachidonic acid

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18
Q

why does NSAIDs inhibiting COX enzymes produce an anti-inflammatory effect?

A

results in inhibition of synthesis of prostaglandins from arachidonic acid,

prostaglandin= proinflammatory

Therefore preventing synthesis of prostaglandins reduces inflammation

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19
Q

what do COX-1 enzymes specifically do? relate this to the common side effect on NSAIDs

A

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

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20
Q

what do COX-2 enzymes specifically do? why were selective-Cox 2 NSAIDs created?

A

stimulates production of prostaglandins in response to inflammatory stimuli.

this is a more targeted pathway with less side effects

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21
Q

name a selective-Cox 2 NSAID

A

Celecoxib

22
Q

list examples of when NSAIDs are needed

A

post operative pain

pericarditis

Rheumatoid arthritis

gout

headache

acute injury

23
Q

should NSAIDs be taken in pregnancy and breast feeding?

A

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

24
Q

aside from GI symptoms, what other adverse effects can NSAIDs have?

A

Renal impairment
Increased risk of cardiovascular events

25
Q

in short what are diuretics?

A

drugs that promote increased production of urine

aka. water tablets

26
Q

what are the 3 main types of diuretic?

which is very potent, moderalty potent and mildly potent?

A

loop diuretics, = very potent
thiazide diuretics = moderately
potassium-sparing diuretics. = mildly

Each works by affecting a different part of the kidneys.

27
Q

how do loop diuretics work ?

A

acts on ascending limb of loop of Henle

inhibits the NKCC2 channels

cause an increase in the excretion of sodium and water

28
Q

give an example of a loop diuretic

A

furosemide

29
Q

give an example of when you would prescribe a loop diuretic

A

to treat fluid retention eg. a large oedema in the heart

renal impairment

30
Q

how do thiazide diuretics work?

A

act on the distal convoluted tubule of nephron

inhibits Na-Cl co transporter

they inhibit reabsorption of sodium and water

31
Q

give an example of a thiazide diuretic

A

bendroflumethiazide

32
Q

give an example of when you would prescribe a thiazide diuretic

A

to treat hypertension (low dose)

mild oedema

33
Q

how do potassium-sparing diuretics work?

A

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

34
Q

name a potassium-sparing diuretics

A

spironolactone

35
Q

give an example of when you would prescribe a potassium-sparing diuretic

A

when you want to increase output of water but prevent too much potassium loss

eg. resistant hypertension

36
Q

what is a risk of taking diuretics?

A

can cause hypokalaemia (low potassium)

greatest risk in thiazide diuretics

37
Q

how can you reduce the risk of hypokalaemia when taking loop or thiazide diuretics ?

A

reduce risk by taking potassium sparing diuretics or KCl supplements

38
Q

which diuretic is slow acting and long lasting?

which is fast acting but short lasting?

A

slow acting and long duration of action = thiazide

fast acting but shorter duration of action = loop

39
Q

what are ACE inhibitors and what are they used for?

A

Angiotensin-converting-enzyme inhibitors

used to treat hypertension (ie. are anti hypertensive) and heart failure and early renal failure

40
Q

name an ACE inhibitor

A

Ramipiril

41
Q

how do ACE inhibitors work ?

A

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

42
Q

why is a side effect of ACE inhibitors a dry cough?

A

brandykinin accumualtion

43
Q

what is an unwanted affect of ACE inhibitors?

A

persistent dry cough

hypotension - rare

renal impairment

44
Q

what are calcium channel blockers used for?

A

treat hypertension

they disrupt calcium movement

45
Q

what is the main side effect of calcium channel blockers (CCBs) and what can this be mistaken for ?

A

ankle swelling
may be mistaken for heart failure

46
Q

name a calcium channel blocker

A

amplodopine

47
Q

what are PPIs? what do they do?

A

proton pump inhibitors

prevent H⁺/K⁺ ATPase proton pump

therefore reduce stomach acid production

this reduced acidity in GI lumen

48
Q

give an example of when you would prescribe a PPI

name the PPI

A

to relieve symptoms of acid reflux, or gastroesophageal reflux disease (GERD).

eg. Lanzoprazole

49
Q

what are corticosteroids?

A

synthetic steroid hormones

anti-inflammatory drugs

50
Q

name a corticosteroid drug

A

Prednisolone

51
Q

give a use of corticosteroids

A

use inhaled corticosteroids to treat asthma

2a- pharmacology lectures (12 decks)

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