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

Question 1

what are DOACs?

Answer 1

Direct oral anticoagulants

Question 2

name 2 DOACs

Answer 2

apixaban

Rivaroxaban

Question 3

how to DOACs work

Answer 3

they inhibit clotting factor 10a

Question 4

how does warfarin work?

Answer 4

inhibits 10,9,7,2

ie. the vitamin K dependent factors (1972)

Question 5

what are LMWHs?

Answer 5

Low-molecular-weight heparins

type of anticoagulants

Question 6

how do LMWHs work?

Answer 6

inhibits clotting factor 10 and thrombin

Question 7

name a LMWH

Answer 7

dalteparin,

enoxaparin

Question 8

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

Answer 8

alteplase (IV)

Question 9

how to Alteplase drugs work?

Answer 9

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

Question 10

how do antiplatlet drugs work?

Answer 10

inhibit P2Y12

stops platelets from sticking together to form the primary platelet plug

Question 11

name an antiplatlet drug

Answer 11

clopidogrel

Question 12

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

Answer 12

DOACs

warfarin

LMWH

alteplase (VI)

antiplatlets

Question 13

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

Answer 13

AF

DVT/PE

prosthetic valves

bleeding disorders

ischemic stroke

myocardial infarction

Question 14

what are NSAIDs?

Answer 14

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

Question 15

give an example of a NSAID

Answer 15

Ibuprofen,

naproxen

aspirin

Question 16

what enzymes do NSAIDs inhibit?

Answer 16

Cox-1 and Cox-2

Question 17

what do COX enzymes do? (in general)

Answer 17

involved in synthesis of prostaglandins from arachidonic acid

Question 18

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

Answer 18

results in inhibition of synthesis of prostaglandins from arachidonic acid,

prostaglandin= proinflammatory

Therefore preventing synthesis of prostaglandins reduces inflammation

Question 19

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

Answer 19

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

Question 20

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

Answer 20

stimulates production of prostaglandins in response to inflammatory stimuli.

this is a more targeted pathway with less side effects

Question 21

name a selective-Cox 2 NSAID

Answer 21

Celecoxib

Question 22

list examples of when NSAIDs are needed

Answer 22

post operative pain

pericarditis

Rheumatoid arthritis

gout

headache

acute injury

Question 23

should NSAIDs be taken in pregnancy and breast feeding?

Answer 23

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

Question 24

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

Answer 24

Renal impairment
Increased risk of cardiovascular events

Question 25

in short what are diuretics?

Answer 25

drugs that promote increased production of urine aka. water tablets

Question 26

what are the 3 main types of diuretic? which is very potent, moderalty potent and mildly potent?

Answer 26

loop diuretics, = very potent thiazide diuretics = moderately potassium-sparing diuretics. = mildly Each works by affecting a different part of the kidneys.

Question 27

how do loop diuretics work ?

Answer 27

acts on ascending limb of loop of Henle inhibits the NKCC2 channels cause an increase in the excretion of sodium and water

Question 28

give an example of a loop diuretic

Answer 28

furosemide

Question 29

give an example of when you would prescribe a loop diuretic

Answer 29

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

Question 30

how do thiazide diuretics work?

Answer 30

act on the distal convoluted tubule of nephron inhibits Na-Cl co transporter they inhibit reabsorption of sodium and water

Question 31

give an example of a thiazide diuretic

Answer 31

bendroflumethiazide

Question 32

give an example of when you would prescribe a thiazide diuretic

Answer 32

to treat hypertension (low dose) mild oedema

Question 33

how do potassium-sparing diuretics work?

Answer 33

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

Question 34

name a potassium-sparing diuretics

Answer 34

spironolactone

Question 35

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

Answer 35

when you want to increase output of water but prevent too much potassium loss eg. resistant hypertension

Question 36

what is a risk of taking diuretics?

Answer 36

can cause hypokalaemia (low potassium) greatest risk in thiazide diuretics

Question 37

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

Answer 37

reduce risk by taking potassium sparing diuretics or KCl supplements

Question 38

which diuretic is slow acting and long lasting? which is fast acting but short lasting?

Answer 38

slow acting and long duration of action = thiazide fast acting but shorter duration of action = loop

Question 39

what are ACE inhibitors and what are they used for?

Answer 39

Angiotensin-converting-enzyme inhibitors used to treat hypertension (ie. are anti hypertensive) and heart failure and early renal failure

Question 40

name an ACE inhibitor

Answer 40

Ramipiril

Question 41

how do ACE inhibitors work ?

Answer 41

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

Question 42

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

Answer 42

brandykinin accumualtion

Question 43

what is an unwanted affect of ACE inhibitors?

Answer 43

persistent dry cough hypotension - rare renal impairment

Question 44

what are calcium channel blockers used for?

Answer 44

treat hypertension they disrupt calcium movement

Question 45

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

Answer 45

ankle swelling may be mistaken for heart failure

Question 46

name a calcium channel blocker

Answer 46

amplodopine

Question 47

what are PPIs? what do they do?

Answer 47

proton pump inhibitors prevent H⁺/K⁺ ATPase proton pump therefore reduce stomach acid production this reduced acidity in GI lumen

Question 48

give an example of when you would prescribe a PPI name the PPI

Answer 48

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

Question 49

what are corticosteroids?

Answer 49

synthetic steroid hormones anti-inflammatory drugs

Question 50

name a corticosteroid drug

Answer 50

Prednisolone

Question 51

give a use of corticosteroids

Answer 51

use inhaled corticosteroids to treat asthma