Common drugs to explain

Question 1

What is the mechanism of action of warfarin?

Answer 1

Thins the blood
by blocking vitamin K
Which is used by the body to make proteins that cause the blood to clot

Question 2

How do statins work?

Answer 2

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…

Question 3

How does metformin work?

Answer 3

Metformin increases the sensitivity of cells to insulin

So allows the body to make better use of lower insulin levels

Question 4

How do iron tablets work?

Answer 4

They replace your bodys store of iron - a mineral needed to make red blood cells (which is deficient)

Question 5

How do bisphosphonates work?

Answer 5

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

Question 6

When should warfarin be taken?

Answer 6

Once daily - usually in the evening

Question 7

When should statins be taken?

Answer 7

once daily in evening

Question 8

When should metformin be taken?

Answer 8

once daily - with breakfast

may be increased to 2x daily

Question 9

When should iron tablets be taken?

Answer 9

1-3x daily depending on brand [will ask the consultant for the specifics for your care]

Question 10

When should bisphosphonates be taken?

Answer 10

once weekly or smaller dose daily

Question 11

How should you take warfarin?

Answer 11

Tablet(s)

Question 12

How should you take a statin?

Answer 12

tablet

Question 13

How should you take metformin?

Answer 13

take tablet with or immediately after a meal at the same time each day

Question 14

How should you take iron tablets?

Answer 14

Work best if taken on an empty stomach because iron can irritate the stomach

Question 15

How should bisphosphonates be taken?

Answer 15

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)

Question 16

What is the length of treatment for warfarin?

Answer 16

3 months for DVT
6 months for PE
lifelong for AF

Question 17

What is the length of treatment for statin?

Answer 17

Lifelong

Question 18

What is the length of treatment for metformin?

Answer 18

lifelong if it works

Question 19

What is the length of treatment for iron tablets?

Answer 19

Usually ~4 months
3-4 weeks
–> for Hb to normalise

then take for 3 months after that
–> to replenish stores

Question 20

What is the length of treatment for bisphosphonates?

Answer 20

Long term

Question 21

What is the length of time before warfarins effect?

Answer 21

2-3 days

Question 22

What is the length of time before the effect of statins?

Answer 22

decreases risk over many years

Question 23

What is the length of time before effect of iron tablets?

Answer 23

3-4 weeks (hb stabilise)

Question 24

What is the length of effect of bisphosphonates?

Answer 24

long term

Question 25

What are the tests needed for warfarin??

Answer 25

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

Question 26

What are the tests needed for statins?

Answer 26

review in 4w then every 6 months | LFTs before starting, @3months and 12months (as statins cause altered LFTs)

Question 27

What are the tests needed for metformin?

Answer 27

U&Es before starting then annually

Question 28

What are the tests needed for iron?

Answer 28

Hb in 3-4 weeks (to see repletion)

Question 29

What are the tests needed for bisphosphonates?

Answer 29

Dental checkups before starting - then regularly - risk of osteonecrosis of jaw

Question 30

What are the important side effects of warfarin?

Answer 30

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

Question 31

What are the important side effects of statins?

Answer 31

Muscle pains hair loss itching also nausea, sickness diarrhoea, abdo pain

Question 32

What are the important side effects of metformin?

Answer 32

nausea diarrhoea abdo pain weight loss

Question 33

What are the important side effects of iron tablets?

Answer 33

GI irritation (nausea, sickness, dia, abdo pain) coloured stools taste bad

Question 34

What are the important side effects of bisphosphonates?

Answer 34

headache heartburn bloating indigestion (GI: dia/const, black stools, abdo pain)

Question 35

What are the contraindications of warfarin?

Answer 35

pregnancy haemorrhagic stroke significant bleeding caution: patients at high falls risk

Question 36

What are the complications and contraindications of statins?

Answer 36

comp: rhabdomylosis contra: pregnancy

Question 37

What are the complications contraindications of metformin?

Answer 37

Comp: lactic acidosis Contra: renal impairment, Ketoacidosis, low BMI and not have with GA or x ray contrast (inc lactic acidosis risk)

Question 38

What are the complications and contraindications of bisphosphonates?

Answer 38

Comp: osteonecrosis of jaw contra: pregnancy, dysphagia, stomach ulcers, severe renal impairment

Question 39

What is the supplementary advice for warfarin takers?

Answer 39

Avoid liver, spinach, cranberry juice, no alcohol binges no nsaids/aspirin give anticoagulant book

Question 40

What is the supplementary advice for statins?

Answer 40

Avoid grapefruit

Question 41

What is the supplementary advice for metformin?

Answer 41

if miss a dose, take ASAP as remember unless its close to next dose time

Question 42

What is the action of levothyroxine?

Answer 42

A synthetic version of the normal hormone produced by the thyroid gland called thyroxine its given to bring thyroxine levels back up to normal

Question 43

What is the timeline of thyroxine?

Answer 43

once daily before breakfast

Question 44

How do you take thyroxine?

Answer 44

tablet

Question 45

What is the length of treatment with thyroxine?

Answer 45

lifelong

Question 46

What is the amount of time before effects of levothyroxine?

Answer 46

a few weeks

Question 47

What tests need to be done for levothyroxine?

Answer 47

start test dose then review in 2-3 weeks TSH test every 2-3 months until stable when TSH stable = check annually

Question 48

what are the important side effects of levothyroxine?

Answer 48

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

Question 49

What supplementary advice is there for those taking levothyroxine?

Answer 49

you get free prescriptions for everything if you take levothyroxine!