Medications Flashcards
(33 cards)
What is the action of warfarin?
It thins the blood by blocking vitamin K. This is the vitamin used by the body to make proteins that cause the blood to clot. Allows blood flow through your veins more easily so you’re less likely to develop a blood clot.
What is the treatment course of warfarin?
- Usually take once daily in the evening as a tablet (also comes as a liquid)- doesn’t need to be taken alongside food
- 3 months for DVT, 6 months for PE, lifelong for AF
- Start 5mg for 4 days, then test INR on day 5 and 8, adjusting dose accordingly.
- If forget dose, take when remember, write it down in yellow book, but if it’s the next day skip the dose and take normal dose at same time
- It is started concomitantly with LMWH if immediate effect is required.
- Then, regular INR checks by anticoagulation clinic with yellow book (regularity determined by INR stability) - to thin blood but not stop in clotting completely so need to get levels right
What are the normal side effects of warfarin?
Bleeding (1-2%) - bruises, cuts take longer to heal, menorrhagia, nosebleeds. Also diarrhoea, rash, hair loss and nausea.
What are the contraindications of warfarin?
- Pregnancy
- Haemorrhagic stroke
- Significant bleeding e.g. stomach ulcer
- Cautions: patients at high falls risk
What are statins?
Statins stop the liver making cholesterol. Cholesterol is one of the things which predisposes to artery problems causing heart disease, stroke and kidney disease.
What is the treatment course for statins?
- Once daily in the evening as tablet form (simvastatin 40mg, atorvastatin 20mg)
- Lifelong
- Review in 4 weeks, then every 6 months
- LFT’s before starting, at 3 months and 12 months (statins cause altered LFTs)
- Never take 2 doses at same time
What are important side effects of statins?
- Muscle pains
- Hair loss
- Itching
- Also nausea, sickness, diarrhoea, abdo pain
What are the complications and contraindications of statins?
Complications - rhabdomyolysis
Contraindications - pregnancy
What is mechanism of action of metformin?
Increases the sensitivity of cells to insulin, thereby allowing the body to make better use of the lower insulin levels and so lowers your blood sugar.
What is the treatment course for metformin?
- Once daily with breakfast (500mb OD, increase dose by 500mg weekly to 500-800mg 3x daily with meals)
- Take tablet with or immediately after a meal at the same time each day
- Lifelong if it works - can come off it if improve lifestyle enough
- U&E’s before starting, then annually
- If forget doses, take next dose on time, do not take a double dose
- To prevent hypoglycaemia eat regular meals, eat more carbs if planning more exercise, carry fast-acting carbs e.g. fruit juice
What are the side effects of metformin?
Nausea, diarrhoea, abdo pain, weight loss (anorexia), metallic taste in mouth, lactic acidosis
Take with meals to reduce these
What are the contraindications of metformin?
- Renal or hepatic impairment
- Ketoacidosis
- Low BMI
- Being treated for HF or have recently had a heart attack
- Drink a lot of alcohol
- Must not be taken on day of, and for 2 days after, having general anaesthetic or x-ray contrast media (increase lactic acidosis risk)
What is levothyroxine?
A synthetic version of the normal hormone produced by the thyroid gland called thyroxine. It is given to bring your thyroid levels back up to normal.
What is the treatment course for levythyroxine?
- Once daily before breakfast as a tablet (50-100 micro grams - can be adjusted in 25-50 micro gram increments) - is available in liquid form
- Lifelong
- Start test dose then review in 2-3 weeks, TSH test every 2-3 months until stable, then check annually.
- Do not take 2 doses together if forgotten a dose
What are side effects of levythyroxine?
Rare as replacing levels of normal hormone. May be hyperthyroid symptoms if level is too high (vomiting, diarrhoea, headache, palpitations, heat intolerance) or hypothyroid symptoms if level is too low.
What are examples of TDM drugs?
- Aminoglycoside antibiotics (gentamicin)
- Antiepileptics (carbamazepine, phenytoin, valproic acid)
- Mood stabilisers (lithium)
- Antipsychotic (pimozide, clozapine)
- Digoxin
- Ciclosporin, tacroliumus (transplant patients)
- Theophylline (aminophylline)
What are the common side effects of ACEi?
- Dry cough
- Angioedema
- Hyperkalaemia
- Hypotension
What is the ACEi treatment?
- After starting and each dose change U&E’s must be checked to ensure there has been no significant rise in creatinine.
- 20-25% rise is acceptable. If there is a rise blood should be checked regularly to ensure no further increase.
- 1.25mg OD ramipril, titrated up to 10mg - tablets and liquid
- Usually take first dose before bed then any time, same time each day
What are the contraindications for ACEi?
Pregnancy
Alternative antihypertensive medications should be considered if planning a pregnancy.
What is the action of aldosterone antagonists?
Spironolactone/eplerenone
- Inhibit reabsorption of Na + water which means decrease BP and K excretion
- SE: hyperkalaemia (muscle weakness)
- Spironolactone with food 25mg OD for HF
- Monitor U+E and serum K
Describe aspirin treatment
- ACS: loading dose of 300mg - 75mg OD long-term (take after food)
- SE: indigestion, bleeding more easily, peptic ulcers
- Contraindications: children <16, 3rd trimester pregnancy
Describe ADP receptor antagonists
Clopidogrel/ticagrelor
- Prevents formation of a dangerous blood clot, risk is higher if you’ve had MI, unstable angina
- SE: bleeding, dyspepsia, diarrhoea, abdominal pain
- Report any sustained bleeding
- Irreversible: 7-10 days to wear off, loading dose 300mg in ACS then 75mg maintenance OD (tablets only)
Describe beta blocker treatment
Bisoprolol, atenolol, carvedilol
- Action via beta 1 receptors, prevents future heart disease, MI, stroke
- Indications: IHD, HF, AF, SVT, HTN
- SE: impotence, fatigue, headache, dizzy/weak, cold hands/feet
- Contraindications: asthma, heart block
- Dose taken same time each day - OD in morning
- HF may have risk of initial deterioration in symptoms (seek help)
Describe calcium channel blockers
Amlodipine, verapamil
- Lowers BP and makes it easier for heart to pump blood around body
- Indications: HTN, stable angina, SV Arrhythmias
- SE: ankle oedema, flushing, headache
- Contraindications: unstable angina, severe AS
- Example: HTN amlodipine 5-10mg OD tablet or liquid
