Stage 2 drugs

Q: What class do Ramipril and Lisinopril belong?

ACE Inhibitors

Q: What is the mechanism of ACE inhibitors?

Inhibit ACE(angiotensin-converting enzyme) → decrease angiotensin II → vasodilation and decreased aldosterone

What are common indications of ACE inhibtors?

Hypertension, heart failure, post-MI, diabetic nephropathy

Name common side effects of ace inhibitor

Dry cough, hyperkalaemia, hypotension, angioedema, renal impairment

Contraindications of ACE inhibtors

Pregnancy, history of angioedema, bilateral renal artery stenosis

Key counselling points of ace inhibitor

Monitor BP, renal function, and potassium. Can cause dizziness initially. Avoid salt substitutes.

What do ARBs stand for?

Angiotensin II Receptor Blocker

ARBs example

• Losartan

• Candesartan

What is the mechanism of ARBs?

Block angiotensin II receptors → vasodilation and decreased aldosterone

What are ARBs they used for?

Hypertension, heart failure, CKD (if ACEIs not tolerated)

Side effects of ARB?

Hyperkalaemia, hypotension(less cough than ACEi), renal impairment

Counselling point of ARB?

Regular monitoring of renal function and potassium. Avoid salt substitutes. avoid potassium-rich salt substitutes

ARBs contraindication

Pregnancy, bilateral renal artery stenosis

Beta Blockers Examples

• Atenolol

• Bisoprolol

• Propranolol)

Beta Blockers Drug Class

Beta-Adrenergic Receptor Antagonists

Beta Blockers mechanism of action

Block β1 ± β2 receptors → decrease heart rate and contractility

Beta Blockers Indications

Hypertension, angina, heart failure, arrhythmias, anxiety (propranolol)

Beta Blockers Side effects

Bradycardia, fatigue, cold extremities, bronchospasm

Beta Blockers Contraindications

Asthma, heart block

Beta Blockers Counselling Point

Don’t stop suddenly; may mask signs of hypoglycaemia

Dihydropyridine CCBs example

• Amlodipine

• Felodipine

• Nifedipine

Dihydropyridine CCBs mechanism

Block L-type calcium channels → vasodilation

Dihydropyridine CCBs Indication

Hypertension, angina

Dihydropyridine CCBs Side Effects

Ankle oedema, flushing, headache

Dihydropyridine CCBs Counselling Points

May cause ankle swelling; take daily

Furosemide Drug Class

Loop diuretic

Furosemide mechanism

Blocks Na⁺/K⁺/2Cl⁻ transporter in loop of Henle → diuresis

Loop diuretic indication

Oedema due to heart failure, liver or renal disease

Loop Diuretic Side Effect

Hypokalaemia, dehydration, ototoxicity

Loop Diuretic Counselling point

Take in morning; monitor renal function and electrolytes

GTN spray drug class

Nitrate (vasodilator)

GTN spray mechanism

Releases NO → vasodilation (mostly venous)

GTN spray indication

Acute angina

GTN spray Side Effects

Headache, hypotension, dizziness

GTn spray counselling points

Sit down during use; if no relief after 3 sprays, call 999

H. pylori Eradication Therapy

What drugs are used?

PPI + amoxicillin + clarithromycin/metronidazole

H. pylori Eradication Therapy

Mechanism?

Antibiotics kill H. pylori; PPI reduces acid

H. pylori Eradication Therapy

Indication?

Peptic ulcer disease

H. pylori Eradication Therapy

Side effects?

Nausea, diarrhoea, taste disturbance

H. pylori Eradication Therapy

Counselling point?

Complete full course; avoid alcohol with metronidazole

NSAIDs

drug class

Non-steroidal anti-inflammatory Drugs

NSAIDs examples

• Ibuprofen

• Naproxen

• Aspirin

NSAIDs mechanism

Inhibit COX enzymes → decrease prostaglandins → less pain/inflammation

NSAIDs Indications

Pain, inflammation, arthritis

NSAIDs Side effects?

GI upset, ulcers, renal impairment

NSAIDs Counselling Points

Take with food; caution with long-term use

LABAs + ICS examples

Salmeterol + Fluticasone

LABAs + ICS drug class

Long-acting beta agonist + inhaled steroid

LABAs + ICS

LABA = bronchodilation; ICS = anti-inflammatory

LABAs + ICS

indications

Asthma, COPD

LABAs + ICS Side Effects

Tremor, oral thrush

LABAs + ICS Counselling point?

Rinse mouth after use; use daily

LAMAs class

Long-acting muscarinic antagonist

LAMAs example

Tiotropium

LAMAs Mechanism?

Blocks M3 receptors → bronchodilation

LAMAs Indication

COPD, severe asthma

LAMAs Side Effects

Dry mouth, constipation

LAMAs Counselling Points

Not for acute symptoms; use daily

Inhaled Steroids Drug Class

Inhaled corticosteroids

Inhaled corticosteroids examples

• Beclomethasone

• Fluticasone

Inhaled Corticosteroids Indication

Asthma, COPD (moderate-severe)

Inhaled Corticosteroids Side Effects

Oral thrush, hoarseness

Inhaled Corticosteroids Counselling Points

Rinse mouth after use; use daily even if asymptomatic

NOACs / DOACs drug class

Direct oral anticoagulants

NOACs / DOACs examples

• Apixaban

• Rivaroxaban

• Edoxaban

• Dabigatran

NOACs / DOACs Mechanism

Inhibit Factor Xa (or thrombin for dabigatran) → prevent clot formation

NOACs / DOACs Indications

AF, DVT, PE prevention/treatment

NOACs / DOACs Side effects?

Bleeding, GI upset

Counselling point?

Take consistently; no INR needed; monitor renal function

Prednisolone drug class

Oral corticosteroid

Prednisolone mechanism

Suppresses inflammation and immune response

Predinisolone side effects

Weight gain, mood changes, insomnia, osteoporosis

Prednisolone Indications

Asthma/COPD exacerbation, autoimmune conditions

Prednisolone Counselling Points

Take in morning with food; taper if long-term; carry steroid card

Omeprazole Drug Class

Proton Pump Inhibitors

Proton Pump Inhibitors examples

• Omeprazole

• Lansoprazole

• Esomeprazole

Proton Pump Inhibitors Indications

GORD, peptic ulcers, H. pylori eradication

Proton Pump Inhibitors Mechanism

Inhibit H⁺/K⁺ ATPase in parietal cells → decrease gastric acid secretion

Proton Pump Inhibitors Side Effects

Headache, diarrhoea, long-term osteoporosis risk

Proton Pump Inhibitors Counselling Points

Take before meals; monitor for deficiencies if long-term

Gaviscon (Sodium Alginate + Calcium/Magnesium Carbonate)

Drug Class

Alginates and antacids

Alginates and antacids indication

GORD, dyspepsia

Alginates and antacids Mechanism

Forms a raft on gastric contents; neutralises acid

Alginates and antacids side effects

Bloating, belching, constipation/diarrhoea

Alginates and antacids Counselling point?

Take after meals and before bed; space from other meds

Salbutamol drug class

Short-acting beta-2 agonist

SABA example

Salbutamol

SABA mechanism

Stimulates β2 receptors → bronchodilation

SABA indication

Acute asthma, COPD exacerbation

SABA Side Effects

Tremor, tachycardia, hypokalaemia

SABA Counselling point?

Use as needed; review if frequent use; shake before use

Senna Drug Class

Stimulant laxative

Stimulant laxative mechanism

Stimulates peristalsis by acting on colonic nerves

Stimulant laxative indications

Constipation

Stimulant laxative Side effects?

Abdominal cramps, diarrhoea

Senna Counselling point?

Use short-term only; take at night

Statins drug class

HMG-CoA reductase inhibitor

HMG-CoA reductase inhibitor examples

Atorvastatin

Simvastatin

Statin mechanism

Inhibits cholesterol synthesis → increases LDL clearance

Statin indication

Hyperlipidaemia, CVD prevention