PreReg solution

Statins help lower cholesterol and reduce the risk of heart disease.

🔹 Class: Aminosalicylate (5-ASA derivative, prodrug)
🔹 Uses:
• Inflammatory bowel disease (ulcerative colitis, sometimes Crohn’s)
• Rheumatoid arthritis (as a DMARD)
• Occasionally in juvenile idiopathic arthritis and psoriatic arthritis

Mechanism of Action
• Prodrug cleaved in the colon by bacteria → 5-aminosalicylic acid (5-ASA) + sulfapyridine

**Calcium-Channel Blockers (CCBs) – Quick Guide**

# # # **Types of CCBs**
1. **Dihydropyridines** (Amlodipine, Felodipine, Nifedipine) – Best for **hypertension**.
- Avoid in **uncontrolled heart failure** (except amlodipine).
- **Amlodipine** is often preferred (cost-effective).

2. **Rate-Limiting CCBs** (Verapamil, Diltiazem) – Used for **angina** if beta-blockers aren’t suitable.
- Avoid in **heart failure, AV block, or bradycardia**.

# # # **Key Points**
✔ **Avoid in heart failure** (except amlodipine in stable cases).
✔ **Once-daily dosing** preferred (amlodipine, modified-release verapamil/diltiazem).
✔ **Start low, titrate up** every 4 weeks based on BP response.

# # # **Contraindications**
❌ **Heart failure** (especially verapamil/diltiazem).
❌ **Severe aortic stenosis, cardiogenic shock**.
❌ **AV block** (verapamil/diltiazem contraindicated in 2nd/3rd degree).

# # # **Common Side Effects**
- Swelling (ankles), headache, dizziness, flushing.
- **Verapamil/Diltiazem**: Bradycardia, constipation.

# # # **Drug Interactions**
⚠ **Beta-blockers + Verapamil/Diltiazem** → Risk of severe bradycardia.
⚠ **Grapefruit juice** ↑ CCB levels → Avoid!
⚠ **Digoxin, statins, DOACs** may need dose adjustments.

# # # **Dosing**
- **Amlodipine**: Start 5 mg daily (max 10 mg).
- **Verapamil MR**: Start 120–240 mg daily.
- **Diltiazem MR**: Brand-specific dosing.

**CCBs are versatile but choose based on comorbidities!**

Doxycycline Cheat Sheet 📝

💊 What is it?
Antibiotic (tetracycline class) used for infections & malaria prevention.

🦠 Common Uses:
✔️ Malaria prophylaxis
✔️ Acne, Lyme disease, chlamydia
✔️ Bacterial infections (sinusitis, pneumonia)

⚠️ Key Warnings:
🚫 Avoid in:

Pregnancy (harms baby’s teeth/bones)

Kids

💊 NSAIDs: What You Need to Know

🔹 GI Risks All NSAIDs can cause ulcers & bleeding. Highest risk Piroxicam, ketoprofen, ketorolac. Lowest risk Low-dose ibuprofen. COX-2 inhibitors (e.g., celecoxib)have **less GI toxicity than traditional NSAIDs.

🔹 Heart Risks
- **↑ Thrombosis risk( MI/stroke) with COX-2 inhibitors, diclofenac (150mg/day), high-dose ibuprofen (2.4g/day)
- Naproxen (1g/day) = safer for heart
- Low-dose ibuprofen (≤1.2g/day) = minimal CV risk.

🔹 Key Rules
✔ Lowest dose, shortest time possible.
✔ Avoid in active ulcers(if needed, add PPI).
✔ Never combine oral NSAIDs(↑ toxicity).
✔ Caution with aspirin(↑ bleeding risk).

⚠ Elderly & high-risk? Use naproxen (CV-safe) + PPIor COX-2 + PPI if GI concerns.

**💊 NSAIDs: What You Need to Know**

🔹 **GI Risks**: All NSAIDs can cause ulcers & bleeding. **Highest risk**: Piroxicam, ketoprofen, ketorolac. **Lowest risk**: Low-dose ibuprofen. **COX-2 inhibitors (e.g., celecoxib)** have **less GI toxicity** than traditional NSAIDs.

🔹 **Heart Risks**:
- **↑ Thrombosis risk** (MI/stroke) with **COX-2 inhibitors, diclofenac (150mg/day), high-dose ibuprofen (2.4g/day)**.
- **Naproxen (1g/day) = safer for heart**.
- Low-dose ibuprofen (≤1.2g/day) = minimal CV risk.

🔹 **Key Rules**:
✔ **Lowest dose, shortest time** possible.
✔ **Avoid in active ulcers** (if needed, add PPI).
✔ **Never combine oral NSAIDs** (↑ toxicity).
✔ **Caution with aspirin** (↑ bleeding risk).

⚠ Elderly & high-risk? Use naproxen (CV-safe) + PPIor COX-2 + PPI if GI concerns.

💊

**💊 NSAIDs: What You Need to Know**

🔹 **GI Risks**: All NSAIDs can cause ulcers & bleeding. **Highest risk**: Piroxicam, ketoprofen, ketorolac. **Lowest risk**: Low-dose ibuprofen. **COX-2 inhibitors (e.g., celecoxib)** have **less GI toxicity** than traditional NSAIDs.

🔹 **Heart Risks**:
- **↑ Thrombosis risk** (MI/stroke) with **COX-2 inhibitors, diclofenac (150mg/day), high-dose ibuprofen (2.4g/day)**.
- **Naproxen (1g/day) = safer for heart**.
- Low-dose ibuprofen (≤1.2g/day) = minimal CV risk.

🔹 **Key Rules**:
✔ **Lowest dose, shortest time** possible.
✔ **Avoid in active ulcers** (if needed, add PPI).
✔ **Never combine oral NSAIDs** (↑ toxicity).
✔ **Caution with aspirin** (↑ bleeding risk).

⚠ Elderly & high-risk? Use naproxen (CV-safe) + PPIor COX-2 + PPI if GI concerns.

💊