aminosalicylates Flashcards
side effects
- Arthralgia
- Cough
- Diarrhoea
- Dizziness
- Fever
- GI discomfort
- Headache
- Leucopenia
- Nausea, vomiting
- Skin reactions
name the AS
- balsalazide
- mesalazine
- sulfasalazine
- olsalazine
What to do if there is a suspicion of a blood dyscrasia
stop drug immediately and perform blood count
counsel patients to report any…
unexplained bleeding, bruising, sore throat, fever, malaise that occurs during treatment
Use in breastfeeding
- monitor breastfed infants for diarrhoea
- sulfasalazine: small amounts in milk (one report of bloody diarrhoea) and theoretical risk of neonatal haemolytic esp in G6PD-deficient infants
Use in pregnancy
- avoid unless benefit outweighs risk
- sulfasalazine: risk of neonatal haemolysis in 3rd trimester, ensure adequate folate supplementation is given to mother
hypersensitivity
contraindicated
monitoring for all AS
- Renal function before starting, 3 months, then annually
mesalazine and lactulose
- preparations that lower stool pH (e.g. lactulose) might prevent the realise of some GR and MR forms of mesalazine
symptoms of acute intolerant syndrome - mesalazine
- discontinue immediately if symptoms occur such as abdominal pain, fever, severe headache, rash
- worsening abdominal pain and diarrhoea may be difficult to distinguish from an exacerbation of UC
brands: mesalazine
Asacol, salofalk, pentasa
How to take pentasa granules
place on tongue and ash down with water or orange juice w/o chewing
how to take salofalk granules
place on tongue and wash down with water w/o chewing
Mesalazine - brand switches
report any changes in symptoms
mesalazine interactions
- increased nephrotoxicity with other nephrotoxic drugs e.g. acyclovir, amphotericin B, aspirin, cefalexin, ceftriaxone, Cs, ACEi, NSAIDs, gentamicin, lithium, MTX, vancomycin etc
mesalazine GR tabs label
do not take indigestion remedies 2 hours before or after
sulfasalazine cautions
- acute porphyria’s
- G6PD deficiency
- Hx asthma or Hx allergy
- maintain adequate fluid intake
- risk haemotological toxicity
- risk hepatic toxicity
- slow acetylator status
when do haematological abnormalities tend to happen with sulfasalazine
- usually in first 3-6 months of treatment
- discontinue if they occur
monitoring for sulfasalazine
- renal before starting, 3 months, annually (like all AS)
- FBC (incl differential WCC and platelet count), initially and then monthly for first 3 months
- LFTs monthly for first 3 months
which AS stains fluids, what colour, and what to counsel pt?
- sulfasalazine stains bodily fluid yellow-orange
- harmless
- soft contact lenses may be stained
sulfasalazine interactions
- nephrotoxic drugs (e.g. acyclovir, amphotericin B, aspirin, ceftriaxone, cefalexin, MTX, lithium, NSAIDs, ACEi)
- increased risk of myelosupporession (mabs, azathioprine, -tinibs, carboplatin, cisplatin, anti-cancer drugs, doxorubicin, paclitaxel, vinblastine, vincristine)
labels for GR tabs
do not take indigestion remedies 2 h before or after
common SE sulfasalazine
- insomnia
- stomatitis
- taste altered
- tinnitis
- urine abnormalities
how to remember which one has important info about intolerance and lactulose
MILK
mesalazine
intolerance (acute intolerance syndrome - severe headache, rash, abdominal pain, fever - discontinue!!!)
lactulose (GR MR forms may be prevented from being released due to low stool pH)
what is a CI for mesalazine
Blood clotting abnormalities
patient comes in asking for some advice. they want to buy some painkillers are are ok to take with their medicines - Asacol 800mg MR tablets.
Their symptoms include fever, bad stomach pain, headache, and a rash.
Tell them to discontinue immediately and refer to GP bc they are displaying signs of acute intolerant syndrome (fever, rash, severe headache, severe abdominal pain)
As for painkillers, it’s best to avoid NSASIDs because they are nephrotoxic. Paracetamol is ok
