aminosalicylates

Question 1

side effects

Answer 1

• Arthralgia
• Cough
• Diarrhoea
• Dizziness
• Fever
• GI discomfort
• Headache
• Leucopenia
• Nausea, vomiting
• Skin reactions

Question 2

name the AS

Answer 2

• balsalazide
• mesalazine
• sulfasalazine
• olsalazine

Question 3

What to do if there is a suspicion of a blood dyscrasia

Answer 3

stop drug immediately and perform blood count

Question 4

counsel patients to report any…

Answer 4

unexplained bleeding, bruising, sore throat, fever, malaise that occurs during treatment

Question 5

Use in breastfeeding

Answer 5

• 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

Question 6

Use in pregnancy

Answer 6

• avoid unless benefit outweighs risk
• sulfasalazine: risk of neonatal haemolysis in 3rd trimester, ensure adequate folate supplementation is given to mother

Question 7

hypersensitivity

Answer 7

contraindicated

Question 8

monitoring for all AS

Answer 8

• Renal function before starting, 3 months, then annually

Question 9

mesalazine and lactulose

Answer 9

• preparations that lower stool pH (e.g. lactulose) might prevent the realise of some GR and MR forms of mesalazine

Question 10

symptoms of acute intolerant syndrome - mesalazine

Answer 10

• 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

Question 11

brands: mesalazine

Answer 11

Asacol, salofalk, pentasa

Question 12

How to take pentasa granules

Answer 12

place on tongue and ash down with water or orange juice w/o chewing

Question 13

how to take salofalk granules

Answer 13

place on tongue and wash down with water w/o chewing

Question 14

Mesalazine - brand switches

Answer 14

report any changes in symptoms

Question 15

mesalazine interactions

Answer 15

• increased nephrotoxicity with other nephrotoxic drugs e.g. acyclovir, amphotericin B, aspirin, cefalexin, ceftriaxone, Cs, ACEi, NSAIDs, gentamicin, lithium, MTX, vancomycin etc

Question 16

mesalazine GR tabs label

Answer 16

do not take indigestion remedies 2 hours before or after

Question 17

sulfasalazine cautions

Answer 17

• acute porphyria’s
• G6PD deficiency
• Hx asthma or Hx allergy
• maintain adequate fluid intake
• risk haemotological toxicity
• risk hepatic toxicity
• slow acetylator status

Question 18

when do haematological abnormalities tend to happen with sulfasalazine

Answer 18

• usually in first 3-6 months of treatment
• discontinue if they occur

Question 19

monitoring for sulfasalazine

Answer 19

• 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

Question 20

which AS stains fluids, what colour, and what to counsel pt?

Answer 20

• sulfasalazine stains bodily fluid yellow-orange
• harmless
• soft contact lenses may be stained

Question 21

sulfasalazine interactions

Answer 21

• 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)

Question 22

labels for GR tabs

Answer 22

do not take indigestion remedies 2 h before or after

Question 23

common SE sulfasalazine

Answer 23

• insomnia
• stomatitis
• taste altered
• tinnitis
• urine abnormalities

Question 24

how to remember which one has important info about intolerance and lactulose

Answer 24

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)

Question 25

what is a CI for mesalazine

Answer 25

Blood clotting abnormalities

Question 26

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.

Answer 26

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