Drugs

Question 1

Paracetamol

Answer 1

For mild-moderate pain
COX-2 inhibitor? Not well understood, not anti-inflammatory
Rare side effects
Caution in liver/renal disease
1g QDS (max 4g daily)
Oral/rectal/IV

Question 2

NSAIDs

Answer 2

Non-selective COX inhibitors - ibuprofen, diclofenac, naproxen, fenoprofen
Selective COX-2 inhibitors - celecoxib, etoricoxib
For mild-moderate pain
Side effects - GI disturbance (peptic ulcer risk)
Contraindications - asthma, pregnancy
All oral, diclofenac can be given IM/IV

Question 3

Opioids

Answer 3

Mild-moderate pain - codeine phosphate
Moderate-severe pain - tramadol hydrochloride
Severe pain - morphine salts, fentanyl, diamorphine, hydrochloride
Side effects - dry mouth, constipation, nausea, respiratory depression

Question 4

Corticosteroids

Answer 4

Prednisolone, cortisone, hydrocortisone
In SLE, RA, polymyalgia rheumatica, GCA, polymyositis, dermatomyositis
Anti-inflammatory, immunosuppressive, anti-proliferative, vasoconstrictive

Question 5

Drugs for osteoporosis

Answer 5

Bisphosphonates
Alendronic acid (alendronate)
Inhibit osteoclast action
Side effects - oesophageal reaction

Question 6

Methotrexate

Answer 6

In psoriatic, reactive, rheumatoid arthritis, sclerosis
DMARD
Inhibit T cell activation, inhibit inflammatory mediators, inhibits dihydrofolate reductase (folic acid converter) so prevents cellular replication
Side effects - mucosal damage (GI, sore mouth), bone marrow supression (neutropenia, infection risk), hepatic cirrhosis, pulmonary fibrosis
Contraindication - pregnancy (teratogenic), renal/liver impairment
Once weekly, oral

Question 7

Sulfasalazine

Answer 7

In enteropathic arthritis, rheumatoid arthritis
DMARD
Mechanism not understood
Side effects - GI upset, oligospermia, hypersensitivity reaction

Question 8

Hydroxychloroquine

Answer 8

In SLE, Sjogren’s, RA
DMARD
Contraindication - psoriasis

Question 9

Anti-TNF

Answer 9

Infliximab, etanercept, adalimumab
Biologic DMARD
In RA, ankylosing spondylitis, psoriatic arthritis
Blocks pro-inflammatory marker TNF-alpha
CI - pregnancy (teratogenic)
IV infusion

Question 10

Other biologics

Answer 10

Rituximab
In RA, SLE
Binds to CD20 on B cells, B cell depletion
IV infusion