Drugs Flashcards
Give some examples of NSAIDs
Ibuprofen Naproxen Diclofenac Indometacin Etodolac Celecoxib (COX 2 inhibitor)
List some of the adverse effects of NSAIDs?
Dyspepsia Oesophagitis Gastritis Peptic ulcer Small/large bowel ulceration
Renal impairment Increased CV events Fluid retention Wheeze Rash
Name 4 commonly used DMARDs
Methotrexate
Sulphasalazine
Leflunomide
Hydroxychloroquine
Which DMARD is usually first choice? How can it be given?
Methotrexate PO or SC
What are the adverse effects of methotrexate?
Leucopenia/thrombocytopenia Hepatitis/cirrhosis (limit alcohol) Pneumonitis Rash + mouth ulcers Nausea + diarrhoea Teratogenic Agranulocytosis
What needs to be monitored in patients taking methotrexate?
FBC –> leucopenia/thrombocytopenia
LFTs –> cirrhosis
What is the rule regarding pregnancy and methotrexate?
Must be stopped at least 3 months before conception
What are the adverse effects of leflunomide?
Similar to methotrexate
Also teratogenic
Very long half life so requires wash out
What are the adverse effects of sulphasalazine?
Nausea Rash + mouth ulcers Neutropenia Hepatitis Reversible oligozoospermia
What needs to be monitored in a patient taking sulphasalazine?
FBC
LFTs
What is a notable but rare adverse effect of hydroxychloroquine?
Retinopathy
Gold and penicillamine are also used as DMARDs, what are their adverse effects?
Bone marrow suppression
Glomerulonephritis
Rash + mouth ulcers
What needs to be monitored in patients taking gold or penicillamine?
FBC
Urine for proteinuria
What are the adverse effects of biologics?
Risk of infection –> especially TB
May be increased risk of cancer, especially skin cancer
When are biologics contraindicated?
Pulmonary fibrosis
Heart failure
What is a common sider effect of colchicine?
Diarrhoea
What are some of the adverse effects of allopurinol?
Rash (vasculitis) - commoner in elderly and in renal impairment so use lower dose Azathioprine interaction Marrow aplasia (rare)
When is febuxostat used?
For gout prophylaxis in those who cannot tolerate allopurinol
What is an adverse effect of febuxostat and in which condition should it be used cautiously?
May cause renal impairment
Use with caution in patient with IHD
List some adverse effects of corticosteroids
Weight gain - centripetal obesity Muscle wasting Skin atrophy Osteoporosis Diabetes Hypertension Cataract Glaucoma Fluid retention Adrenal suppression Immunosuppression Avascular necrosis of femoral head
What factors should be considered when prescribing steroids?
- lowest possible dose for shortest possible time
- consider steroid sparing agents
- osteoporosis prophylaxis
- watch CV risk factors
