Drugs used in inflammatory diseases Flashcards
When is paracetamol preferred over NSAIDs
elderly
HT, CVD, renal impairment, GI issues
meds that interact with NSAIDs (warfarin)
When is Aspirin contraindicated
children
peptic ulcers
bleeding disorders
cardiac failure
elderly
caution w asthma
What interacts with aspirin?
Drugs that increase GI irritation and bleeding ( steroids, NSAIDs, SSRIs, anticoags.)
Drugs that increase risk of renal side effects (bisphosphonates)
Drugs that aspirin can increase toxicity of (methotrexate)
What drugs for inflammation are non selective?
Ibuprofen, indomethacin, mefenamic acid, naproxen
What drugs for inflammation are selective?
Celecoxib, etoricoxib
What drugs for inflammation have a COX-2 preference?
Diclofenac, etodolac, meloxicam
Why do NSAIDs cause GI side effects?
Suppression of physiological homeostatic prostanoid (COX1)
What are some key points to remember when prescribing NSAIDs/ DMARDs for inflammation?
Start at lowest dose
For shortest time
No more than 1 NSAID at a time
Take w food
Co-prescribe with gastroprotective if at risk of GI s/e (PPI’s)
Monitor
What monitoring needs to happen for NSAIDs?
Symptoms of dyspepsia/ GI irritation
Hb - for bleeding
Signs of GI bleeding - dark stools
What drugs for inflammation have the highest risk of CV events and which has the lowest?
HIGHEST - COX2 inhibitors, diclofenac 150mg, ibuprofen 2.4g+
LOWEST - ibuprofen low dose (1.2g)
What NSAIDs are contraindicated for Heart failure / CVD
&
What are cautioned?
COX-2 Inhibitors, High dose ibuprofen= CI
Non-selective NSAIDs CAUTIONED
What can NSAID’s do to renal function?
Can decrease renal blood flow and increase risk of kidney injury
Sodium and water retention can cause oedema and hypertension
What interactions w NSAIDs are likely to cause decreased renal function?
Co-prescribed nephrotoxic medicines (diuretics and ACE-inhibitors)
Anti-hypertensives (opposite effect!)
Lithium and methotrexate (decreases renal elimination and causes toxicity)
What needs to be monitored when it comes to renal function and NSAID’s?
GFR, urine output, urea
BP
electrolytes (sodium and potassium)
Oedema (watch weight, visual signs)
If you were to remember ONE THING about methotrexate dosing - what would it be?
ONCE A WEEK- same day
What does a test dose of methotrexate do?
Rules out idiosyncratic adverse effects
What strength is prescribed for methotrexate in community?
2.5mg tablets ONLY
Councelling points for methotrexate?
usually takes 6 weeks for effect in RA
Dose may be changed too, optimal dose should be achieved in ~4-6 weeks
What monitoring needs to be done when starting therapy and what needs to be done during treatmentwith methotrexate?
STARTING:
full blood count
Liver function tests
Urea and electrolytes
Renal function
Chest x-ray
DURING:
full blood count (every 1-2 weeks until stable, then every 2-3 months)
Self monitor for infection (bruising, bleeding), nausea, vomiting, dark urine, SOB.
What are side effects of methotrexate?
And cautions?
Bone marrow suppression
Surgery
renal impairment
diarrhoea
ascites
peptic ulcers
When is methotrexate contraidicated?
Active infection
renal impairment
hepatic impairment
bone marrow suppression
Immunodeficiency
Pregnancy and breastfeeding
What else should be given with methotrexate?
Why?
Folic acid
5mg OD (1-6 days a week, never on same day as methotrexate)
Decreases risk of hepatotoxicity and GI side effects
What counselling points should be told to a patient on methotrexate?
Missed dose? can be taken within 2 days
Interacts with:
anti-folates (some antibiotics, eg: co-trimoxazole, trimethoprim)
NSAIDs
Live vaccines
Ciclosporin
Recommended to get the Pneumococcal and flu vaccines!
What type of drug is Leflunomide
A DMARD- disease modifying anti-rheumatic drug
