Drugz

Question 1

Anti-inflamm and pain relief drugs for rheumatoid conditions

Answer 1

• Aspirin for transient MSK pain and pyrexia (fever)
• NSAIDs for inflam cond’s
• Paracetamol 1st line pain relief where NSAIDs not indicated. Codeine if not sufficient

Question 2

Paracetamol (acetaminophen) mechanism of action

Answer 2

• Inhibits synthesis of prostaglandins in the CNS and peripherally blocks pain impulse generation
• Reduces pyrexia by inhibition of the hypothalamic heat-regulating centre

Question 3

Paracetamol indications

Answer 3

Mild to moderate pain, pyrexia. NSAIDs are preferred for pain relief in the inflammatory arthritides

Question 4

Paracetamol SEs

Answer 4

Rare unless in overdose

Question 5

Paracetamol cautions/contraindications

Answer 5

Dosing interval 6 hours or greater if eGFR

Question 6

NSAIDs mechanism of action

Answer 6

Inhibition of cyclo-oxygenase (COX), the enzyme which catalyses the synthesis of cyclic endoperoxidases from arachidonic acid to form prostaglandins.

Question 7

Drawback of NSAID mechanism of action and how can it be avoided

Answer 7

• Inhibition of the COX-1 isoform in the GI tract leads to reduction in protective prostaglandins and predisposes to gastroduodenal damage.
• COX 2 is the form mainly induced in response to pro-inflammatory cytokines.
• The selective inhibitors of COX-2 (‘coxibs’, etoricoxib and celecoxib) have a lower risk of gastroduodenal damage that the non-selective NSAIDs (e.g. ibuprofen, diclofenac)

Question 8

NSAIDs indications

Answer 8

• Pain and inflammation associated with inflammatory arthritides and severe osteoarthritis
• Crystal synovitis
• Transient MSK pain
• Pain caused by secondary bone tumours

Question 9

E.gs of NSAIDs and their benefits and drawbacks

Answer 9

Ibuprofen - fewer SEs but anti-inflam weaker
Indometacin - more potent but more SEs
Diclofenac and naproxen in between the two

Question 10

SE’s NSAIDs

Answer 10

• GI toxicity w highest risk in elderly. Inflammation and ulceration most apparent in stomach and duodenum
• Co-prescribe PPIs w non-selective NSAIDs in high risk pts (>65y, pmhx peptic ulceration, other med that inc GI risk: warfarin, aspirin, corticosteroids)
• Hypersensitivity reactions, blood disorders, fluid retention, AKI, hepatitis, pancreatitis, exacerbation of colitis

Question 11

Cautions and contraindications NSAIDs

Answer 11

• contraindicated in pts w hx of hypersensitivity to aspirin or any other NSAID.
• contraindicated in severe HF
• Avoid in pts w previous GI ulceration
• In pts w renal, cardiac or hepatic impairment NSAIDs may cause a deterioration in organ function

Question 12

What drugs affect bone metabolism?

Answer 12

bisphosphonates, calcium, vitamin D

Question 13

mechanism of action bisphosphonates

Answer 13

adsorbed onto hydroxyapatite crystals in bone and inhibit growth and activity of osteoclasts, thereby reducing the rate of bone turnover

Question 14

indications bisphosphonates

Answer 14

OSTEOPOROSIS -Prophylaxis and treatment in combination with calcium and vit D supplements if dietary intake inadequate.
PAGET’S DISEASE AND HYPERCALCAEMIA OF MALIGNANCY - treatment
OSTEOLYTIC LESIONS AND BONE PAIN in bone metastases associated with breast cancer or multiple myeloma - treatment

Question 15

SE’s bisphosphonates

Answer 15

• GI - dyspepsia, nausea, vomiting, abdo pain, diarrhoea, constipation
• Flu like symptoms
• Oesophageal reactions with alendronic acid
• MSK pain
• Biochemical abnormalities (hypophosphataemia, hypocalcaemia, hyper or hypokalaemia, hypernatraemia)
• Anaemia
• Thrombocytopenia
• Lymphocytopenia
• Seizures
• AKI
• Conjunctivitis
• Osteonecrosis of the jaw - greatest risk in pts recieving IV bisphosphonates for cancer indications

Question 16

Egs of bisphosphonates

Answer 16

Alendronic acid
Risedronate
Disodium pamidronate

Question 17

Cautions / contraindications bisphosphonates

Answer 17

• correct vit D deficiency and hypocalcaemia before starting
• avoid risedronate and alendronate in symptomatic oesophageal disorders
• dose adjustment in severe renal impairment

Question 18

what is the reference nutrient intake of calcium

Answer 18

700mg

Question 19

indications for calcium

Answer 19

hypocalcaemia, osteomalacia, when dietary calcium intake (with or without vit D) is deficient in the prevention and treatment of osteoporosis

Question 20

what preparations are used for calcium administration

Answer 20

calcium carbonate and calcium gluconate

Question 21

SEs calcium

Answer 21

GI disturbances; with injection, peripheral vasodilatation, fall in blood pressure, injection-site reactions

Question 22

vit D mechanism of action

Answer 22

fat soluble vitamin whose main action is to promote intestinal absorption of calcium. An oral supplement of 10µg prevents deficiency

Question 23

vit D indications

Answer 23

• prevention in those at risk of deficiency e.g asians consuming unleavened bread and in the elderly
• adjunct in osteoporosis rx
• vit D def caused by intestinal malabsorption, chronic liver dis and severe renal impairment
• hypocalcaemia and hypoparathyroidism

Question 24

preparations of vit D?

Answer 24

ergocalciferol
alfacalcidol
calcitriol

Question 25

what is ergocalciferol used for

Answer 25

• prevention of deficiency
• adjunct in osteoporosis rx
• vit D def caused by intestinal malabsorption, chronic liver dis and severe renal impairment
• hypocalcaemia and hypoparathyroidism

Question 26

what is alfacalcidol used for

Answer 26

vit D def in CKD pts

Question 27

what is calcitriol used for

Answer 27

vit D def in CKD pts

Question 28

SEs of vit D

Answer 28

symptoms of OD = anorexia, lassitude, nausea and vom, polyuria, thirst, headache, raised conc of calcium and phosphate in plasma and urine

Question 29

contraindications of vit D

Answer 29

hypercalcaemia

metastatic calcification