Medications

Question 1

Methotrexate

Answer 1

Methotrexate

Facts

• Tetrahydrofolate Analogue; targets cellular replication
• Greatest impact on rapid cell turnover (auto-immunity, leukemia, lymphoma)
• Can be given PO, IV and IT

Side Effects

• Immunosuppresion (fewer white cells)
• Oral, Anal and Stomach mucosal breakdown (squamous cell turnover)
• Hair thinning and skin sensitivity (keratinocyte turnover)
• Anemia, pro-bleeding (bone marrow suppresion)
• Drug induced hepatitis (monitor LFTs)

Question 2

SULFASALAZINE

Answer 2

SULFASALAZINE

Facts

• Pro-drug that generates salicylate and sulfinpyradone (Prostaglandin inhibition)
• Mechanism is not completely understood however
• CANNOT be used in patients on ASA or demosntrated ASA INTOLERANCE

Side Effects

• Gastritis +/- ulcerations
• Renal injury
• Platelet dysfunction

Question 3

HYDROXYCHLOROQUINE

Answer 3

HYDROXYCHLOROQUINE

Facts

• Concentrates in cells (increasing pH) causing protein denaturation
• Anti-malarial drug with anti-inflammatory side effects

Side Effects

• Chronic use can cause damage to eyes
• QT Prolongation

Question 4

Acetyl Salicylic Acid (ASA) or Aspirin

Answer 4

Aspirin

Facts

• Antiinflamatory though PGE₂ production inhibition
• Antipyretic though decreased Hypothalamic triggering by PGE₂
• Anti-thrombotic through TXA₂ production inhibition

Side Effects

• Transient platelet dysfunction (small bleeds)
• Gastritis +/- ulceration
• Possible risk for PDA in maternal ingestion during pregnancy