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Y3 DRUGS PROFILES > PAIN/MSK DRUGS > Flashcards

PAIN/MSK DRUGS Flashcards

1
Q

give 3 examples of NSAIDs

A

diclofenac
ibuprofen
naproxen

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2
Q

what are the 3 A’s of action of NSAIDs?

A

anti-pyretic
analgesic
anti-inflammatory

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3
Q

how do NSAIDs act as anti-pyretics?

A

inhibit prostaglandin production from hypothalamus. prostaglandins increase temperature

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4
Q

how do NSAIDs act as analgesics?

A

decrease peripheral prostaglandins that stimulate pain receptors

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5
Q

how do NSAIDs act as anti-inflammatory drugs?

A

cox 1 & 2 inhibition

suppress vasodilation & oedema

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6
Q

what particular type of pain are NSAIDs effective in and why?

A

MSK = acute gout, RA and osteoarthritis

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7
Q

what female condition is naproxen used in?

A

dysmenorrhoea

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8
Q

what other drug type are NSAIDs often given in conjunction with?

A

PPIs/H2 antagonists/gastro-protectives

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9
Q

give 4 hypersensitivity reactions that can occur with NSAIDs

A

bronchospasm
angioedema
urticaria
Fluid retention

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10
Q

give 4 diseases that contraindicate use of NSAIDs

A 
Ischaemic heart disease
Cerebrovascular disease
Heart failure(*)
Peptic ulcers
Liver disease
Renal failure 
Hypertension (Hypersensitivity can make it worse*)
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11
Q

why are NSAIDs contraindicated in the third trimester of pregnancy?

A

associated with failure of closure of ductus arterioles in utero (causes pulmonary hypertension)

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12
Q

why are NSAIDs contraindicated in hepatic failure?

A

increased risk of GI bleed and fluid retention

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13
Q

why are NSAIDs contraindicated in renal impairment?

A

increased water retention, can lead to renal failure

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14
Q

Which painkiller is NSAIDs used alternatively for?

A

paracetamol

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15
Q

Interaction of NSAIDS with what drugs increase the risk of

a) GI ulceration
b) GI bleed
c) renal impairment

A

aCorticosteriods and low dose aspirin

b) Anticouagulants, SSRI’s venlafaxine
c) ACE inhibitors and diuretics

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16
Q

What is the interaction between NSAIDS and warfarin?

A

Increase the chance of bleeding

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17
Q

What drugs does Nsaids reduce their therapeutic effect?

A

Anti hypertensives and diuretics

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18
Q

what kind of drug are codeine and morphine?

A

opiate analgesic

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19
Q

give 2 instances for when codeine is used except for pain

A

cough suppressant

diarrhoea

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20
Q

give an example of when morphine is used?

A

o MI, post-operative analgesia (acute pain)
o Acute pulmonary oedema
o Palliative care (relief of breathlessness)
o Chronic pain

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21
Q

give 6 abdominal contraindications of morphine

A 
acute abdomen
Dealyed gastric emptying 
alcohol intoxication
hepatic failure
Renal failure 
phaeochromocytoma
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22
Q

give 2 head &neck contraindications of morphine

A

raised ICP

head injury

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23
Q

give 1 respiratory contraindication of morphine

A

severe disease e.g COPD

Causing Cor pulmonale

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24
Q

name a chronic autoimmune disease that contraindicates use of codeine

A

myasthenia gravis

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25
Q

name a GI contraindication of codeine

A

obstructive or inflammatory bowel disease

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26
Q

give 2 endocrine contraindications of codeine

A

hypothyroidism

adrenocortical insufficiency

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27
Q

what is a respiratory side effect of opiates?

A

respiratory depression

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28
Q

give 2 circulatory side effects of opiates

A

hypotension

urinary retention

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29
Q

why shouldn’t opioids be used with hypnotics or alcohol?

A

enhance sedative effect

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30
Q

why shouldn’t opioids be used with cimetidine?

A

inhibits opioid metabolism

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31
Q

what is an opiate overdose reversed with?

A

naloxone

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32
Q

how long can it take for tolerance/dependance to begin in opiate use?

a) 5 days
b) 2 weeks
c) 5 weeks
d) 5 months

A

b) 2 weeks

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33
Q

what kind of COX inhibitor is paracetamol?

A

COX-2 specific

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34
Q

why does paracetamol have less anti-inflammatory action than NSAIDs?

A

CNS specific, so doesn’t act on peripheries

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35
Q

give 3 tell-tale signs of paracetamol overdose

A

liver damage
nausea vomiting
right subcostal pain

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36
Q

why shouldn’t paracetamol be used with coumarins?

A

increase anti-coagulant effect

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37
Q

why should’t paracetamol work with carbimazepine and phenytoin

A

increases metabolism of paracetamol

38
Q

what is the antidote for paractamal overdose?

A

acetylcystiene

39
Q

give an example of a xanthine-oxidase inhibitor

A

allopurinol

Febuxostat

40
Q

what enzyme and subsequent product are inhibited by allopurinol?

A

xanthine oxidase enzyme is inhibited in metabolising xanthine (from purine) to uric acid. Consequently reduction in plasma uric acid levels and therefore reduces precipiation of uric acid into joints and kidney

41
Q

what common MSK condition is an indication for use of allopurinol?

A

To prevent gout

42
Q

give 2 other indications for use of allopurinol

A
  • To prevent hyperuricaemia and tumour lysis syndrome associated with chemotherapy
  • Prevent uric acid and calcium oxalate renal stones
43
Q

give a hepatic side effect of allopurinol

A

jaundice

44
Q

give 2 complications of hypersensitivity syndrome of allopurinol? rare and life threatening

A

lymphadenopathy
eosinophilia
fever
Involvement of other organs such as skin and liver

45
Q

why shouldn’t allopurinol be used with thiazide diuretics or ACE inhibitors?

A

increase risk of hypersensitivity reaction

46
Q

Why should mercaptopurine and azathioprine dose be reduced when taking allopurinol?

A

Increase toxicity levels

47
Q

How does NSAIDS prevent the production of prostagladins from arachidonic acid?

A

By inhibiting cyclooxygenase

48
Q

What is the action of Cox-1?

A

Constitutive form
Produces prostagladins that preserve the integrity of the gut mucosa, maintains renal perfusion and prevents thrombus formation on vascular endothelium

49
Q

What is the actions of Cox-2?

A

Inducible form

Inflammatory stimuli causes the production of prostagladins that cause inflammation and pain

50
Q

Inhibition of which cox gives therapeutic benefit and which one gives adverse effects of NSAIDs?

A

Cox-1 = adverse effects

Cox 2= therapeutic effects

51
Q

What are the pros and cons of a Cox-2 inhibitor?

A

It has less GI side effects but increases risk for cardiovascular event

52
Q

Why shouldn’t patient with peptic ulcers have NSAIDS?

A

Increase risk of GI bleed

53
Q

How does morphine work?

A

A strong opiate which acts on opiate receptors in the CNS. It helps to relieve pain but also blunts the medulla response to hypoxia and hypercapnia which improves respiratory response and breathlessness.

54
Q

Which two cardiac conditions is morphine used for?

A

MI and acute pulmonary oedema

55
Q

What is the treatment for acute pulmonary oedema?

A 
Morphine
Nitrate
Furosemide
Oxygen
Salbutamol if wheeze is present
56
Q

What is a synthetic analogue of codeine?

A

Tramadol which is used for moderate pain

57
Q

When prescribing a regular opiates what should you prescribe with it?

A

Laxatives

58
Q

Should you give dihydrocodeine or codeine via IV route?

A

No never as can cause a similar affect to anaphylactic shock

59
Q

Why should patients who are epileptic not be given Tramadol?

A

It reduces seizure threshold

60
Q

Why should you not give morphine to someone with biliary colic?

A

Can cause spasm of the sphincter of Oddi and therefore increase pain

61
Q

Why should you not give naproxen to a elderly patient?

A

It’s a steroid and not good for AKI patients causing fluid retention

62
Q

Why shouldn’t codeine be used in elderly patients?

A

Constipation and they have poor renal function, so reduced excretion and therefore cause side effects

63
Q

What are common GI side effects of opiates?

A

N&V
Abdo pain
Constipation

64
Q

What general side effects do opiates have?

A 
Hallucinations
Dependency
Hypothermia
Hypersensitivity
Drowsiness
65
Q

What are the circulatory effects of paracetamol?

A

Hypotension and flush

66
Q

What is the first line analgesia for acute and chronic pain?

A

Paracetamol

67
Q

What is paracetamol used for?

A

Pain, Pyrexia and associated symptoms

68
Q

How is paracetamol metabolised?

A

Cytochrome p450

69
Q

What action should be taken when taking allopurinol and Capecitabine?

A

Stop taking Capecitabine

70
Q

What is a common side effect of allopurinol?

A

Rash

71
Q

What commonly occurs in the 1st month of taking allopurinol?

A

Acute attack of gout

72
Q

What should you take with allopurinol in the 1st month to reduce the risk of acute attack of gout?

A

NSAIDS or colchicine

73
Q

What are the contradictions of using allopurinol?

A

Reccurent skin fash
Hypersensitivity
liver or renal impairment as it is metabolised by the liver and excreted by the kidney

74
Q

Should you start taking allopurinol during a acute attack of gout?

A

No you should not, but do continue taking if you began before the attack occured due to control serum levels of uric acid

75
Q

How should you take allopurinol?

A

Orally and after food

76
Q

During a hypersenstivity reaction of allopurinol what can occur?

A

Rash, fever, leukopenia, eosinophilia

77
Q

How does methotrexate work?

A

It inhibits dihydrofolate reductase in converting dietary folic acid into tetrahydrofolate (FH4)

FH4 is needed for DNA and protein synthesis and therefore prevents cellular replication

78
Q

What are the properties of methotrexate?

A

Anti inflammatory and immunosuppresants

79
Q

what diseases is methotrexate used for?

A

Disease modifier for RA
Chemotherapy for leukaemia, lymphoma and solid tumours
Sever psoriasis and psoriatic arthritis

80
Q

How is methotrexate administrated?

A

once Weekly
Orally for autoimmune disease
IV for chemo

81
Q

What do you take with methotrexate and why?

A

Take folic acid the other 6 days to keep cells health

Hydration and urinalysis alkalinisation to enhance the excretion of methotrexate

82
Q

What are the contradictions of methotrexate?

A

Pregnancy as its teratogenic
Renal failure
Abnormal liver function as can cause hepatotoxicity
Peptic ulcers, UC and diarrohea

83
Q

What precautions need to be taken around methotrexate and pregnancy?

A

Use contraceptives 3 months prior and after treatment

84
Q

What are common side effects of short term use of methotrexate?

A

Mucosal damage

Bone marrow suppression

85
Q

What side effects do you get with methotrexate over dose?

A

Hepatotoxicity
Renal failure
Neurological changes–> headache, seizures and coma

86
Q

What are the side effects of long term use of methotrexate?

A

Pulmonary fibrosis when given for RA

hepatic cirrhosis

87
Q

How does NSAIDS, aspirin and penicillin increase methotrexate toxicity?

A

By inhibiting renal excretion of methotrexate

88
Q

What drug interactions with methotrexate increase risk of haematological abnormalities?

A

Trimethoprim and phenytoin

89
Q

What is the drug interaction between methotrexate and clozapin?

A

Neutropenia

90
Q

What can side effect of rash from taking allopurinol be indication of?

A

Stevens–Johnson syndrome or toxic epidermal necrolysis.

Y3 DRUGS PROFILES (9 decks)

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