Pharmacology Flashcards
What stage on the WHO pain ladder is this: “Opiod for moderate to severe pain plus non opiod with/without adjuvant analgesic”
Step 3
List sme adverse effects of NSIADs
Peptic ulcers Renal impairement CVS events Wheeze rash
What NSAID mechanism is particularly bad for CVS events?
Cox 2 inhibitors
Do DMARDs have an analgesic effect?
Not directly (pain may improve as inflammation reduces though!)
What should be given before DMARDs are started?
Vaccines (not live)
What is the first choice DMARS?
Methotrexate
What is the mechanism of action of methotrexate?
Folate antagonist
What conditions is methotrexate used in?
RA, Psoriatic arthritis, connective tissue disease, vasculitis
What do you need to monitor in a patient who is on methotrexate?
FBC
LFTs
List the adverse effects of methotrexate
Leucopenia/Thrombocytopenia Hepatitis/cirrhosis Pneumonitis Rash/mouth ulcers Nausea/diarrhoea
List the adverse effects on sulfasalazine
Nausea Rash/mouth ulcers Neutropenia Hepatitis Oligozoospermia (reversible)
What do you need to monitor in a patient on sulfasalzine?
LFTs
FBC
What conditions is hydroxychloroquine used in?
Connective tissue disease such as SLE, sjogrens and RA
What is a rare side effect that can occur with hydroxychloroquinines?
Retinopathy
How does ciclosporin work?
Inhibits the activation of T cells
What adverse effects can occur with ciclosporin use?
Nephrotoxicity
Hypertenion
How do antimalarial drugs work as DMARDS?
Interfere with antigen processing
What adverse effects can occur with azathriopine?
Hepatotoxicity
Myelotoxicity
GI problems
Give 4 subcutaneous anti TNF medications
Etanercept
Adalimumub
Certolizumab
Golimumab
Give an example of an IV anti TNF medication
Infliximab
What three conditions is anti TNF mediation licensed for?
Rheumatoid arthritis
Psoriatic arthritis
Ankylosing spondylitis
What is the major risk with anti TNF treatments?
Infection
In what two conditions in anti TNF treatment contraindicated?
Pulmonary fibrosis
Heart failure
What is rituximab?
A monoclonal antibody against B lymphocytes
What does tocilizumab do?
Inhibits IL - 6
What does abatecept do?
Blocks full activation of T lymphocytes
What does ustekinumub do?
Inhibts IL12 and IL23
What are the adverse effects of colchicine?
Diarrhoea and vomiting
How do you treat an acute episode of gout?
NSAIDS
Colchicine
Steroids
Name three urate lowering drugs
Allopurinol
Febuxostat
Uricosurics
What kind of drug is allopurinol?
Xanthine oxidase inhibitor
How is purine converted to uric acid?
Purine in converted to Xanthine. This is then converted to uric acid by xanthine oxidase
List some adverse effects of allopurinol
Rash (vasculitis)
Interacts with azathioprine
Inhibits warfarin
Marrow aplasia (extremely rare)
List 4 uricosurics
Probenecid
Sulphinpyrazone
Benzbromarone
Azapropazone
How do urocosurics work?
By increasing the excretion of uric acid in the urine, and so decreasing the levels in the blood.
Where do uricosurics work?
Proximal tubule of the kidney
What rheumatological conditions are corticosteroids used in?
Connective tissue disease Polymyalgia rheumatica Giant cell arteritis Vasculitis Rheumatoid arthritis
Give 4 metabolic effects of corticosteroids
Salt & water retention
Increases gluconeogeneis.
Increased hepatic glycogen deposition
Increased protein breakdown
List some adverse effects of corticosteroids
Weight gain Muscle wasting Skin atrophy Osteoporosis Diabetes Hypertension Cataracts Gluacoma Fluid retention Adrenal suppression Immunosuppression AVN of the femoral head
Give 4 ways in which you can reduce the toxic effects of corticosteroids?
Lowest possible dose for shortest time.
Consider steroid sparing agents
Osteoporosis prophylaxis
Control CVS risk factors
