Pharmacology

Question 1

What is the function of paracetamol?

Answer 1

pure analgesic with little anti-inflam action

Question 2

What is step 1 in the pain pathway?

Answer 2

non-opiod +/- adjuvant

Question 3

What is sstep 2 in the pain pathway?

Answer 3

weak opiod =/-non-opioid +/- adjuvant

Question 4

What is step 3 in the pain pathway?

Answer 4

strong opioid +/- non-opioid +/- adjuvant

Question 5

What is the first line NSAID in Tayside?

Answer 5

naproxen

Question 6

What are the indications for NSAIDs?

Answer 6

inflammatory arthritis; mecahnical MSK pain; pleuritic/pericardia lpain

Question 7

What are the GI SE of NSAIDs?

Answer 7

dyspepsia; oesophagitis; gastritis; peptic ulcer; small/large bowel ulceration

Question 8

What are the other SE of NSAIDs?

Answer 8

renal impairment; increased CVS events; fliud retention; wheeze (exacerbation of asthma); rash

Question 9

What are COX-2 inhibitors?

Answer 9

NSAIDs which selectively target Cyclooxygenase-2 which is an enzyme responsible for inlfam and pain

Question 10

What the benefits and risks of COX-2 inhibitors?

Answer 10

reuces the risk of peptic ulceration but increases CVS risk

Question 11

What are the actions of DMARDs?

Answer 11

pure anti-inflammatory with no direct analgesice effect; reduce rate of joint damage

Question 12

What is the aim for DMARD therapy in RA patients?

Answer 12

to start therapy within 3 months of symptom onset

Question 13

What are the commonly used DMARDs?

Answer 13

methotrexate; sulphasalazine; leflunomide; hydroxycholoquien

Question 14

What is the mode of action of methotrexate?

Answer 14

folate antagonist

Question 15

What are the 2 routes of administration for methotrxate?

Answer 15

orally and subcut

Question 16

What diseases is methotrexate used to treat?

Answer 16

RA; psoriatic arthritis; connective tissue disease; vasculitis

Question 17

What are the SE of methotrexate?

Answer 17

leucopenia/thrombocytopenia; hepatitis/ cirrhosis; penumonitis; rash/mouth ulcers; nausea/diarrhoea

Question 18

When must methotrexate be stopped?

Answer 18

teratogenic- so must be stopped in BOTH males and females at least 3 moths before conception

Question 19

Why is methotrexate used more frequently then sulfasalazine when both are first line?

Answer 19

methotrexate works quicker and is better tolerated

Question 20

Why is started RA patients on DMARDs ASAP imprtoant?

Answer 20

theres only a limited time to reduce inflam before joint function cannot be recovered

Question 21

How can the SE of methotrexate be modified?

Answer 21

changing the mode of action: PO/ injection

Question 22

How long after stopping leflunomide can patients get pregnnat?

Answer 22

at least 2 years

Question 23

What are the adverse effects of sulfasalzine

Answer 23

nausea; rash/mouth ulcers; neutropenia; hepatitis; reversible oligozoospermia

Question 24

What is the very serious skin condition that can be caused by sulfasalazine?

Answer 24

Stevens-Johnson syndrom

Question 25

What is HCQ used for?

Answer 25

connective tissue disease such as SLE; Sjogrens and RA

Question 26

What is the action of HCQ?

Answer 26

no effect on joint damage?

Question 27

What is the SE of HCQ?

Answer 27

retinopathy

Question 28

Name an anti-TNF drug?

Answer 28

inflixumab

Question 29

What is the benefit of biologics compared to DMARDs?

Answer 29

1.5x more effective than DMARDs

Question 30

When are biologics used in patients with RA?

Answer 30

when they have a high disease activity score and have already used methotrexate

Question 31

What are anti-TNFs licensed for?

Answer 31

RA; psoriatic arthritis and ank.spon

Question 32

How are anti-TNFs give?

Answer 32

subcut

Question 33

What are hte SE of anti-TNFs?

Answer 33

risk of infection; increase risk of skin cancer; exacerbate heart failure

Question 34

What must be screened for before commencing anti-TNF therapy?

Answer 34

TB

Question 35

What is the action of secukinimab?

Answer 35

inhibits IL17

Question 36

What is rituximab?

Answer 36

monocolonal antibody against B cells

Question 37

How is gout treated actuely?

Answer 37

colchicine; NSAIDs; steroids either oral or IM

Question 38

What is the common SE of colchicine?

Answer 38

diarrhoea

Question 39

What are hte urate lowering drugs availbale?

Answer 39

allopurinol; febuxostat; uricosurics

Question 40

What are the actions of allopurinol and febuxostat?

Answer 40

block xanthine oxidase whic hconverts xanthine to uric acid

Question 41

Why must allopurinol not be started during an acute attack of gout?

Answer 41

may result in an exacerbation of gout due to the rapid reduction in uric acid level

Question 42

When is the rash caused by allopurinol made more likely?

Answer 42

in the elderly and in renal impairment

Question 43

What is the serious SE of allopurinol?

Answer 43

marrow aplasia

Question 44

What drug must never be used at the same time as allopurinol?

Answer 44

azathioprine

Question 45

When is febuxostat used?

Answer 45

in patients who cannot tolerate allopurinol

Question 46

In what patients should febuxostat be used caustiously?

Answer 46

in those with IHD

Question 47

What diseases are steroids indicated for?

Answer 47

connective tissue disease; PMR/ GCA; vasculitis; RA

Question 48

What are the SE of steroids?

Answer 48

weight gain- centripetal obesity; muscle wasting; skin atrophy; osteoporosis; diabetes; HT; cataracts; glaucoma; fluid retention; adrenal suppression; immunosuppression; avascular necrosis of femoral head

Question 49

How is allopurinol treatment started/managed?

Answer 49

6 weeks after acute flare; blood urate levels and PMHx asked about; allopurinol started and after 6 weeks urate levels checked again and dose changed; continues til urate levels are below 360mcg/L