Pharmacology Flashcards
What is the function of paracetamol?
pure analgesic with little anti-inflam action
What is step 1 in the pain pathway?
non-opiod +/- adjuvant
What is sstep 2 in the pain pathway?
weak opiod =/-non-opioid +/- adjuvant
What is step 3 in the pain pathway?
strong opioid +/- non-opioid +/- adjuvant
What is the first line NSAID in Tayside?
naproxen
What are the indications for NSAIDs?
inflammatory arthritis; mecahnical MSK pain; pleuritic/pericardia lpain
What are the GI SE of NSAIDs?
dyspepsia; oesophagitis; gastritis; peptic ulcer; small/large bowel ulceration
What are the other SE of NSAIDs?
renal impairment; increased CVS events; fliud retention; wheeze (exacerbation of asthma); rash
What are COX-2 inhibitors?
NSAIDs which selectively target Cyclooxygenase-2 which is an enzyme responsible for inlfam and pain
What the benefits and risks of COX-2 inhibitors?
reuces the risk of peptic ulceration but increases CVS risk
What are the actions of DMARDs?
pure anti-inflammatory with no direct analgesice effect; reduce rate of joint damage
What is the aim for DMARD therapy in RA patients?
to start therapy within 3 months of symptom onset
What are the commonly used DMARDs?
methotrexate; sulphasalazine; leflunomide; hydroxycholoquien
What is the mode of action of methotrexate?
folate antagonist
What are the 2 routes of administration for methotrxate?
orally and subcut
What diseases is methotrexate used to treat?
RA; psoriatic arthritis; connective tissue disease; vasculitis
What are the SE of methotrexate?
leucopenia/thrombocytopenia; hepatitis/ cirrhosis; penumonitis; rash/mouth ulcers; nausea/diarrhoea
When must methotrexate be stopped?
teratogenic- so must be stopped in BOTH males and females at least 3 moths before conception
Why is methotrexate used more frequently then sulfasalazine when both are first line?
methotrexate works quicker and is better tolerated
Why is started RA patients on DMARDs ASAP imprtoant?
theres only a limited time to reduce inflam before joint function cannot be recovered
How can the SE of methotrexate be modified?
changing the mode of action: PO/ injection
How long after stopping leflunomide can patients get pregnnat?
at least 2 years
What are the adverse effects of sulfasalzine
nausea; rash/mouth ulcers; neutropenia; hepatitis; reversible oligozoospermia
What is the very serious skin condition that can be caused by sulfasalazine?
Stevens-Johnson syndrom
What is HCQ used for?
connective tissue disease such as SLE; Sjogrens and RA
What is the action of HCQ?
no effect on joint damage?
What is the SE of HCQ?
retinopathy
Name an anti-TNF drug?
inflixumab
What is the benefit of biologics compared to DMARDs?
1.5x more effective than DMARDs
When are biologics used in patients with RA?
when they have a high disease activity score and have already used methotrexate
What are anti-TNFs licensed for?
RA; psoriatic arthritis and ank.spon
How are anti-TNFs give?
subcut
What are hte SE of anti-TNFs?
risk of infection; increase risk of skin cancer; exacerbate heart failure
What must be screened for before commencing anti-TNF therapy?
TB
What is the action of secukinimab?
inhibits IL17
What is rituximab?
monocolonal antibody against B cells
How is gout treated actuely?
colchicine; NSAIDs; steroids either oral or IM
What is the common SE of colchicine?
diarrhoea
What are hte urate lowering drugs availbale?
allopurinol; febuxostat; uricosurics
What are the actions of allopurinol and febuxostat?
block xanthine oxidase whic hconverts xanthine to uric acid
Why must allopurinol not be started during an acute attack of gout?
may result in an exacerbation of gout due to the rapid reduction in uric acid level
When is the rash caused by allopurinol made more likely?
in the elderly and in renal impairment
What is the serious SE of allopurinol?
marrow aplasia
What drug must never be used at the same time as allopurinol?
azathioprine
When is febuxostat used?
in patients who cannot tolerate allopurinol
In what patients should febuxostat be used caustiously?
in those with IHD
What diseases are steroids indicated for?
connective tissue disease; PMR/ GCA; vasculitis; RA
What are the SE of steroids?
weight gain- centripetal obesity; muscle wasting; skin atrophy; osteoporosis; diabetes; HT; cataracts; glaucoma; fluid retention; adrenal suppression; immunosuppression; avascular necrosis of femoral head
How is allopurinol treatment started/managed?
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
