Pharmacology

Question 1

What is the step-up order for pain management?

Answer 1

• step 1: non-opioid eg paracetamol, aspirin and NSAID
• step 2: weak opioid eg codeine
• step 3: strong opioid eg morphine

Question 2

What are NSAIDs and what are they used for?

Answer 2

• anti-inflammatory and analgesic

- used for inflammatory arthritis, mechanical MSK pain and pleuritic pain

Question 3

What are DMARDs and what are they used for?

Answer 3

• slow-acting anti-inflammatories that reduce rater of joint damage
• main two are methotrexate and sulfasalazine

Question 4

What are the features of Methotrexate?

Answer 4

• folate antagonist
• oral or SC
• teratogenic so should be stopped 3 months before pregnancy
• used in RA, psoriatic arthritis, connective tissue disease and vasculitis
• monitor FBC and LFT

Question 5

What are the features of Leflunomide?

Answer 5

• teratogenic
• similar to methotrexate
• another drug must be given to remove it

Question 6

What are the features of Sulphasalazine?

Answer 6

• in combination with methotrexate

Question 7

What are the features of Hydroxychloroquine?

Answer 7

• no effects on joints
• used in SLE, sjogren’s and RA
• pretty weak so not 1st line or used alone

Question 8

What are biologics?

Answer 8

• drugs designed to target immune system aspects that are implicated in inflammatory arthritis

Question 9

What are the features of anti-TNF therapy?

Answer 9

• used for RA, psoriatic arthritis and ankylosing spondylitis
• more effective than DMARDs and can be used together

Question 10

What are the features of Allopurinol?

Answer 10

• xanthine oxidase inhibitor
• acute gout treatment
• start on low dose and increase

Question 11

What are the features of febuxostat?

Answer 11

• xanthine oxidase inhibitor for when allopurinol is not tolerated

Question 12

What are the features of corticosteroids?

Answer 12

• used for connective tissue disorders, PR/GCA, vasculitis and RA
• use low dose and consider steroid sparing agents
• prepare for osteoporosis and monitor heart

Question 13

What are the side-effects of DMARDs?

Answer 13

• bone marrow suppression
• infection
• liver derangement
• pneumonitis
• nausea

Question 14

What are the risks with biologic agents?

Answer 14

risk of infection esp TB and cause skin cancer

Question 15

When are biologics contraindicated?

Answer 15

can’t be used in PF and HF but safe in pregnancy