Pharmacology Flashcards
Describe the steps of pain control
- non opioid (eg aspirin, paracetamol or NSAID +/- adjuvant)
- weak opioid for mild to moderate pain (eg codeine)
- strong opioid for moderate to severe pain (eg morphine)
Describe NSAIDs
- anti inflammatory
- analgesic
Name examples of NSAIDs
- ibuprofen
- naproxen
- diclofenac
- indometacin
- etodolac
- celecoxib (cox 2 inhibitor)
Name indications for NSAIDs
- inflammatory arthritis
- mechanical musculoskeletal pain
- pleuritic / pericardial pain
Name some side effects of NSAIDs
- peptic ulceration
- renal impairment
- increased CV risk
- exacerbation of asthma
- dyspepsia
- oesophagitis
- small / large bowel ulceration
- fluid retention
- wheeze
Ideally when should DMARD therapy be started in rheumatoid arthritis?
Within 3 months of symptoms starting
Describe the DMARDs
- slow acting, weeks to months
- pure anti-inflammatory with no direct analgesic effect
- improve standard lab tests of inflammation
- reduce rate of joint damage
- most need regular monitoring for adverse effects
Name some commonly used DMARDs
- methotrexate
- sulphasalazine
- leflunomide
- hydroxychloroquine
Describe methotrexate
- mode of action unknown
- folate antagonist
- first choice DMARD in most patients
- can be given orally or subcutaneously
- often used in combination
- used in RA, psoriatic arthritis, connective tissue disease and vascultiis
Describe methotrexate adverse effects
- leucopenia / thrombocytopenia
- hepatitis / cirrhosis
- pneumonitis
- rash / mouth ulcers
- nausea / diarrhoea
- need monitoring of FBC and LFTs
- co prescribed with folic acif
What is the most important side effect of methotrexate in females?
- teratogenic
- must be stopped in females of childbearing age at least 3 months before conception
- generally safe to continue in males
Describe leflunomide
- similar efficacy to methotrexate
- similar side effects
- also teratogenic
- very long half life, so requires wash out
Describe sulfasalazine
Often used in combination with methotrexate in early inflammatory arthritis
Describe the adverse effects of sulfasalazine
- nausea
- rash / mouth ulcers
- neutropenia
- hepatitis
- reversible oligozoospermia
- monitoring of FBC and LFTs
Describe hydroxychloroquine
- no effect on joint damage
- used in connective tissue disease such as SLE (helps skin, joints and general malaise) sjogrens syndrome and RA
- retinopathy; recognised but rare
Describe the biologics
- drugs designed to target specific aspects of immune system found to be implicated in inflammatory arthritis
- targets include; TNF, cd 20 b cells, IL 6, IL 17, 12 and 23
Describe anti-TNF therapy
- licensed for RA, psoriatic arthritis and akylosing spondylitis
- about 1.5 times as effective as standard DMARDs
- more effective in combination with DMARDs
- majority given by sub-cutaneous injection
Name some examples of anti-TNF
- etanercept
- adalimumab
- certolizumab
- infliximab
- golimumab
- biosimilars; benepali, amgevita
Describe adverse effects of anti-tnf therapy
- risk of infection (esp TB)
- question over risk of malignancy (esp skin cancer)
- contraindicated in certain situations eg pulmonary fibrosis, heart failure
Describe treatment of an acute episode of gout
- colchicine (diarrhoea common)
- NSAIDs
- steroids, either oral or IM
Name some urate lowering drugs
- allopurinol
- febuxostat
- uricosurics
What is allopurinol?
- xanthine oxidase inhibitor
- rapid reduction in uric acid level may result in exacerbation gout
Describe febuxostat
- also xanthine oxidase inhibitor
- those who cannot tolerate allopurinol
- renal impairment
- avoid in patients with ischaemic heart disease
Name the uricosurics
- probenecid
- sulphinpyrazone
- azapropazone
- benzbromarone
