Rheumatology drugs

Question 1

What kind of drug is sulfasalazine? (1)

Name 2 side effects of sulfasalazine. (2)

Answer 1

Aminosalicylate

Mouth ulcers, hepatitis, reversible male infertility, rash, nausea, myelosuppression

Question 2

What kind of drug is methotrexate? (1)

Answer 2

Dihydrofolate reductase inhibitor, inhibiting purine metabolism and inhibiting T cell activation.

Question 3

Name 3 side effects of methotrexate. (3)

Answer 3

Mouth ulcers, diarrhoea, liver fibrosis (cirrhosis), pulmonary fibrosis, renal impairment, myelosuppression, nausea.

Question 4

Describe the monitoring required with methotrexate therapy. (2)

Answer 4

FBC, LFTs and U+Es before initiation and every 1-2 weeks until stabilised, thereafter every 3 months.

Question 5

Name 2 side effects of TNF-a blockers. (2)

Answer 5

Infusion reactions (infliximab), infections, demyelinating disease, heart failure, lupus-like syndrome, autoimmune syndromes.

Question 6

Name 2 side effects of leflunomide. (2)

Answer 6

myelosuppression, nausea, diarrhoea, hypertension, hepatitis, alopecia.

Question 7

What kind of drug is allopurinol? (1)

Answer 7

Xanthine oxidase inhibitor

Question 8

What is the mechanism of action of paracetamol? (1)

Answer 8

Inhibits synthesis of prostaglandins in the CNS and peripherally blocks pain impulse generation.
Reduces pyrexia by inhibition of the hypothalamic heat-regulating centre.

Question 9

How does NSAIDs increase the risk of gastroduodenal ulcers? (2)

Answer 9

NSAIDs inhibit COX-1 enzyme, which causes reduction in the conversion of arachadonic acid to prostaglandins.
Inhibition of the COX-1 isoform in the GI tract leads to reaction in the protective prostaglandins and predisposes to gastroduodenal damage.
Hence COX-2 selective inhibitor such as etoricoxib have a lower risk of GI side effects.

Question 10

Name 3 side effects associated with NSAID use. (3)

Answer 10

Peptic ulceration
Hypersensitivity reaction (bronchospasm, rash, angio-oedema)
Fluid retention, AKI, hepatitis, pancreatitis.

Question 11

Name one contraindication to the use of selective COX-2 inhibitors. (1)

Answer 11

IHD
Cerebrovascular disease
Peripheral arterial disease
Moderate-sevre heart failure

Question 12

What is the mechanism of action of bisphosphonates? (2)

Answer 12

Adsorbed onto hydroxyapatite crystals in bone and inhibit growth and activity of osteoclasts, thereby reducing the rate of turnover.

Question 13

name 2 indications for bisphosphonates. (2)

Answer 13

Prophylaxis and treatment of osteoporosis
Treatment of Paget’s disease
Treatment of hypercalcaemia of malignancy
Treatment of osteolytic lesions and bone pain in bony metastases associated with breast cancer and multiple myeloma.

Question 14

Describe to Joan how to take her alendronic acid tablets. (3)

Answer 14

Take first thing on a morning on the same day each week.
Take with full glass of water.
Do not eat or drink anything else for at least 30 minutes
Remain sitting or standing upright for at least 30 minutes,

Question 15

Name 2 indications for vitamin D supplementation. (2)

Answer 15

Prevention of vit D deficiency in those at risk
As adjunct in prevention and treatment of osteoporosis
Vitamin D deficiency caused by intestinal malabsorption, chronic liver disease or chronic renal impairment.
Hypocalcaemia of hypoparathyroidism.