Specific Pharmacology

Question 1

Azathioprine (8)

Answer 1

1. Immunisuppressing DMARD
2. MoA - disrupts T and B cell DNA synthesis
3. Drug of choice for Pregnant SLE and used in RA

Main S/Es:
4. Myelosuppression
5. Photosensitivity and skin cancers
6. N&V

Interractions:
7. Allopurinol is Contraindicated if on this as it increases toxicity

8. TPMT testing is needed to assess toxicity risk

Question 2

Indications for use of Bisphosphonates (4)

Answer 2

1. Tx or PPx of Osteoporosis
2. Hypercalcaemia
3. Paget’s
4. Bone Met pain

Question 3

S/Es of Bisphosphonates (5)

Answer 3

1. Oesophageal ulcers and irritaiton - why you wait 30 mins after taking them before eating - these are from calcium complexes being formed with the drug if you eat and why u stay upright 30 mins after swallowing
2. Osteonecrosis of the Jaw
3. Hypocalcaemia - due to reduced bone turnover
4. Increased risk of atypical femoral stress fractures
5. Acute phase reaction of, fever, myalgia, arthralgia after administraiton

Question 4

Contraindications to Bisphosphonate Use (2)

Answer 4

1. Hypocalcaemia - correct first if low dietry intake
2. Vit D defficiency - correct first

Question 5

Denosumab (5)

Answer 5

1. Blocks RANK-L reducing osteoclast action

S/E including
2. Dyspnoea

3. Diarrhoea
4. Hypocalcaemia
5. unsure where it sits in OP pathway - Bisphosphonates still 1st line
6. Potential for atypical femoral #

Question 6

Drugs that cause Drug-Induced Lupus (5)

Answer 6

1. Hydralazine
2. Procainamide

les common

3. Isoniazid
4. minocycline
5. Phenytoin

Question 7

Hydroxychloroquine (5)

Answer 7

1. Used to treat RA and SLE/DLE
2. Causes vision loss “bulls-eye retinopathy”
3. Needs Opthalology assessment before use
4. Needs yearly eye monitoring by specialist
5. Safe for use in pregnancy

Question 8

S/Es of Methotrexate (6)

Answer 8

1. Pneumonitis - non-productive cough, dyspnoea, malaise, fever
2. Myelosuppression
3. Pulmonary Fibrosis
4. Mucocitis
5. Liver Fibrosis
6. No Preganancy until 6 months post-use

Question 9

Methotrexate and Pregnancny (1)

Answer 9

1. No, and don’t get preggers until 6 months after using it please and thank you

Question 10

Monitoring for Methotrexate (6)

Answer 10

1. U&Es
2. LFTs
3. FBCs

WHEN?

4. Before starting
5. WEEKLY until stabalised
6. Then 2 - 3 monthly

Question 11

Tx for Methotrexate Toxicity (1)

Answer 11

1. Folinic Acid

Question 12

Methotrexate Interractions (5)

Answer 12

1. Trimethoprim
   and
2. Co-trimoxazole
   as they increase risk of
3. Marrow Aplasia
4. High-dose Aspirin
5. increases toxicity risk from reduced excretion

Question 13

3 Indications for Methotrexate (3)

Answer 13

1. Inflammatory Arthritises - mainly RA. Only works on peripheral joints - not the axial skeleton
2. Psoriasis
3. Some Cancers - ALL