Pharmacology

Question 1

List the steps for pain killer treatment

Answer 1

1- non-opioid (NSAID, paracetamol)
2- weak opioid (codeine) +/- non-opioid +/- adjuvant
3- strong opioid (morphine)

Question 2

Name some examples of NSAIDs

Answer 2

Ibuprofen
Aspirin
Naproxen

Question 3

What are the indications for NSAIDs

Answer 3

Inflammatory arthritis
Mechanical musculoskeletal pain
Pleuritic chest pain
And many more

Question 4

What are the effects of NSAIDs

Answer 4

Anti-inflammatory

Analgesic

Question 5

What are the side effects of NSAIDs

Answer 5

Peptic ulceration
Renal impairment
Increased CV risk
Exacerbation of asthma
Fluid retention

Question 6

What is the first choice of DMARD in most conditions

Answer 6

Methotrexate

Question 7

As DMARDs are slow acting, which drugs are used alongside them

Answer 7

NSAIDs and short-term steroids

Cover the period where DMARD is not yet fully active

Question 8

How is methotrexate given

Answer 8

orally or subcutaneously

Question 9

What conditions is methotrexate used in

Answer 9

RA
psoriatic arthritis
connective tissue diseases

Question 10

What are the side effects of methotrexate

Answer 10

Leucopoenia (suppresses white cells and patients)
Hepatitis/cirrhosis
Nausea
Pneumonitis

Question 11

What monitoring is necessary for methotrexate patients

Answer 11

Must get regular blood tests to monitor LFT and WBC

white cell count often drops with treatment

Question 12

How is sulfasalazine used

Answer 12

In combination with methotrexate

Question 13

Is sulfasalazine safe in pregnancy

Answer 13

Yes

Question 14

What are some side effects of sulfasalazine

Answer 14

Nausea
Rash
Mouth ulcers
Neutropenia
Hepatitis
Reversible low sperm count

Question 15

What is hydroxychloroquine used for

Answer 15

Connective tissue disease
Lupus
Mild DMARD - no effect on joint damage

Question 16

What are the side effects of hydroxychloroquine

Answer 16

Usually well tolerated

Rarely causes eye problems

Question 17

What are biologics

Answer 17

Drugs designed to target specific aspects of the immune system that may be implicated in inflammatory arthritis
Targets include: TNF, B cells, Interleukin 6, 17, 12 and 23

Question 18

Biologics are more effective than DMARDs - true or false

Answer 18

TRUE

Get a response from 2/3 of patients but difference is amazing

Question 19

What diseases is anti-TNF licenced for use in

Answer 19

RA
psoriatic arthritis
ankylosing spondylitis

Question 20

What are some side effects of anti-TNF therapy

Answer 20

Increased skin cancer risk
Increased risk of infection
Can reactivate latent TB
Exacerbate HF

Question 21

Is anti-TNF treatment safe in pregnancy

Answer 21

Yes

May need to be stopped in 3rd trimester

Question 22

What are the side effects of colchicine

Answer 22

Diarrhoea

Vomiting

Question 23

How do you build up treatment in acute gout

Answer 23

Tend to try anti-inflammatory first, then colchicine, then steroids (oral or IM)

Question 24

What are some side effects of allopurinol

Answer 24

Rash - most common

Reacts with azathioprine and can rarely lead to marrow suppression

Question 25

What is the aim of gout prophylaxis

Answer 25

To keep urate levels down below a certain threshold

Question 26

What are some side effects of steroids

Answer 26

Weight gain
Muscle wasting Osteoporosis
Skin atrophy
Diabetes
Hypertension 
Some can affect fertility or pregnancy

Question 27

Steroids have a rapid onset of action - true or false

Answer 27

True