aminosalicylates Flashcards
(26 cards)
side effects
- Arthralgia
- Cough
- Diarrhoea
- Dizziness
- Fever
- GI discomfort
- Headache
- Leucopenia
- Nausea, vomiting
- Skin reactions
name the AS
- balsalazide
- mesalazine
- sulfasalazine
- olsalazine
What to do if there is a suspicion of a blood dyscrasia
stop drug immediately and perform blood count
counsel patients to report any…
unexplained bleeding, bruising, sore throat, fever, malaise that occurs during treatment
Use in breastfeeding
- monitor breastfed infants for diarrhoea
- sulfasalazine: small amounts in milk (one report of bloody diarrhoea) and theoretical risk of neonatal haemolytic esp in G6PD-deficient infants
Use in pregnancy
- avoid unless benefit outweighs risk
- sulfasalazine: risk of neonatal haemolysis in 3rd trimester, ensure adequate folate supplementation is given to mother
hypersensitivity
contraindicated
monitoring for all AS
- Renal function before starting, 3 months, then annually
mesalazine and lactulose
- preparations that lower stool pH (e.g. lactulose) might prevent the realise of some GR and MR forms of mesalazine
symptoms of acute intolerant syndrome - mesalazine
- discontinue immediately if symptoms occur such as abdominal pain, fever, severe headache, rash
- worsening abdominal pain and diarrhoea may be difficult to distinguish from an exacerbation of UC
brands: mesalazine
Asacol, salofalk, pentasa
How to take pentasa granules
place on tongue and ash down with water or orange juice w/o chewing
how to take salofalk granules
place on tongue and wash down with water w/o chewing
Mesalazine - brand switches
report any changes in symptoms
mesalazine interactions
- increased nephrotoxicity with other nephrotoxic drugs e.g. acyclovir, amphotericin B, aspirin, cefalexin, ceftriaxone, Cs, ACEi, NSAIDs, gentamicin, lithium, MTX, vancomycin etc
mesalazine GR tabs label
do not take indigestion remedies 2 hours before or after
sulfasalazine cautions
- acute porphyria’s
- G6PD deficiency
- Hx asthma or Hx allergy
- maintain adequate fluid intake
- risk haemotological toxicity
- risk hepatic toxicity
- slow acetylator status
when do haematological abnormalities tend to happen with sulfasalazine
- usually in first 3-6 months of treatment
- discontinue if they occur
monitoring for sulfasalazine
- renal before starting, 3 months, annually (like all AS)
- FBC (incl differential WCC and platelet count), initially and then monthly for first 3 months
- LFTs monthly for first 3 months
which AS stains fluids, what colour, and what to counsel pt?
- sulfasalazine stains bodily fluid yellow-orange
- harmless
- soft contact lenses may be stained
sulfasalazine interactions
- nephrotoxic drugs (e.g. acyclovir, amphotericin B, aspirin, ceftriaxone, cefalexin, MTX, lithium, NSAIDs, ACEi)
- increased risk of myelosupporession (mabs, azathioprine, -tinibs, carboplatin, cisplatin, anti-cancer drugs, doxorubicin, paclitaxel, vinblastine, vincristine)
labels for GR tabs
do not take indigestion remedies 2 h before or after
common SE sulfasalazine
- insomnia
- stomatitis
- taste altered
- tinnitis
- urine abnormalities
how to remember which one has important info about intolerance and lactulose
MILK
mesalazine
intolerance (acute intolerance syndrome - severe headache, rash, abdominal pain, fever - discontinue!!!)
lactulose (GR MR forms may be prevented from being released due to low stool pH)
