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Billy week 141 > Drugs > Flashcards

Drugs Flashcards

(56 cards)

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1
Q

UC acute first line?

A

5-ASAs (mesalazine)

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2
Q

UC remission?

A

5-ASAs (mesalazine)

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3
Q

MOA of 5-ASAs?

A

Anti-inflammatory

Inhibit synthesis of:

  • TXA
  • PGs
  • PAF

Oxygen radical scavengers

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4
Q

Sulfasalazine A/Es

A

Common, about 50%

Rash
Fever
Leukopenia
Agranulocytosis

Warn to report any sore throats, fever etc

Infertility in men (azoospermia / decreased motility)
Stains secretions orange

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5
Q

Which drugs stain secretions orange?

A

Sulfasalazine

Rifampicin

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6
Q

Mesalazine A/Es

A

Well tolerated

Nausea
Headache
Rash
Fever

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7
Q

Which mesalazine is time controlled?

A

Pentasa

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8
Q

Which mesalazine is pH independent and therefore works throughout the gut?

A

Pentasa

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9
Q

Which mesalazine is a multimatrix delivery system?

A

Mezavant

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10
Q

Which mesalazine is pH dependent and where does it work?

A

Azacol

Ileum and colon

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11
Q

Which 5-ASA can cause renal impairment?

A

Mesalazien

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12
Q

Role of corticosteroids?

A

Induce remission in UC & crohns

NOT FOR MAINTENANCE; not for use more than a couple of weeks ideally!

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13
Q

Caution with corticosteroids?

A

Taper when coming off them

Monitor for A/Es / infection

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14
Q

MOA of corticosteroids?

A

Anti-inflammatory

Prevent stimulation of pro-inflammatory mediators

  • PGs
  • LTs
  • PAF
  • Cytokines

Inactivate pro-inflammatory transcription factors

  • NF-kB
  • AP-1
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15
Q

AEs of corticosteroids?

A

Cushingoid

  • Moon face
  • Buffalo hump
  • Striae
  • Easy bruising
  • Weight gain
  • Increased appetite
  • Disturbed sleep
  • Fatigue
  • Mood changes
  • Depression
  • HTN
  • Osteoporosis
  • Hirsutism
  • Cataracts
  • Glaucoma
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16
Q

How to convert from CSs to another drug?

A

Taper

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17
Q

Cautions with CSs?

A

Bone protection e.g. calcium, vit D, bisphosphonates

Taper dose

Monitor for AEs / infections

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18
Q

Which CSs are oral?

A

Prednisolone
Bumetanide
Beclametasone

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19
Q

Which CSs are IV?

A

Hydrocortisone

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20
Q

Which CSs are TOP?

A

Hydrocortisone

Prednisolone

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21
Q

Azathioprine MOA?

A

Unknown

Metabolised to 6-MP

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22
Q

Steroid sparing agents using in IBD?

A

Azathioprine

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23
Q

Cautions with azathioprine?

Study These Flashcards
A

Cytotoxic & can cause BMS

Regular monitoring:
FBC & LFTs 1/7 for 8/52, then 3/12ly

MEASURE TPMT BEFORE STARTING

24
Q

A/Es azathioprine?

Study These Flashcards
A 
Fever
Rash
Arthralgia
Bone marrow suppression*
Leukopenia*
Hepatotoxicity*
  • Requires monitoring - which and how often?
25
Which IBD drug would you be cautious about prescribing before taking a certain blood test from the patient; which blood test, and why?
Azathioprine TPMT TPMT metabolises azathioprine and 6-MP. If someone is TPMT deficient (1 in 300), they are much higher risk of bone marrow suppression, so we check everyone before starting it.
26
Azathioprine indications?
Crohn's: - relapse to severe active crohn's - first line maintenance UC: - when remission is achieved from severe UC by ciclosporin - when "steroid dependent disease" * when relapse is within 6/52 of steroid stopping * when relapse occurs at below 15mg steroids * when relapse occurs twice in 12 months
27
Use of ciclosporin?
Severe acute UC only: when IV corticosteroids +- 5-ASAs have failed
28
Treatment of severe active UC?
5-ASAs IV corticosteroids If IV corticosteroids for 1 week fail (3 days if fulminant), switch to ciclosporin for a week. If ciclosporin works, treat for 3 months +- thiopurines to maintain remission. If it fails, colectomy# If colectomy inappropriate, could consider biologics I guess
29
Dose / route of ciclo?
IV or PO; IV is much lower dose than PO!
30
Cautions with ciclosporin?
Reacts with PVC giving sets, change every 6h with infusion, or use non-PVC. Avoid UV exposure Monitor bloods regularly: - U&Es (renal function; may need to lower dose if dose sensitive increase in creatinine and urea) - LFTs - BP (discontinue if develops HTN refractory to anti-HTNives, diuretics etc) - Monitor serum K+, Mg2+ (seizures)
31
Ciclosporin MOA?
Calcineurin inhibitor - prevents expansion of T cell subsets
32
A/Es ciclosporin?
SIKHHH ``` Seizures Infection Kidney impairment Hypertension Hypertrophy of gums Hirsutism ```
33
Interactions of ciclosporin?
``` Everything it seems! Corticosteroids Antivirals Diuretics CCBs ACEi Grapefruit juice Antibiotics ``` And the list goes on and on...
34
MTX MOA?
Anti-inflammatory: | - Prevents synthesis of eicosanoids (PGs, TXA etc; the AA pathway products)
35
MTX indications?
2rd line for maintenance of CD when AZA/6-MP failed/intolerant
36
MTX cautions?
Blood dyscrasias family history Monitor FBC, LFTs Folic acid 5mg weekly starting 3d after first dose, to minimise A/E risk
37
MTX A/Es?
Blood dyscrasias Hepatotoxicity GI (N, V, D)
38
MTX dosing?
WEEKLY!! IM, SC, PO available Note that PO is only available in 2.5mg tablets so that when a patient says "I take 3" they don't end up with 30mg as happened when 10mg were circulating.
39
MOA of infliximab/adalimumab?
TNF alpha inhibitors
40
Cautions with monoclonal antibodies?
There is a long protocol BASELINE BLOODS - FBC - U&Es - LFTs - CRP - ESR - Chest X-ray - Echo if ?endocarditis INFECTION SCREEN - TB history (work, travel, health) - VZV - HZV - HIV - HEP B/C VACCINATIONS - VZV (if no history of chickenpox, shingles, or VZV vaccination) - HPV - Flu (inactivated trivalent vaccine); yearly - Pneumococcal (polysaccharide vaccine); 3 yearly - Hep B if seronegative - NO LIVE VACCINES IN PREVIOUS 4 WEEKS! Delayed hypersensitivity reaction
41
Infliximab - describe it
Chimeric anti-TNF antibody (human IgGi + mouse protein)
42
Infliximab biosimilars names?
Remicade, inflectra, remsima
43
How do you prescribe infliximab?
By its brand name
44
Indications of infliximab use?
- Severe active crohn's or severe active fistulating crohn's: CDAI above 300 or HBI 8/9+ - IV corticosteroids / azathioprine failed or intolerated - Surgery inappropriate - Active ulcerative colitis when IV corticosteroids and 5-ASAs failed or not tolerated and ciclosporin failed or contraindicated
45
Contraindications of ciclosporin?
HTN Heart failure Severe infections Malignancy
46
Infliximab dosing?
Weeks 0, 2, 6 and then 8 weekly
47
Descibe adalimumab?
Humanised monoclonal antibody
48
Brand name of adalimumab?
Humira
49
Adalimumab indications?
- Severe active crohn's or severe active fistulating crohn's: CDAI above 300 or HBI 8/9+ - IV corticosteroids / azathioprine failed or intolerated - Surgery inappropriate - Active ulcerative colitis when IV corticosteroids and 5-ASAs failed or not tolerated and ciclosporin failed or contraindicated
50
Adalimumab dosing?
STAT S/C injection then two weekly, up to weekly if refractory
51
3rd line monoclonal antibody and it's MOA?
Vedolizumab Alpha4beta7 integrin humanised monoclonal antibody
52
How to treat infectious complications in IBD e.g. perianal fistulas in fistulating CD?
Metronidazole or ciprofloxacin Metronidazole PO TDS for 1/12, maximum 3/12 (peripheral neuropathy) Ciprofloxacin PO BD
53
What role does diet have to play in IBD?
Large; high fibre etc
54
What lifestyle modification is key in CD?
Smoking cessation
55
What drug can be used for diarrhoea in certain forms of IBD?
Colestyramine Bile salt binder, useful in diarrhoea terminal ileal disease / bowel resection
56
Why is the limit of metronidazole treatment 3/12?
Peripheral neuropathy

Billy week 141 (1 decks)

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