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Yr 3 Inflammatory and GI > Drugs used in inflammatory diseases > Flashcards

Drugs used in inflammatory diseases Flashcards

1
Q

When is paracetamol preferred over NSAIDs

A

elderly
HT, CVD, renal impairment, GI issues
meds that interact with NSAIDs (warfarin)

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2
Q

When is Aspirin contraindicated

A

children
peptic ulcers
bleeding disorders
cardiac failure
elderly
caution w asthma

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3
Q

What interacts with aspirin?

A

Drugs that increase GI irritation and bleeding ( steroids, NSAIDs, SSRIs, anticoags.)
Drugs that increase risk of renal side effects (bisphosphonates)
Drugs that aspirin can increase toxicity of (methotrexate)

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4
Q

What drugs for inflammation are non selective?

A

Ibuprofen, indomethacin, mefenamic acid, naproxen

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5
Q

What drugs for inflammation are selective?

A

Celecoxib, etoricoxib

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5
Q

What drugs for inflammation have a COX-2 preference?

A

Diclofenac, etodolac, meloxicam

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6
Q

Why do NSAIDs cause GI side effects?

A

Suppression of physiological homeostatic prostanoid (COX1)

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7
Q

What are some key points to remember when prescribing NSAIDs/ DMARDs for inflammation?

A

Start at lowest dose
For shortest time
No more than 1 NSAID at a time
Take w food
Co-prescribe with gastroprotective if at risk of GI s/e (PPI’s)
Monitor

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8
Q

What monitoring needs to happen for NSAIDs?

A

Symptoms of dyspepsia/ GI irritation
Hb - for bleeding
Signs of GI bleeding - dark stools

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9
Q

What drugs for inflammation have the highest risk of CV events and which has the lowest?

A

HIGHEST - COX2 inhibitors, diclofenac 150mg, ibuprofen 2.4g+
LOWEST - ibuprofen low dose (1.2g)

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10
Q

What NSAIDs are contraindicated for Heart failure / CVD
&
What are cautioned?

A

COX-2 Inhibitors, High dose ibuprofen= CI

Non-selective NSAIDs CAUTIONED

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11
Q

What can NSAID’s do to renal function?

A

Can decrease renal blood flow and increase risk of kidney injury
Sodium and water retention can cause oedema and hypertension

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12
Q

What interactions w NSAIDs are likely to cause decreased renal function?

A

Co-prescribed nephrotoxic medicines (diuretics and ACE-inhibitors)
Anti-hypertensives (opposite effect!)
Lithium and methotrexate (decreases renal elimination and causes toxicity)

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13
Q

What needs to be monitored when it comes to renal function and NSAID’s?

A

GFR, urine output, urea
BP
electrolytes (sodium and potassium)
Oedema (watch weight, visual signs)

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14
Q

If you were to remember ONE THING about methotrexate dosing - what would it be?

A

ONCE A WEEK- same day

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15
Q

What does a test dose of methotrexate do?

A

Rules out idiosyncratic adverse effects

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16
Q

What strength is prescribed for methotrexate in community?

A

2.5mg tablets ONLY

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17
Q

Councelling points for methotrexate?

A

usually takes 6 weeks for effect in RA
Dose may be changed too, optimal dose should be achieved in ~4-6 weeks

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18
Q

What monitoring needs to be done when starting therapy and what needs to be done during treatmentwith methotrexate?

A

STARTING:
full blood count
Liver function tests
Urea and electrolytes
Renal function
Chest x-ray

DURING:
full blood count (every 1-2 weeks until stable, then every 2-3 months)
Self monitor for infection (bruising, bleeding), nausea, vomiting, dark urine, SOB.

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19
Q

What are side effects of methotrexate?
And cautions?

A

Bone marrow suppression

Surgery
renal impairment
diarrhoea
ascites
peptic ulcers

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20
Q

When is methotrexate contraidicated?

A

Active infection
renal impairment
hepatic impairment
bone marrow suppression
Immunodeficiency
Pregnancy and breastfeeding

21
Q

What else should be given with methotrexate?
Why?

A

Folic acid
5mg OD (1-6 days a week, never on same day as methotrexate)
Decreases risk of hepatotoxicity and GI side effects

22
Q

What counselling points should be told to a patient on methotrexate?

A

Missed dose? can be taken within 2 days
Interacts with:
anti-folates (some antibiotics, eg: co-trimoxazole, trimethoprim)
NSAIDs
Live vaccines
Ciclosporin
Recommended to get the Pneumococcal and flu vaccines!

23
Q

What type of drug is Leflunomide

A

A DMARD- disease modifying anti-rheumatic drug

24
Q

What is the usual oral dose for leflunomide?

A

RA- 100mg for 3 days, then 10-20mg a day
Takes 4-6 weeks for mild improvements

25
Q

What monitoring parameters need to be undertaken with Leflunomide?

A

Before treatment:
Liver function tests, FBC, BP
Then every 2 weeks for first 6 months
Then every 8 weeks

26
Q

What side effects can happen with leflunomide?

A

Hepatic impairment, Bone marrow suppression, increased blood pressure

27
Q

When is Leflunomide contraindicated?

A

hepatic or renal impairment
immunodeficiency
Infection
Hypoproteinaemia

28
Q

How long does leflunomide last in the body?
How can we clear it quicker?

A

1-4weeks
monitor
washout procedure- cholestyramine 8g TDS or activated charcoal 50g QDS for 11 days

29
Q

What counselling points need to be made to a patient on leflunomide?

A

Avoid live vaccines
Avoid alcohol

30
Q

What type of drug is Ciclosporin?

A

A calcineurin Inhibitor

31
Q

What does Ciclosporin treat?

A

IBD
Transplants
Psoriasis
Severe atopic dermatitis
RA

32
Q

What are some side effects from ciclosporin?

A

Headache, tremor, HYPOtension, hirsutism,
Renal impairment

33
Q

What needs to be monitored when on ciclosporin?

A

Renal function, hepatic function, BP, Lipids, Electrolytes (Potassium and magnesium), Uric acid (CI in gout)

34
Q

What can increase the levels of ciclosporin?

A

CYP 450 Inhibitors- like grapefruit juice and macrolides etc

35
Q

What can decrease the levels of ciclosporin?

A

CYP 450 Inducers-like phenobarbital, phenytoin and st. johns wart

36
Q

What should you do when a patient is on ciclosporin and has statins?

A

Decrease the statin dose

37
Q

What drugs should you avoid when on ciclosporin?

A

CYP450 Inducers and Inhibitors
Statins
Nephrotoxic drugs
Any drugs w/ similar effects as ciclosporin (Eg: K+ sparing diuretics)

38
Q

What mechanisms does ciclosporin inhibit?

A

CYP 3A4, P-glycoprotein and OAT protein

39
Q

Name an Anti-TNF biologic

A

Etanercept
adalimumab
Infliximab

40
Q

Name an IL-6 receptor inhibitor biologic

A

Tocilizumab

41
Q

Name an Anti-B cell biologic

A

Rituximab

42
Q

Name an Anti-T cell biologic

A

Abatacept

43
Q

Name a JAK inhibitor biologic

A

Tofacitinib
usually nibs

44
Q

What counselling points do you need to make a patient aware of when on a biologic?

A

Increase risk of infection
May increase risk of malignancy
Alcohol decreased or stopped if DMARD’s.

45
Q

What monitoring needs to be done when on a biologic?

A

FBC
eGFR and Cr (renal function)
Liver function tests (AST & ALT & albumin)
Tuberculosis
Hepatitis
Chest x-ray

46
Q

When do you review biologics

A

every 6 months

47
Q

What is Infliximab

A

a TNF inhibitor

48
Q

What in infliximab used for

A

RA
crohns
UC
Ankylosing spondylitis
psoriasis

49
Q

What is the dosing for infliximab for RA?

A

3mg x kg at week 0,2, 6 then every 8 weeks

50
Q

What side effects occur with infliximab?

A

Infection, headache, pain

51
Q

When is infliximab contraindicated?

A

Severe infection
TB
Abscesses
Opportunistic infections

Yr 3 Inflammatory and GI (15 decks)

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