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Flashcards in MSK Deck (23)
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1

NSAIDs: Indications

As needed for mild to moderate pain, especially inflammatory

2

NSAIDs: Mechanism of Action

Principally by COX2 inhibition, so lower levels of prostaglandins. COX2 is the inducible isoform, so is more related to inflammation. COX1 is the baseline isoform so accounts for the side effects

3

NSAIDs: ADRs

GI bleeding, renal impairment, increased risk of stroke

4

NSAIDs: Warnings and Interactions

Avoid in renal failure, heart failure and liver failure. Avoid in NSAID hypersensitivity

Several drugs increase the risk of GI bleeding: steroids, aspirin, SSRIs
NSAIDs increase risk of bleeding with warfarin

5

NSAIDs: Prescription

Monitor by symptoms
Advise patients to avoid dehydration

6

Bisphosphonates (Alendronic acid): Indications

Osteoporosis
Sever hypercalcaemia of malignancy

7

Bisphosphonates (Alendronic acid): Mechanism of Action

They are incorporated into bone. They inhibit osteoclasts and induce apoptosis so reduce bone turnover.

8

Bisphosphonates (Alendronic acid): ADRs

Oesophagitis when taken orally, hypophosphataemia, jaw osteonecrosis when large doses are used IV

9

Bisphosphonates (Alendronic acid): Warnings and Interactions

They are really excreted so should be avoided in renal failure. Predictably, they are contraindicated in hypocalcaemia.

They bind calcium in the GI tract so should not be taken with calcium supplements (incl. milk)

10

Bisphosphonates (Alendronic acid): Prescription

Monitor efficacy by DEXA, be alert to side effects

11

Methotrexate: Indications

RA DMARD
Chemotherapy
Treatment resistant severe psoriasis

12

Methotrexate: Mechanism of Action

Inhibits DTFR so prevents cellular replication. It also inhibits inflammatory mediators e.g. TNFa but these mechanisms are not fully understood

13

Methotrexate: ADRs.

mucosal damage, bone marrow suppression, hypersensitivity reactions, pulmonary fibrosis

14

Methotrexate: Warnings and Interactions

It is teratogenic. It is really excreted so should be avoided in renal failure.

Toxicity is more likely if it is used alongside drugs which reduce renal function e.g. NSAIDs. Other folate antagonists e.g. trimethoprim increase the risk of haematological issues

15

Methotrexate: Prescription

Taken once a week
Monitoring for efficacy by symptoms and inflammatory markers
Monitor by safety: FBC, LFT and renal function

16

Aminosalicylates (sulfasalazine, mesasalazine): Indications

Mesasalazine is 1st line for UC
Sulfasalazine for RA

17

Aminosalicylates (sulfasalazine, mesasalazine): Mechanism of Action

They release 5-ASA, which has unclear anti-inflammatory and immunosuppressive effects. Sulfasalazine also release sulfapyridine which is probably active in RA

18

Aminosalicylates (sulfasalazine, mesasalazine): ADRs

GI upset (nausea, diarrhoea), headache, leucopenia (rare but serious)

19

Aminosalicylates (sulfasalazine, mesasalazine): Warnings and Interactions

they are aminosalicylates so are contraindicated in aspirin hypersensitivity

Depend on GI pH for breakdown and release e.g. PPIs may cause premature breakdown and lactulose may prevent breakdown and 5-ASA release

20

Aminosalicylates (sulfasalazine, mesasalazine): Presciption

Monitor CRP/symptoms for efficacy and FBC/renal function/LFT for safety

21

Them fancy -mabs (adalilumab, infliximab, rituximab): indications

RA
IBD

22

Them fancy -mabs (adalilumab, infliximab, rituximab): Mechanism of Action

They are monoclonal antibodies. Infliximab and adalilumab inhibit TNFa. Rituximab binds to CD20 on B cells to inhibits and destroys them.

23

Them fancy -mabs (adalilumab, infliximab, rituximab): ADRs

Reactivation of latent infections, immunosuppression,