Pharmacology

Question 1

What stage on the WHO pain ladder is this: “Opiod for moderate to severe pain plus non opiod with/without adjuvant analgesic”

Answer 1

Step 3

Question 2

List sme adverse effects of NSIADs

Answer 2

Peptic ulcers
Renal impairement
CVS events 
Wheeze
rash

Question 3

What NSAID mechanism is particularly bad for CVS events?

Answer 3

Cox 2 inhibitors

Question 4

Do DMARDs have an analgesic effect?

Answer 4

Not directly (pain may improve as inflammation reduces though!)

Question 5

What should be given before DMARDs are started?

Answer 5

Vaccines (not live)

Question 6

What is the first choice DMARS?

Answer 6

Methotrexate

Question 7

What is the mechanism of action of methotrexate?

Answer 7

Folate antagonist

Question 8

What conditions is methotrexate used in?

Answer 8

RA, Psoriatic arthritis, connective tissue disease, vasculitis

Question 9

What do you need to monitor in a patient who is on methotrexate?

Answer 9

FBC

LFTs

Question 10

List the adverse effects of methotrexate

Answer 10

Leucopenia/Thrombocytopenia
Hepatitis/cirrhosis
Pneumonitis
Rash/mouth ulcers
Nausea/diarrhoea

Question 11

List the adverse effects on sulfasalazine

Answer 11

Nausea
Rash/mouth ulcers
Neutropenia
Hepatitis
Oligozoospermia (reversible)

Question 12

What do you need to monitor in a patient on sulfasalzine?

Answer 12

LFTs

FBC

Question 13

What conditions is hydroxychloroquine used in?

Answer 13

Connective tissue disease such as SLE, sjogrens and RA

Question 14

What is a rare side effect that can occur with hydroxychloroquinines?

Answer 14

Retinopathy

Question 15

How does ciclosporin work?

Answer 15

Inhibits the activation of T cells

Question 16

What adverse effects can occur with ciclosporin use?

Answer 16

Nephrotoxicity

Hypertenion

Question 17

How do antimalarial drugs work as DMARDS?

Answer 17

Interfere with antigen processing

Question 18

What adverse effects can occur with azathriopine?

Answer 18

Hepatotoxicity
Myelotoxicity
GI problems

Question 19

Give 4 subcutaneous anti TNF medications

Answer 19

Etanercept
Adalimumub
Certolizumab
Golimumab

Question 20

Give an example of an IV anti TNF medication

Answer 20

Infliximab

Question 21

What three conditions is anti TNF mediation licensed for?

Answer 21

Rheumatoid arthritis
Psoriatic arthritis
Ankylosing spondylitis

Question 22

What is the major risk with anti TNF treatments?

Answer 22

Infection

Question 23

In what two conditions in anti TNF treatment contraindicated?

Answer 23

Pulmonary fibrosis

Heart failure

Question 24

What is rituximab?

Answer 24

A monoclonal antibody against B lymphocytes

Question 25

What does tocilizumab do?

Answer 25

Inhibits IL - 6

Question 26

What does abatecept do?

Answer 26

Blocks full activation of T lymphocytes

Question 27

What does ustekinumub do?

Answer 27

Inhibts IL12 and IL23

Question 28

What are the adverse effects of colchicine?

Answer 28

Diarrhoea and vomiting

Question 29

How do you treat an acute episode of gout?

Answer 29

NSAIDS Colchicine Steroids

Question 30

Name three urate lowering drugs

Answer 30

Allopurinol Febuxostat Uricosurics

Question 31

What kind of drug is allopurinol?

Answer 31

Xanthine oxidase inhibitor

Question 32

How is purine converted to uric acid?

Answer 32

Purine in converted to Xanthine. This is then converted to uric acid by xanthine oxidase

Question 33

List some adverse effects of allopurinol

Answer 33

Rash (vasculitis) Interacts with azathioprine Inhibits warfarin Marrow aplasia (extremely rare)

Question 34

List 4 uricosurics

Answer 34

Probenecid Sulphinpyrazone Benzbromarone Azapropazone

Question 35

How do urocosurics work?

Answer 35

By increasing the excretion of uric acid in the urine, and so decreasing the levels in the blood.

Question 36

Where do uricosurics work?

Answer 36

Proximal tubule of the kidney

Question 37

What rheumatological conditions are corticosteroids used in?

Answer 37

``` Connective tissue disease Polymyalgia rheumatica Giant cell arteritis Vasculitis Rheumatoid arthritis ```

Question 38

Give 4 metabolic effects of corticosteroids

Answer 38

Salt & water retention Increases gluconeogeneis. Increased hepatic glycogen deposition Increased protein breakdown

Question 39

List some adverse effects of corticosteroids

Answer 39

``` Weight gain Muscle wasting Skin atrophy Osteoporosis Diabetes Hypertension Cataracts Gluacoma Fluid retention Adrenal suppression Immunosuppression AVN of the femoral head ```

Question 40

Give 4 ways in which you can reduce the toxic effects of corticosteroids?

Answer 40

Lowest possible dose for shortest time. Consider steroid sparing agents Osteoporosis prophylaxis Control CVS risk factors