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Flashcards in Pharmacology Deck (49):
1

What is the function of paracetamol?

pure analgesic with little anti-inflam action

2

What is step 1 in the pain pathway?

non-opiod +/- adjuvant

3

What is sstep 2 in the pain pathway?

weak opiod =/-non-opioid +/- adjuvant

4

What is step 3 in the pain pathway?

strong opioid +/- non-opioid +/- adjuvant

5

What is the first line NSAID in Tayside?

naproxen

6

What are the indications for NSAIDs?

inflammatory arthritis; mecahnical MSK pain; pleuritic/pericardia lpain

7

What are the GI SE of NSAIDs?

dyspepsia; oesophagitis; gastritis; peptic ulcer; small/large bowel ulceration

8

What are the other SE of NSAIDs?

renal impairment; increased CVS events; fliud retention; wheeze (exacerbation of asthma); rash

9

What are COX-2 inhibitors?

NSAIDs which selectively target Cyclooxygenase-2 which is an enzyme responsible for inlfam and pain

10

What the benefits and risks of COX-2 inhibitors?

reuces the risk of peptic ulceration but increases CVS risk

11

What are the actions of DMARDs?

pure anti-inflammatory with no direct analgesice effect; reduce rate of joint damage

12

What is the aim for DMARD therapy in RA patients?

to start therapy within 3 months of symptom onset

13

What are the commonly used DMARDs?

methotrexate; sulphasalazine; leflunomide; hydroxycholoquien

14

What is the mode of action of methotrexate?

folate antagonist

15

What are the 2 routes of administration for methotrxate?

orally and subcut

16

What diseases is methotrexate used to treat?

RA; psoriatic arthritis; connective tissue disease; vasculitis

17

What are the SE of methotrexate?

leucopenia/thrombocytopenia; hepatitis/ cirrhosis; penumonitis; rash/mouth ulcers; nausea/diarrhoea

18

When must methotrexate be stopped?

teratogenic- so must be stopped in BOTH males and females at least 3 moths before conception

19

Why is methotrexate used more frequently then sulfasalazine when both are first line?

methotrexate works quicker and is better tolerated

20

Why is started RA patients on DMARDs ASAP imprtoant?

theres only a limited time to reduce inflam before joint function cannot be recovered

21

How can the SE of methotrexate be modified?

changing the mode of action: PO/ injection

22

How long after stopping leflunomide can patients get pregnnat?

at least 2 years

23

What are the adverse effects of sulfasalzine

nausea; rash/mouth ulcers; neutropenia; hepatitis; reversible oligozoospermia

24

What is the very serious skin condition that can be caused by sulfasalazine?

Stevens-Johnson syndrom

25

What is HCQ used for?

connective tissue disease such as SLE; Sjogrens and RA

26

What is the action of HCQ?

no effect on joint damage?

27

What is the SE of HCQ?

retinopathy

28

Name an anti-TNF drug?

inflixumab

29

What is the benefit of biologics compared to DMARDs?

1.5x more effective than DMARDs

30

When are biologics used in patients with RA?

when they have a high disease activity score and have already used methotrexate

31

What are anti-TNFs licensed for?

RA; psoriatic arthritis and ank.spon

32

How are anti-TNFs give?

subcut

33

What are hte SE of anti-TNFs?

risk of infection; increase risk of skin cancer; exacerbate heart failure

34

What must be screened for before commencing anti-TNF therapy?

TB

35

What is the action of secukinimab?

inhibits IL17

36

What is rituximab?

monocolonal antibody against B cells

37

How is gout treated actuely?

colchicine; NSAIDs; steroids either oral or IM

38

What is the common SE of colchicine?

diarrhoea

39

What are hte urate lowering drugs availbale?

allopurinol; febuxostat; uricosurics

40

What are the actions of allopurinol and febuxostat?

block xanthine oxidase whic hconverts xanthine to uric acid

41

Why must allopurinol not be started during an acute attack of gout?

may result in an exacerbation of gout due to the rapid reduction in uric acid level

42

When is the rash caused by allopurinol made more likely?

in the elderly and in renal impairment

43

What is the serious SE of allopurinol?

marrow aplasia

44

What drug must never be used at the same time as allopurinol?

azathioprine

45

When is febuxostat used?

in patients who cannot tolerate allopurinol

46

In what patients should febuxostat be used caustiously?

in those with IHD

47

What diseases are steroids indicated for?

connective tissue disease; PMR/ GCA; vasculitis; RA

48

What are the SE of steroids?

weight gain- centripetal obesity; muscle wasting; skin atrophy; osteoporosis; diabetes; HT; cataracts; glaucoma; fluid retention; adrenal suppression; immunosuppression; avascular necrosis of femoral head

49

How is allopurinol treatment started/managed?

6 weeks after acute flare; blood urate levels and PMHx asked about; allopurinol started and after 6 weeks urate levels checked again and dose changed; continues til urate levels are below 360mcg/L