Name some NSAIDs
Ibuprofen Aspirin Naproxen Diclofenac Indometacin Etodolac Celecoxib
When to use Etodolac?
symptomatic relief of osteoarthritis and rheumatoid arthritis.
Side Effects of Indometacin?
headache, dizziness, and gastro-intestinal disturbances
When to use Celecoxib?
relief of pain in osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis
MoA of Ibuprofen
It is a propionic acid derivative with anti-inflammatory, analgesic, and antipyretic properties.
MoA of NSAIDS
They reduce the production of prostaglandins by inhibiting the enzyme cyclo-oxygenase.
Why do you need to stay on NSAIDS for a while?
Pain relief starts soon after taking the first dose and a full analgesic effect should normally be obtained within a week, whereas an anti-inflammatory effect may not be achieved (or may not be clinically assessable) for up to 3 weeks.
Why is Naproxen good to use in clinical practice?
because it combines good efficacy with a low incidence of side-effects
When are NSAIDS contraindicated?
Asthmatics
GI patients- prescribe in combination with a PPI to protecti GI tract.
Name some Analgesics
Paracetamol Codeine Co-codamol Dihyrocodeine Tramadol Amytriptyline Gabapentin Morphine
Name some Disease Modifying Anti-Rheumatoid Drugs (DMARDS)
Methotrexate
Sulphasalazine
Leflunomide
Hydroxychloroquine
MoA of Methotrexate
inhibition of enzymes involved in purine metabolism
MoA of Sulphasalazine
Suppression of IL-1 & TNF-alpha, induce apoptosis of inflammatory cells and increase chemotactic factors
MoA of Leflunomide
Pyrimidine synthesis inhibitor
MoA of Hydroxychloroquine
induces apoptosis of inflammatory cells and decrease chemotaxis
Side effects of Methotrexate
- hepatitis, cirrhosis, pneumonitis, rash, ulcers, reduction of white blood cells,
- it’s teratogenic
What should be done whilst on Methotrexate?
- on contraceptives
- Regular LFTs and FBCs
Name some Anti-TNFs?
Etanercept Adalimumab Certolizumab Infliximab Golimumab
How are Anti-TNFs given?
Subcutaneous injection
How can Anti-TNFs become more effective?
by being taken alongside DMARDS
What are side effects of Anti-TNFs?
Risk of infection, especially TB
MoA of Anti-TNFs
They suppress the physiologic response to tumour necrosis factor (TNF), which is part of the inflammatory response.
Name some Biologics
Rituximab Tocilizumab Abatacept Ustekinumab Secukinumab
MoA of Rituximab
monoclonal antibody against B lymphocytes
MoA of Tocilizumab
inhibits IL6
MoA of Abatacept
composed of CTLA-4 Ig- that blocks activation of T lymphocytes
MoA of Ustekinumab
inhibits IL12 and IL23
MoA of Secukinumab
inhibits IL17
Name some urate-lowering drugs
Allopurinol
Febuxostat
When would you use Febuxostat?
For those who cannot tolerate allopurinol
MoA of Allopurinol and Febuxostat
xanthine oxidase inhibitors
Side effects of Allopurinol
rash in elderly / renal patients
interacts with azathioprine
MoA of Azathioprine
Azathioprine inhibits purine synthesis. Purines are needed to produce DNA and RNA. By inhibiting purine synthesis, less DNA and RNA are produced for the synthesis of white blood cells, thus causing immunosuppression.
What kind of drug is azathioprine?
Immunosuppressant
What should you always prescribe with Allopurinol?
NSAIDS- as Gout can be exacerbated due to rapid reduction in uric acid level
Name some Uricosuric drugs
Probenecid
Sulphinpyrazone
Benzbromarone
MoA of Uricosuric drugs
they increase the excretion of uric acid in the urine by acting on the proximal tubule
When are uricosuric drugs contraindicated?
Renal patients
MoA of Colchicine
interrupts the cycle of monosodium urate crystal deposition in joint tissues and the resultant inflammatory response that initiates and sustains an acute attack
Side effects of colchicine
GI upset
Dont’s take with macrolides: erythromycin/ clarithromycin