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LPN INTENSIVE CLINICALS�� BNF CHAPTER 8 & 10 ��� INTENSIVE GPHC Exam revision � programme FOR JUNE 2025

LONDON PHARMACIST NETWORK (LPN)

INTENSIVE REVISION FOR JUNE 2025

GPHC EXAM.

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GOUT - INTRO

  • Gout is a type of arthritis in which small crystals form inside and around the joints. It causes sudden attacks of severe pain and swelling.
  • It's estimated that between one and two in every 100 people in the UK are affected by gout.
  • The condition mainly affects men over 30 and women after the menopause. Overall, gout is more common in men than women.
  • Gout can be extremely painful and debilitating, but treatments are available to help relieve the symptoms and prevent further attacks.

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GOUT CAUSES

CAUSES OF GOUT

  • Genetics
  • DIET – Red meat, sea food, alcohol , Certain sugary drinks may also increase risk of gout.
  • AMINO ACIDS
  • PURINES
  • URIC ACID
  • SOME Drugs can exacerbate gout ??

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SIGNS AND SYMPTOMS

  • Signs and symptoms of gout include:
  • severe pain in one or more joints
  • the joint feeling hot and very tender
  • swelling in and around the affected joint
  • red, shiny skin over the affected joint  

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TYPES

ACUTE GOUT ATTACK

CHRONIC OR LONG-TERM GOUT

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PRESENCE OF TOPHI

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THERAPY

ACUTE GOUT

NSAIDs – Naproxen , diclofenac.

Check for = asthma, bleeding risk, heart failure, meds e.g warfarin

COLCHICINE avoid in Egfr less than 10ml/min and adjust if between 10 to 50 ml/ min

CANAKINUMAB- pre-screening

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THERAPY

CHRONIC GOUT

ALLOPURINOL – rashes- SJS, water intake, azathioprine intrx

FEBUXOSTAT – mhra, SJS and CVD

SULFINPYRAZONE – acute porphyria

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DRUGS TO AVOID

  • If a patient is being treated for acute how long before starting long-term treatment ?
  • AVOID DEHYDRATION
  • Diuretics
  • ASPIRIN
  • CICLOSPORIN interact with colchicine
  • NIACIN – VIT B3

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QUESTION

  • WHICH DRUG DOES NOT REQUIRE PREGNANCY PREVENTION PROGRAMME

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  • A. MYCOPHENOLATE MOPHETIL
  • B. THALIDOMIDE
  • C. ISOTRETINOIN
  • D. SODIUM VALPROATE
  • E. AZATHIOPRINE

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METHOTREXATE

.DIHYDROFOLATE REDUCTASE

.TAKE WEEKLY

.2.5MG STRENGTH VS 10MG STRENGTH- stopped !!!

.HOW TO TAKE FOLIC ACID ??

.males wait 3 MONTHS and 6 months for females before conception after stopping the drug.

.COUNSEL PATIENTS ON HOW TO TAKE ?

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METHOTREXATE ADVERSE EFFECTS

BLOOD DISORDER

LIVER TOXICITY

RESPIRATORY EFFECTS

PHOTOSENSITIVITY

DEHYDRATION

ASCITES

CONTRACEPTION AND CONCEPTION

OTHER SIDE-EFFECTS G.I IRRITATION TOXICITY withdraw if stomatitis, ANAEMIA, taste disturbance, dyspnoea

GIVE CALCIUM FOLINATE IN ACUTE TOXICITY

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DRUG INTERACTIONS

NSAIDS NOT OTC

ASPIRIN NOT OTC

PENICILLINS

TRIMETHOPRIM

CO-TRIMOXAZOLE

PPIs

QUINOLONES

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VINKA ALKALOIDS

  • Examples- vindensine, vincristine , vinblastine
  • Used for treating various cancers
  • IV USE
  • Vinorelbine semi- synthetic vinka-alkaloid
  • Intrathecal route is contraindicated
  • 50ml bag sizes for adults
  • 5ml to 10ml for children and young adolescence
  • Neurotoxicity !!!!!
  • Note – Ototoxicity and nephrotoxicity caused by cisplatin

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EMETOGENIC CHEMOTHERAPY DRUGS

Moderately emetogenic treatment — carboplatin, doxorubicin hydrochloride, intermediate and low doses of cyclophosphamide, mitoxantrone, and high doses of methotrexate. 

Highly emetogenic treatment — cisplatin, dacarbazine, and high doses of alkylating drugs.

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MYCOPHENOLATE MOFETIL

  • Immunosuppressant
  • Renal transplantation and hepatic transplantation
  • Cautions – cough and dyspnoea, recurrent infections
  • PPP – MHRA
  • Side-effects alopecia, anaemia, drowsiness, increased risk of infections, red cell aplasia
  • Pregnancy page 896

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  • How long should male/ female patients wait before conception ?

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CYCLOSPORIN

POTENT IMMUNOSUPRESSANT

PRESCRIBE BY BRAND

PHOTOSENSITIVE- UV LIGHT, SUNLIGHT, SUN BEDS, SUN LAMPS

AVOID GRAPE-FRUIT JUICE

INTERACT WITH MACROLIDES CLARITHROMYCIN, ERYTHROMYCIN, CARBAMAZEPINE, ST JOHNS WORT, COLCHICINE

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MONITORING- CICLOSPORIN

  • BLOOD CONCENTRATIONS
  • blood pressure twice before starting
  • blood lipids
  • LIVER FUNCTION
  • POTASSIUM AND MAGNESIUM LEVELS- risk of high K
  • KIDNEY FUNCTIONS

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AZATHIOPRINE

  • Azathioprine is metabolised to mercaptopurine.
  • Side-effects- bone marrow suppression, increased risk of infection
  • Pre-treatment screening – TPMT
  • Seek advise for those with reduced or absent TPMT activity
  • PREGNANCY ???
  • Nausea, neutropenia and hypersensitivity
  • ALLOPURINOL interaction ???
  • MONITORING REQ toxicity , full blood count, myelosuppression signs

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TACROLIMUS

  • Tacrolimus is a calcineurin inhibitor.
  • BRAND-ONLY for oral tacrolimus to prevent graft rejection and toxicity.
  • PHOTOSENSITIVE – Avoid sunlight, UV light, sun lamps
  • Report and Seek advise for those with visual symptoms
  • AVOID IN PREGNANCY! Use contraceptives !!!!
  • Avoid if allergic to macrolides.
  • Side-effects – cardiomyopathy in children, QT prolong risk, diabetes
  • MONITORING- plasma conc, ECG, blood pressure, electrolytes

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