Sulfasalazine contains a 5-ASA and a sulfapyridine.  The sulfapyridine is responsible for producing AEs: headaches, nausea, rasha, reversible infertility, malaise, gas and cramps. (still seen in 5-ASA)

Sulfasalazine is indicated only in RA now, as 5-ASA have surpassed it.

The treatment of chronic IBD.  Including inducing and maintaining remission in mild UC.

They are less effective in Crohns.

Gram negative obligate anaerobes are the most likely bacteria. 

Metronidazole is an effective antibiotic against these bacteria. Alcohol is contraindicated in metronidazole use.

Methotrexate (purine inhibition), Ciclosporin (calcineurin inihibitor), Azathioprine (purine),

Monoclonal Ab- Adalimumab, Inflixumab TNF alpha inihibitors

Chloroquine and hydrochloroquine (IL suppression)

There biggest advantage is that they are steroid sparing

Many patients receive an NSAID and at least one DMARD, sometimes with low-dose oral glucocorticoids. If disease remission is observed, regular NSAIDs or glucocorticoid treatment may no longer be needed.

It is a combination antacid/antidiarrheal.  It reduces the secretion of fluid into the gut and increases absorption.

It may cause black tongue and black stool.

Opioids work as mu receptor agonists against pain and diarrhea.

The common side effects are respiratory depression, sedation, constipation and euphoria.

It is an opioid receptor agonist in the myenteric plexus, decreasing the activity of the ircular smooth muscle.

It is contraindicated in compromised hepatic patient.

1. Exercise and diet - fibre
2. Bulking agents - Metamusil
3. Stool softner - Coloxyl
4. Osmotic laxatives - Movicol
5. Stimulants - Coloxyl and Senna
6. Suppositories - Duracol
7. Lavage 

Coloxyl draws water into the colon to soften the stool

Senna increases muscle activity to move the stool

Metoclopromide is an antiemetic and a gastro prokinetic.  It is a dopamine antagonist.  It is used to treat constipation and nausea.

It is the most common cause of drug induced movement disorders i.e tardive dyskinesia

Prochlorperazine is an extremely strong typical antipsychotic (dopamine antagonist) indicated in resistant nausea and vomiting.  It has significant EPSE.  Particularly post chem/radio therapy. 5-10 minute onset and 4 hr action.

Ondansetron is a 5-HT serotonin antagonist indicated particularly in post chemotherapy nausea and vomiting.  Ondansetron is a well tolerated drug with few side effects.  It is very expensive.

It has less cognitive impairment i.e. good in elderly

Produces neurotoxic metabolites

Fentanyl is a potent, synthetic opioid analgesic with a rapid onset and short duration of action.  It is indicated for breakthrough pain and can be administered transdermally.  Safest opioid.

Oxycodone s a narcotic analgesic generally indicated for relief of moderate to severe pain.  Second line to morphine for cancer pain.  High risk of addiction and withdrawal symptoms.

Hydrocortisone is the weakest topical corticosteroid.

Betamethasone is much stronger.

Corticosteroids should be deliever in pulses, using the most potent preparation possible for the shortest amount of time.

Occlusion of site can help concentrate medication.

Epidermal atrophy, striae, hypopigmentation

Hyperglycemia, immunosuppresion, adrenosuppression and Cushing's syndrome.

Inhibitis DNA synthesis of fast growing dysplastic cells.  

Is used to treat solar keratosis.  

3-5 days reddening --> 2 weeks of blistering --> 4 weeks of erosion.

Indicated in the treatment of superficial BCC or SK on the face and genitals.  

It induces infiltration of tumor destructuve cells. 

Poor compliance due to specific instructions.

Very few systemic symptoms.