08/03

Question 1

Methotrexate side effects ?

Answer 1

Bone marrow suppression: significant drops in white cell count and platelet count calls for immediate withdrawal.
GI toxicity: withdraw if stomatitis or diarrhoea develop
Liver toxicity
Pulmonary toxicity: seek medical attention if dyspnoea, cough or fever develops;

Question 2

Methotrexate cautions?

Answer 2

Photosensitivity—psoriasis lesions aggravated by UV

dehydration (increased risk of toxicity)

Question 3

Why folic acid given with methotrexate ?

Answer 3

Folic acid decreases mucosal and gastrointestinal side-effects of methotrexate and may prevent hepatotoxicity
Folinic acid in severe acute toxicity

Question 4

Methotrexate monitoring parameters ?

Answer 4

have full blood count and renal and liver function tests repeated every 1–2 weeks until therapy stabilised, thereafter patients should be monitored every 2–3 months.

Question 5

What are coronary heart disease modifiable/non-modifiable risk factors ?

Answer 5

Modifiable: obesity, hypertension, high cholesterol ( high LDL, low HDL), lack of exercise, smoking diabetes.
Non-modifiable: age, family history of CHD

Question 6

Risk factors for AKI ?

Answer 6

Age 65 years or over
Chronic kidney disease ( eGFR < 60 ml/min)
Heart failure
Liver disease
Diabetes
History of AKI
Oliguria
Sepsis
Dementia
Hypovolaemia
NSAIds, ahminoglycosides, ACE
ARBs diuretics
Iodine based contrast media within the past week

Question 7

What is the treatment of osteoarhtiritis ?

Answer 7

-paracetamol and topical nonsteroidal anti-inflammatory drugs (NSAIDs, particularly for hand or knee involvement
-If treatment with paracetamol and/or topical NSAIDs is ineffective, consider the use of:
Oral NSAIDs such as ibuprofen