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Pre-reg Exam 2021 > Arthritis > Flashcards

Arthritis Flashcards

1
Q

What is rheumatoid arthritis?

A

Autoimmune disease where the immune system mistakenly attacks the synovium

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2
Q

What are the symptoms of rheumatoid arthritis?

A

Joint pain and swelling, usually affects hands, feet and wrists

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3
Q

What is used to treat rheumatoid arthritis?

A

DMARDs

Disease modifying anti rheumatic drugs

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4
Q

What do you use to treat new diagnosis of rheumatoid arthritis?

A

Methotrexate + other DMARD + temporary corticosteroid

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5
Q

What are the DMARDs?

A

Sulfasalazine
Penicillamine
Gold

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6
Q

What are the side effects of the DMARDs?

A

Blood dyscrasias

Sulfasalazine colours secretions orange/yellow

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7
Q

What are the antimalarial DMARDs?

A

Hydroxychloroquine

Chloroquine

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8
Q

What screening needs to occur when using antimalarial DMARDS?

A

Ocular toxicity

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9
Q

What are the DMARDs that affect the immune response?

A 
Methotrexate
Azathioprine 
Ciclosporin
Leflunomide
Cyclophosphamide
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10
Q

What are the side effects of the DMARDs that affect the immune response?

A

Blood dyscrasias
Ciclosporin - hepatotoxic
Leflunomide - hepatotoxic (contraception 2 years after treatment for women, 3 months for men)
Cyclophosphamide- cytotoxic anthracycline, urothelial toxicity (haemorrhagic cystitis, permanent male sterility)

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11
Q

What are the cytokine modulating DMARDs?

A

Infliximab

Etanercept

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12
Q

What are the side effects of the cytokine modulating DMARDs?

A

Blood dyscrasias

Report symptoms of TB

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13
Q

What is the mechanism of action of methotrexate?

A

Anti folate
Inhibits the conversion of dihydrofolate to tetrahydrofolate needed to make purines and pyrimidines and therefore DNA - prevents cellular replication

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14
Q

Are antifolate drugs teratogenic?

A

Yes

Also cause blood dyscrasias

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15
Q

What is methotrexate used for?

A

Rheumatoid arthritis
Cancer
Psoriasis
Crohn’s

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16
Q

When is methotrexate taken?

A

Once weekly on the same day each week

17
Q

What must be on a prescription for methotrexate?

A

Dose and frequency and only prescribe one strength

18
Q

Why is folic acid taken with methotrexate?

A

Helps reduce methotrexate side effects

19
Q

What are the regimens used for folic acid when taken with methotrexate?

A

5mg once weekly on day after methotrexate
5mg daily except on methotrexate day
1mg daily except methotrexate day

20
Q

What do you do if you miss a dose of methotrexate?

A

> 3 days take next scheduled dose on normal day

21
Q

What are the counselling points for methotrexate?

A

Weekly doses and avoid OTC NSAIDs
Annual flu vaccination
Methotrexate treatment booklet

22
Q

What are the side effects of methotrexate?

A 
Blood dyscrasias
Hepatotoxicity 
Nephrotoxicity 
Pulmonary toxicity
GI toxicity
23
Q

What are the methotrexate counselling points for blood dyscrasias?

A

Low white blood cells - susceptible to infection. Report mouth ulcers, fever, malaise, sore throat

Low red blood cells - anaemia. Report extreme tiredness, pallor, dizziness

Low platelets - thrombocytopenia. Report bruising and bleeding easily

24
Q

What are the methotrexate counselling points for hepatotoxicity?

A

Report nausea, vomiting, dark ursine, jaundice, abdominal pain, pruritis, malaise, pale coloured stools

25
Q

What are the methotrexate counselling points for pulmonary toxicity?

A

Report shortness of breath, cough, fever

26
Q

What are the methotrexate counselling points for GI toxicity?

A

Report stomatitis as its the first sign of GI toxicity

27
Q

When does contraception need to be used with methotrexate?

A

During and 3 months after

28
Q

What are the methotrexate interactions that cause an increased risk of blood disorders?

A

Phenytoin
Trimethoprim
Co-trimoxazole
Clozapine

29
Q

What are the methotrexate interactions that cause reduced renal excretion and therefore methotrexate toxicity?

A

NSAIDs

30
Q

What are the methotrexate interactions that cause an increased risk of hepatotoxicity?

A

Isotretinoin
Phenothiazines
Rifampicin
Ketoconazole

Pre-reg Exam 2021 (79 decks)

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