Arthritis ( Dmards+methotrexate)

Question 1

What are the ordinary DMARDs?

Answer 1

sulfasalazine ( blood dyscrasias, colours bodily secretions orange)
penicilamine ( blood dyscrasias)
gold ( blood dyscrasias)

Question 2

What are the antimalarial DMARDs?

Answer 2

hydrochlroquine/ chloroquine ( screening for ocular toxicity)

Question 3

What are the drugs affecting immune response DMARDs? ( blood dyscrasias )

Answer 3

methotrexate
azathioprine
ciclosporin ( nephxrotoxic)
leflunamide ( hepatatoxic, effective contraception for 2 years after treatment for women and 3 months after treatment for men )
cyclophosphamide ( cytotoxic anthracycline: urothelial toxicity i.e haemorhagic cystitis and permanent male sterility)

Question 4

What are the cytokine modulators DMARDs ?

Answer 4

infliximab, etanercept ( blood dyscrasias, report symptoms of tuberculosis e.g persistent cough, weight loss and fever)

Question 5

How does methotrexate work ?

Answer 5

anti-folate; inhibits the conversion of dihydrofolate ( folic acid) to tetrahydrofolate needed to make purines and pyrimidines and therefore DNA; prevents cellular replication.

Question 6

What are the side effects of methotrexate ?

Answer 6

blood dyscrasias ( low white blood cells, low red blood cells, low platelets )
hepatoxicity
nephrotoxicity 
pulmonary toxicity ( SOB, cough, fever)
gasto-intestinal toxicity ( stomatitis)

Question 7

What are the symptoms of low white blood cells ?

Answer 7

susceptible to infection; mouth ulcers, fever, malaise, sore throat

Question 8

what are the symptoms of low red blood cells ?

Answer 8

anaemia: report extreme tiredness, pallor, dizziness

Question 9

what are the symptoms of low platelet count ?

Answer 9

thrombocytopenia: report bruising and bleeding easily

Question 10

What are the conception and contraception requirements relating to methotrexate ?

Answer 10

effective contraception during and 3 months after; both men and women

Question 11

Which drugs interactions with methotrexate can lead to blood dyscrasias ?

Answer 11

phenytoin, trimethoprim ( antifolates)

clozapine (neutropenia)

Question 12

Why NSAIDs should be avoided with methotrexate ?

Answer 12

reduced renal excretion = toxicity

Question 13

Which drugs should not be given with methotrexate because of the increased risk of hepatoxicity ?

Answer 13

isotretinoin, phenothiazine antipsychotics, rifampicin, ketocenazole