Counselling Week 2 (Adalimumab, Celecoxib, Methotrexate, Allopurinol, Mesalazine) Flashcards
This medication is adalimumab and the brand we have given you is called
Humira (all comes in injections)
Mode of action and indication of adalimumab
Use to treat a wide variety of conditions, this includes: rheumatoid arthritis, psoriasis, ankylosing spondilitis, chrons disease and ulcerative colitis.
The active ingredient in this medicine is adalimumab, which is a fully human monoclonal antibody. Monoclonal antibodies are proteins made by bloods cell to fight a foreign protein in the body. By doing this, it reduces inflmmation in the body.
Dose and directions for use (C/A labels) for adalimumab (3 marks)
Rheumatoid or psoriatic arthritis, ankylosing spondylitis
SC, 40 mg once every 2 weeks (1 injection every 2 weeks)
Psoriasis, uveitis
- SC, 160 mg on day 0 (or 80 mg on day 0 and day 1), then 80 mg on day 14, then 40 mg once every 2 weeks.
Crohn’s disease, ulcerative colitis
SC, 160 mg on day 0 (or 80 mg on day 0 and day 1), then 80 mg on day 14, then 40 mg once every 2 weeks.
If there is a decline in response, consider increasing the dose to 40 mg once a week or 80 mg every 2 weeks.
> Humira is injected under the skin (sub-cutaneous injection). • It can be injected by the patient, or by someone else, such as a family member, friend or carer. • An injection should not be attempted until proper training has been received on the correct injection technique.
CAL labels
12-16 weeks for full effect but you start to see an improvement in 1-2 weeks
6,7b
6: Refrigerate, do not freeze
7b: Discard days after opening.
AE (common, serious, allergic) of adalimumab (3 marks)
All medications can cause side effects, but not everyone will experience them. Some common side effects that may occur include: pain, swelling, redness or itching at the site of the injection. Also, runny nose, sinus infection, sore throat cough, congestion on the chest, asthma or worsening of asthma symptoms may occur
Rarer side effects include abdominal pain and confusion
Please see your doctor if you notice signs of infection. This includes fever, lack of energy, problems with teeth or gums, burning when passing urine
Lifestyle/self-care of Adalimumab (2 marks)
Do not attempt to self-inject until you are sure that you understand how to prepare and give the injection. Your doctor or his/her assistant will also show you best how to self-inject.
Remind any doctor, dentist or pharmacist you visit that you are using Humira, especially if you are scheduled for surgery or to receive any live vaccines.
Take fish oil as they contain omega 3 fatty acids which will help decrease joint pain, swelling and stiffness for RA.
Fish oil at least 2.7 g (omega-3) orally, daily –> mild anti-inflammatory effect in rheumatoid arthritis
Fish oil may take up to 3 months for maximal effectiveness, so it may be necessary to co-prescribe fish oil with an NSAID initially
The Mediterranean-style diet, characterised by a high consumption of fruit, vegetables, cereals and legumes, a little red meat but more fish, olive oil as the main source of fat, and a moderate intake of wine, appears to be the most universally accepted dietary intervention; it has the added benefit of weight control and reducing cardiovascular risk.
Questions + CMI (1 mark)
I have printed information for you about this medication, is there anything you would like me to explain more? Do you have any questions?
This medication is celecoxib and the brand we have given you is called
Celebrex, celaxi, celexi
100mg or 200mg
Mode of action and indication of celecoxib (3 marks)
This medication contains celecoxib and belongs to a group of medicines called coxibs which are used to relieve pain and inflammation in a number of conditions.
> Although Celexi can relieve the symptoms of pain and inflammation, it will not cure your condition.
This medication is used to relieve the symptoms of joint pain, tenderness, swelling and stiffness in:
- osteoarthritis
- rheumatoid arthritis
- ankylosing spondylitis, a chronic inflammatory rheumatic disorder that primarily affects, but is not limited to, the spine.
Celebrex also provides short-term pain relief in conditions such as:
- menstrual cramps or period pain
- after surgery
- muscle and joint injuries
Dose and directions for use (C/A labels) for celecoxib (3 marks)
Ankylosing spondylitis, osteoarthritis
- Upto 200mg daily in 1 or 2 doses
Rheumatoid arthritis
Adult, oral 100 mg twice daily. May be increased to 200 mg twice daily (short term).
Period pain
Adult, oral 400 mg daily in 1 or 2 doses on the first day, then 200 mg once or twice daily if needed; maximum 5 days treatment.
CAL labels
10A: Do not take more than one aspirin tablet or capsule each day while being treated with this medicine,
12: This medicine may affect mental alertness, and/or coordination. If affected, do not driver a motor vehicle or operate machinery.
19b: Consult your doctor or pharmacist before taking other medications for pain or inflammation.
AE (common, serious, allergic) of celecoxib (3 marks)
All medications can cause side effects but not everyone will experience them, some common side effects include stomach pain, indigestion, dizziness.
Rarer side effects include muscle weakness and confusion.
Please see your doctor if you experience skin rash, including hives, raised red, itchy spots. Also see your doctor if you experience severe stomach or throat pain, vomiting blood or black sticky bowel motions.
Lifestyle/self care of celecoxib
Take this medication with food to reduce the chances of upsetting the stomach.
Do not take aspirin for pain relief as it will increase the risk of side effects with this medicine.
Don’t take this medicine if you are dehydrated, for example due to vomiting or diarrhoea, because it might increase the likelihood of side effects.
Heat packs for pain and stiffness in RA/OA/AS
Cold pack used for heat and swelling
Learn to rest when your body needs rest, maintain a correct posture to reduce stress on joints/
Monitoring pain levels using a pain management diary
Pacing physical activities (eg spreading physically hard jobs throughout the day with breaks in between to reduce sustained physical loading)
Referral to an appropriate health professional (eg physiotherapist, exercise physiologist) may be beneficial to initiate and reinforce an exercise program; this may include prescribing a personalised program of simple exercises (eg swimming, walking) that the patient can do unsupervised.
Questions + CMI (1 mark)
I have printed information for you about this medication, is there anything you would like me to explain more? Do you have any questions?
This medication is methotrexate and the brand we have given you is called
Methoblastin (tablets)
Methotrexate injection (trexject and methotrexate)
Mode of action and indication of methotrexate
This medication is used for a wide variety of medications. This includes cancer, psoriasis, and rheumatoid arthritis.
> also used for juvenile idiopathic arthritis, crohn’s disease
The medicine works by blocking an enzyme needed by the body’s cells to live. This interferes with the growth of some cells that are growing rapidly in psoriasis and cancer.
In rheumatoid arthritis, this medicine reduces the overactivity of the immune system leading to less pain, swelling and damage to the joints.
Dose and directions for use (C/A labels) for methotrexate (3 marks)
RA, psoriasis
- Oral/SC/IM, initially 10–15 mg once a week, adjust dose according to response. Usual maintenance 10–25 mg once a week (maximum, oral 30 mg; SC/IM 25 mg).
Juvenile idiopathic arthritis
Oral/SC/IM, 10–20 mg/m2 (maximum 25 mg) once a week
Cancer
> idk innit, amh says consult treatment protocols
CAL
5: Ask your doctor or pharmacist before using any other medicine including over the counter medicines or health products
8: Avoid excessive skin exposure to sunlight and sunlamps while being treated with this medicine
10a: Do not take more than one aspirin tablet or capsule each day while being treated with this medicine
20: Take once weekly on the same day
21: Special handling and disposal required → ask your pharmacist
AE (common, serious, allergic) of methotrexate (3 marks)
All medications can cause side effects, but not everyone will experience them. Some common side effects include hair loss which is reversible, stomach pain and increased sensitivity to the sun.
Rarer side effects include severe skin reactions
Please see your doctor if you are experiencing persistent diarrhoea or dry, non-productive cough. Or swelling of the face, lips, tongue or other parts of the body
Please see a doctor if you see signs of mouth ulcers as this can be a sign of toxicity.
Lifestyle/self-care of Methotrexate (2 marks)
Take this medication strictly as directed. It should be taken once a week on the same day each week; it must not be taken every day.
Drinking alcohol can increase the side effects of methotrexate. Limit consumption, eg avoid drinking more than 1 standard drink in a day for women or 1–2 standard drinks in a day for men; discuss this with your doctor if it is a problem for you.
Avoid sun exposure, wear protective clothing and use sunscreen as methotrexate may make you more sensitive to sunlight.
Fish oil at least 2.7 g (omega-3) orally, daily –> mild anti-inflammatory effect in rheumatoid arthritis –> fish oil may take up to 3 months for maximal effectiveness, so it may be necessary to co-prescribe fish oil with an NSAID initially
