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Stage 3 Case 3 > DMARDs > Flashcards

DMARDs Flashcards

1
Q

RA management NICE: Initial therapy

A

Monotherapy with cDMARD within 3 months

Escalated to dose that can be managed.

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2
Q

RA management NICE: DAS28 scoring

A

Multiple measures of disease activity to make a decisions on treatment

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3
Q

RA management NICE: Short-term bridging treatment

A

Glucocorticoids. Steroids used with initial cDMARD, as cDMARD does not work straight away and get rid of symptoms.

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4
Q

Where is the steroid bridging treatment used?

A 
Use intramuscular (muscle), or intraarticular (joint).
 Avoid oral
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5
Q

Why Avoid oral steroids for bridging treatment?

A

Have lots of side effects
Systemic, change to blood glucose, osteoporosis, GI irritation, suppression of the adrenal system and physiocratic effects

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6
Q

What are side effects that may be experienced with IM and IA steroids?

A

Thinning of skin and pain at injection site.

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7
Q

What are Specific targeted therapies?

A

Oral drugs like Janus Kinase inhibitors (expensive)

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8
Q

RA management NICE: Ineffective initial DMARD therapy (4)

A

Step up
Try different
Biological DMARD
Specific targeted therapies.

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9
Q

RA management NICE: Symptom control

A 
Analgesia
 Physio
 OT
 Lifestyle advice (exercise)
 CBT
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10
Q

RA management NICE: target achieved for >1 year without glucocorticoids

A

Consider stepdown

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11
Q

RA management NICE: First line drugs? (3)

A

Oral methotrexate, leflunomide or sulfasalazine

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12
Q

RA management NICE: Consider hydroxychloroquine for first line

A

If patient has mild disease or palindromic disease

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13
Q

Issue with DMARD?

A

Takes a while to work so patients may not notice any changes.
They do not treat symptoms.

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14
Q

What do DMARD do?

A

Prevent progression and destruction of the joints over time.

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15
Q

What are biological DMARDs?

A

Monoclonal antibodies that target cytokines like Anti-TNF

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16
Q

What are RA patients more at risk of?

A

Strokes and CVD

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17
Q

What do NSAIDs increase the risk of?

A

CVD particularly COX-2 inhibitors.

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18
Q

What is mild disease or palindromic disease

A

Flare ups the normal joint function. Not much damage or long term progression to the joint.

19
Q

What does the DAS-28 score look at? (3)

A

How many tender and swollen joints out of 28.
ESR/CRP
Patients feeling 1-100

20
Q

DAS-28 score = very active disease

A

> 5.1

21
Q

DAS-28 score = active disease

A

5.1-3.2

22
Q

DAS-28 score = remission

A

<2.6

23
Q

DAS-28 score = response to treatment

A

A change of 0.6

24
Q

ESR

A

Erythrocyte sedimentation rate

How quickly RBC settle in a test tube.

25
Q

CRP

A

C-reactive protein

Increases when inflammation in the body

26
Q

Normal ESR

A

0 to 22 mm/hr for men and 0 to 29 mm/hr for women

27
Q

High ESR?

A

Inflammation

28
Q

Normal CRP

A

Less than 10 mg/L

29
Q

CS-DMARD

A

Classical synthetic

30
Q

B-DMARD

A

Biologic

31
Q

Ts-DMARD

A

Targeted

32
Q

CS-DMARD examples

A

Methotrexate, sulfasalazine, hydroxychloroquine, leflunomide, azathioprine

33
Q

B-DMARD examples

A

Etanercept, adalimumab, golimumab, abatacept, rituximab

34
Q

Ts-DMARD examples

A

Tofacitinib, baricitinib

35
Q

Prescribing principles cDMARD: shared-care arrangements

A

Initiated in hospital by a HCP. Once patient stable, care transferred to GP.

36
Q

Prescribing principles cDMARD: Chicken pox

A

Due to impaired immune function need to avoid contact. Must seek medical advice immediately.

37
Q

Prescribing principles cDMARD: Intercurrent illness

A

Stop DMARD

38
Q

Prescribing principles cDMARD: Monitoring trends and blood results.

A

Need to interval for each drug. More than one drug, monitor using minimal interval period. (shortest frequency of monitoring?)
Use multiple blood results.

39
Q

What is monitored in blood results for cDMARDs?

A

Neutrophils, platelets.

40
Q

Prescribing principles cDMARD: Vaccines

A

Flu, pneumococcal and COIVD 19.

41
Q

Prescribing principles cDMARD: Live vaccines

A

Contraindicated. More prone to develop disease. Varicella zoster is the exception.

42
Q

What is methotrexate never prescribed with?

A

Trimethoprim

43
Q

Why is methotrexate and trimethoprim not prescribed together?

A

Anti-folate effect

44
Q

What do with cDMARDs, JAK inhibitors or bDMRADs when COIVD 19 infection?

A

Temporarily stop with consultant advice

Stage 3 Case 3 (8 decks)

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