DMARDS Flashcards
what are DMARDS
disease-modifying antirheumatic drugs (DMARDs)
list some types of DMARDS?
drugs which suppress the disease process
GOLD
penicillamine
sulfazalazine
drugs which affect the immune response:
chloroquinine/hydroxychloroquinine methotrexate azathioprine cyclosporin leflunomide
Biological agents (anti TNF)
eg
infliximab, etanercept, and adalimumab
Complications and reasons to discontinue DMARDS?
all DMARDs have a potential to cause myelosuppression. Many also cause renal or liver toxicity, skin rash, or gastrointestinal disturbance
Tuberculosis in patients receiving TNF-alpha inhibitors can be life-threatening, and deaths from tuberculosis have occurred in these patients.
Patients should be warned to report any warning symptoms or signs as detailed below:
Symptoms of myelosuppression Sore throat Fever and other signs of infection Unexpected bleeding or bruising Purpura and rashes Mouth ulcers Cough or breathlessness
indications for DMARDS?
Lupus, RA
symptoms of lupus?
mneumonic rash or pain
RASH OR PAIN:
Rash (malar A or discoid)
Arthritis
Soft tissues/serositis
Hematologic disorders (e.g., cytopenias) Oral/nasopharyngeal ulcers
Renal disease, Raynaud phenomenon Photosensitivity, Positive VDRL/RPR Antinuclear antibodies
Immunosuppressants
Neurologic disorders (e.g. seizures, psychosis)
list the treatments of LUPUS?
NSAIDs, steroids, immunosuppressants, hydroxychloroquine.
side affect of hydroxychloroquinine?
Taking a high dose of hydroxychloroquine for prolonged periods of time may increase the risk of damage to the retina of the eye, although high doses are not usually required for treatment of rheumatoid conditions or lupus.
An eye examination is recommended before starting treatment and periodically thereafter. It is common to have an eye check-up done once each year.
side affects and monitoring when taking methotrexate?
Common side effects include
upset stomach and a sore mouth.
Methotrexate can interfere with the bone marrow’s production of blood cells. Low blood cell counts can cause fever, infections, swollen lymph nodes, and easy bruisability and bleeding.
Liver or lung damage can occur, even with low doses, and therefore requires monitoring.
People using methotrexate are strongly discouraged from drinking alcoholic beverages because of the increased risk of liver damage with this combination.
Monitoring reduces the risk of long-term damage from methotrexate. A chest x-ray is recommended before beginning treatment, and regular blood testing is recommended.
While taking methotrexate, all patients should take folic acid 1 mg daily or folinic acid 5 mg weekly to reduce the risk of certain side effects, such as upset stomach, sore mouth, low blood cell counts, and abnormal liver function.
investigations for lupus?
Check an autoimmune profile—95% are ANA (anti-nuclear antibody) +ve.
Other immunological abnormalities— i double-stranded DNA, RhF +ve (40%), d complement (C3, C4). FBC: d Hb, d WCC, d, i ESR.
USMLE
Antinuclear antibodies (ANA)—sensitive, not specific.
Anti-dsDNA antibodies—specific, poor prognosis (renal disease).
drugs that induce lupus?
Drug-induced lupus Occurs with: • Minocycline • Isoniazid • Hydralazine • Procainamide • Losartan • Chlorpromazine • Anticonvulsants • Sulfasalazine
