DMARDs

Question 1

Methotrexate: MOA

Answer 1

-Inhibits cytokine production
-Inhibits purine biosynthesis + may stimulate adenosine
= anti inflammatory properties

Question 2

Methotrexate: Side Effects/Red Flags

Answer 2

COMMON
-N+V, mucositis, alopecia, elevated LFTs, anaemia, neutropenia

LESS
-Pneumonitis, teratogenic (take folic acid as well), arbotifacient

Question 3

Methotrexate: monitoring

Answer 3

• Baseline CXR
• CBC and liver transaminase test in 1st month then 3-6 months after
• Albumin blood level checked periodically (liver toxicity)

Question 4

Methotrexate: Contraindications

Answer 4

Pregnancy + Lactation
Alcoholism, liver disease, renal failure, bone marrow suppression, interstitial lung disease

Caution in HIV

Counsel patients to avoid alcohol = liver injury

Question 5

Hydroxychloroquine: MOA

Answer 5

Unknown

Question 6

Hydroxychloroquine: Side Effects

Answer 6

(Generally safe and well-tolerated)

COMMON:
GI intolerance (take dose w/ food), skin hyperpigmentation, headache, dizziness

LESS
Retinopathy, myopathy

Question 7

Hydroxychloroquine: Monitoring

Answer 7

Baseline and annual ophthalmological assessment

Inform patients to report any visual changes

Question 8

Sulfasalazine: MOA

Answer 8

Acts locally to inflammatory response and systemically inhibits prostaglandin synthesis

Question 9

Sulfasalazine: Side Effects

Answer 9

(Limited use due to SE)

GI intolerance
Rash (antiH and steroids)
Leukopenia
Alopecia
Stomatitis
Elevated liver enzymes
Myelosuppresion

Question 10

Sulfasalazine: Monitoring

Answer 10

CBC and liver transaminase test w/i first 1-2 months (thereafter 3-6monthly)

Question 11

Sulfasalazine: Contraindications

Answer 11

Drug interactions

• Absorption decreases when co-administered with antibiotics or iron supplements
• Potentiates warfarin effect (close monitoring of INR)