DMARDs

Question 1

Disease-modifying anti-?agents’.
They include methotrexate, ?, ?, penicillamine
and ? compounds.
They are generally instituted as soon as a diagnosis of inflammatory ? is reached, and can reduce the ? score, ? score and ? level.

Answer 1

rheumatic
sulfasalazine
hydroxychloroquine
gold
arthritis
pain
disability
RF

Question 2

Their clinical effect is often ?, thus ? are often used to ‘cover’ the ? phase.
? therapies generally appear superior to ?

o E.g. methotrexate plus ? for less severe disease, or
methotrexate plus ? for more severe presentations

Answer 2

slow
steroids
induction
combo
monotherapy
hydroxychloroquine
sulfasalazine

Question 3

Methotrexate;

1st line DMARD, acting as a ? ? antagonist.

? onset of action.

? weekly dosing (oral/ IM);
o ? ? should be taken on the other ? days of the week.

Patients should be warned for signs of toxicity;
o ?, ? or shortness of breath (pulmonary toxicity).

Answer 3

folic acid
quickest
once
folic acid
six
bruising
infection

Question 4

Methotrexate

Frequent monitoring of ?, ?and ? are required every ? weeks once settled on the drug.
Common side effects are ?, ?and ?.
It is not suitable in ?, or for males attempting to ?.

Answer 4

fbc, lft, u+e
10
nausea
tingling
headaches
preg
conceive

Question 5

Sulfasalazine;

Takes around ? weeks to have a clinical response.

?, ? and ? should be monitored ? for the first ? months.

Side effects;
o Nausea & ?.
o ?.
o ? abnorms.
o Azoospermia (no ? in sperm).
o ?-? discoloration of ?/ contact lenses.

Answer 5

8
fbc
ue
lft
monthly
three
dyspepsia
rashes
blood
semen
yellow orange
urine

Question 6

Hydroxychloroquine;

? effective and ? toxic, taking ? weeks for a clinical response

The only monitoring required is a baseline ? ? and ? recheck.
Side effects;
o ? .
o ? disturbances.
o Peripheral ?.
o ? damage.

Answer 6

least
least
6
visual acuity
annual
rashes
GI
neuropathy
retinal

Question 7

Biologics;

Anti-? agents are the most common, e.g. ?, etanarcept.

Contraindications/cautions are active ?, latent ?, ?, pulmonary ? or severe ? failure.

Adverse effects are ? infections, non-? skin cancers and ? site reactions;
o Ensure patients are ? each year.
o ? required to exclude ?prior to commencing treatment.

Answer 7

TNF
infliximab
infection
tb
malig
fibrosis
heart
opportunistic
melanoma
injection
vaccinated
cxr
tb

Question 8

Biologics

They are taught to present ? if there is any signs of potential ?, and will be treated ?.
? reactions can also occur, so many are given in ?, or initially given at hospital and patient ‘taught’ to ?-?.

Answer 8

early
infection
aggressively
infusion
hospital
self inject