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MSK > DMARDs and Biologics > Flashcards

DMARDs and Biologics Flashcards

1
Q

How long do DMARDs typically take to work?

A

6-12 weeks for symptomatic benefit

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2
Q

What are the common side effects of DMARDs?

A

Immunosuppression (can result in pancytopenia, increased susceptibility to infection and neutropenic sepsis)

Do regular FBC and LFT and possible U&E monitoring due to myelosupression and liver cirrhosis

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3
Q

What are the potential SE of methotrexate?

A 
Pneumonitis
Oral ulcers 
Hepatotoxicity 
Teratogenic
Immunosuppression
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4
Q

What are the potential SE of sulfasalazine?

A 
Rash
Decreased sperm count 
Oral ulcers
GI upset 
Immunosuppression
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5
Q

What are the potential SE of hydroxychloroquine?

A

Retinopathy

Immunosuppression

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6
Q

What is the pre treatment screening for biologic agents?

A

Screening for TB, hepatitis B/C, HIV is essential

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7
Q

What are the SE of biologic agents?

A

Reactivation of TB and hepatitis B
Worsening heart failure
Serious infection

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8
Q

Which DMARDs need renal function tests performed as regular monitoring?

A

Cyclosporine and methotrexate

They need BUN (blood, urea, nitrogen) and creatinine tests

Every 2 weeks to start then less frequent

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9
Q

What monitoring is needed with hydroxychloroquine?

A

Regular eye tests

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10
Q

When should you immediately stop a DMARD?

A 
If the patient has a 
Sore throat
Fever
Unexplained bruising or bleeding
Nausea, vomiting, diarrhoea, weight loss
Breathlessness
Peripheral neuropathy
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11
Q

What is the dose regimen for methotrexate for moderate to severe RA?

A

7.5mg once weekly, maximum 20mg per week

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12
Q

What is the dose regimen for leflunomide for moderate to severe RA?

A

Initially 100mg once daily for 3 days, then reduced to 10-20mg once daily

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13
Q

What monitoring is needed with leflunomide?

A

FBC
LFT
BP

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14
Q

What are the monitoring requirements for etanercept?

A

Test for TB before

Monitor for skin cancer before and during treatment

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15
Q

What are the monitoring requirements for infliximab?

A

Monitor for infection before, during and after

Observe carefully after for hypersensitivity reactions

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16
Q

What are the common SE of etanercept?

A 
Cystitis
Fever 
Hypersensitivity 
Pain
Skin reactions
17
Q

What is the common dose regimen for etanercept?

A

Etanercept is a SC injection

25mg twice weekly

18
Q

What is the common dose regimen for infliximab?

A

By IV infusion

3mg/kg initially, then 3mg/kg every 2 weeks, then 4 weeks, then 8 weeks

19
Q

What are the interactions of evening primrose oil and cod liver oil?

A

Slows clotting so do not give with LMWH/warfarin etc

20
Q

How long should men wait until conceiving after stopping methotrexate?

A

3 months

MSK (11 decks)

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