DMARDs and Biologics Flashcards
How long do DMARDs typically take to work?
6-12 weeks for symptomatic benefit
What are the common side effects of DMARDs?
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
What are the potential SE of methotrexate?
Pneumonitis Oral ulcers Hepatotoxicity Teratogenic Immunosuppression
What are the potential SE of sulfasalazine?
Rash Decreased sperm count Oral ulcers GI upset Immunosuppression
What are the potential SE of hydroxychloroquine?
Retinopathy
Immunosuppression
What is the pre treatment screening for biologic agents?
Screening for TB, hepatitis B/C, HIV is essential
What are the SE of biologic agents?
Reactivation of TB and hepatitis B
Worsening heart failure
Serious infection
Which DMARDs need renal function tests performed as regular monitoring?
Cyclosporine and methotrexate
They need BUN (blood, urea, nitrogen) and creatinine tests
Every 2 weeks to start then less frequent
What monitoring is needed with hydroxychloroquine?
Regular eye tests
When should you immediately stop a DMARD?
If the patient has a Sore throat Fever Unexplained bruising or bleeding Nausea, vomiting, diarrhoea, weight loss Breathlessness Peripheral neuropathy
What is the dose regimen for methotrexate for moderate to severe RA?
7.5mg once weekly, maximum 20mg per week
What is the dose regimen for leflunomide for moderate to severe RA?
Initially 100mg once daily for 3 days, then reduced to 10-20mg once daily
What monitoring is needed with leflunomide?
FBC
LFT
BP
What are the monitoring requirements for etanercept?
Test for TB before
Monitor for skin cancer before and during treatment
What are the monitoring requirements for infliximab?
Monitor for infection before, during and after
Observe carefully after for hypersensitivity reactions
What are the common SE of etanercept?
Cystitis Fever Hypersensitivity Pain Skin reactions
What is the common dose regimen for etanercept?
Etanercept is a SC injection
25mg twice weekly
What is the common dose regimen for infliximab?
By IV infusion
3mg/kg initially, then 3mg/kg every 2 weeks, then 4 weeks, then 8 weeks
What are the interactions of evening primrose oil and cod liver oil?
Slows clotting so do not give with LMWH/warfarin etc
How long should men wait until conceiving after stopping methotrexate?
3 months
