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3154 MSK > dosing > Flashcards

dosing Flashcards

1
Q

celecoxib dose acute & prophylaxis

A

acute: 400mg LD -> 200mg
200mg BD (5-7d, until sx resolve)

Prophylaxis: 200mg OD

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2
Q

CS prednisolone dose acute & prophylaxis

A
  • acute: 30-40mg OD (or divide to 2 dose), 2-5d until sx resolve
  • Prophylaxis: 5-7.5mg OD
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3
Q

CS prednisolone taper

A
  • Taper by half dose over 7d (discontinue)
    • (weight) 0.5mg/kg OD 2-5 d –> taper
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4
Q

colchicine dose (acute flares)

A

max 1.5mg/day
* 1mg LD –> 0.5 mg 1hr later
* OR 0.5mg BD-TDS

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5
Q

colchicine prophylaxis dose

A

adjunct with ULT:
0.5mg OD/ BD (max 1.2mg/day)

If flare up occurs: incr dose to acute flare dose

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6
Q

allopurinol dose initiate and titrate

A
  • Initiate: ≤100mg/day
    • CKD stage ≥3, <50ml/min: ≤50mg/day
  • Titrate: 50-100mg incr every 2-8wks
    • Monitor SU, clinical resp (dose adj to target), drug toxicity SCAR
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7
Q

allopurinol maintain and max dose

A
  • maintain: > 300mg/day

Max 800/day

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8
Q

febuxostat dose

A

40-80mg OD

Initiate: ≤40mg/day
Titrate: 80mg/day
If target not met after 2-4 wks

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9
Q

probenecid dose

A
  • Initiate: 250mg BD 1wk –> 500mg BD
  • Titrate: 500mg every 4wks
    • As tolerates, to reach target
  • Maintain: ≤2g/day

500-3000mg/ day

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10
Q

PO bisphosphonate dose

A

alendronate: 70mg once per week (same day)

risendronate: once a mth
(5yrs)

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11
Q

bispho IV dose

A

Zoledronic acid (IV: 5mg 30min infusion per yr)
Once a yr (15-30mins via cannula vein)

(3yrs)

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12
Q

romosozumab DOA

A

SC inj (once a mnth)
- Fatty tissue of abdomen

USED FOR 12MNTHS (1 yr)

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13
Q

denosumab DOA

A

SC inj every 6mnths
- Fatty tissue of abdomen

+ 1000mg Ca + (=/> 400 IU vit D) daily

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14
Q

raloxifene dose

A

raloxifene (60mg OD)

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15
Q

calcitonin

A

Inj (IV, SC, IM), nasal spray

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16
Q

teriparatide

A

SC inj 20mcg OD
- Fatty tissue of abdomen
MAX DURATION 24MNTHS in lifetime (2yrs)
Longer tx incr risk of osteosarcomas (mice)

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17
Q

vit D range

A

≥ 20-30ng/mL (800-1200IU)
and
≤ 50-100ng/mL (4000IU)

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18
Q

vit D daily intake

A

600IU/d (51-70yo)
800IU/d (>70yo)

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19
Q

vit D suppl dose

A

600-800IU/day cholecalciferol

20
Q

vit D DDI

A

decr vit D: rifampicin, anticonvulsants (PT, VA, CBP)

cholestyramine, orlistat (binds to fat, vit D is fat soluble) = SPACE OUT

Al containing pdts

21
Q

Ca normal range

A

> 2.2-2.7 mmol/L

22
Q

Ca daily intake

A

1000 mg/day (>51yo)
800mg/day (19-51yo)

Indication: give suppl if dietary < 700 mg/day

23
Q

vit Ca DDI

A
  • Decr Ca absorption (incr pH): PPI, high fibre diet
  • Decr other drug absorption: Fe, tetracycline, FQ, bisphosphonate, thyroid suppl.
    = Space apart from bisphophonate!!
24
Q

MTX dose

A

initiate 7.5mg once weeklu

titrate: 2.5-5mg/wkly (every 4-12wks based on resp)

TARGET: 15mg/day (within 4-6wks of initiate)
max: 25mg/wk

25
Q

MTX dose adj

A

crcl < 30ml/min (<50ml = 50% dose)
pre-exist liver disease/ AST/ALT > 3X ULN (75% dose)

26
Q

folic acid dose

27
Q

add CS with DMARD

bridge

A

7.5mg mg/d up to 3mnths
* taper and discont within 3mnths

28
Q

dose adj for csDMARD

A

MTX adj for renal (<50ml/min, AVOID in <30) and liver
sulfa adj for renal < 60ml/min
hydroxychloroquine no adj, caution
leflunomide adj for liver (AVOID ALT >2xULN)

29
Q

ROA for bDMARD

A
  • anti-TNF (infliximab (IV), adalimumab (SC), etanercept (SC))
  • IL1R antagonist: Anakinra (SC)
  • Anti CTLA4 IG: Abatacept (IV, sc)
  • Anti-CD20: rituximab (IV)
  • Anti-IL6 receptor mAb: tocilizumab (IV)
  • JAKi tofacitinib (PO)
30
Q

naproxen dose

A

More effective in women (Fu >40%, lower dose more potent)
T1/2: 12-14hrs
Indication: dysmenorrhea, MSK

  • LD: 220-500mg
  • Maintain: 220-250mg tab Q8H – Q12h
  • max 750mg/d
31
Q

indomethacin

A

Strongly anti-inflamm due to additional steroid-like Phospholipase A inhibition

  • indication: gout
  • ADR: 15-25% report confusion, depression, psychosis, hallucination also occur
32
Q

diclofenac

A

Short plasma t1/2: < 2hr
Indication: MSK (RA, OA). Accumulates in synovial fluid, longer t1/2

  • ADR: low GI risk
33
Q

celecoxib dose

acute pain

A

400mg initial, 200mg later 12h
200mg BD prn

34
Q

paracetamol dose

A

500mg-1g QDS (narrow TI for liver toxicity)

35
Q

paracetamol monitor what dose
- Can lead to liver damage

A
  • Refer =/> 10g / 24hr to ED
  • Incr risk of harm with doses =/> 4g/ 24hr
36
Q

tramadol dose

mod-severe pain

A

acute pain
* initiate 50mg q4-6h~ 100mg
* max 400mg/d

chronic pain
* initiate 25-50mg q6h ~ 100mg
* max 400mg/d

37
Q
  • TNFa
  • IL6i
  • IL1RA
  • anti CD20
  • anti CTLA4
A
  • TNFa
    • infliximab
    • etanercept
    • adalimumab
  • IL6i
    • tocilizumab
  • IL1RA
    • anakinra
  • anti CD20
    • rituximab
  • anti CTLA4
    • abatacept
38
Q

methotrexate caution, ci

A

caution: CRCL < 30 (avoid)
>3x ULN

CI: PREEXISTING LIVER DISEASE
immunodef syndrome
blood dyscrasia
teroteogenic

39
Q

methotrexate DDI

A

NSAID, COX2i
PPI
probenecid
vaccines
alcohol

40
Q

sulfasalazine cautions and CI

A

caution (<60ml/min)
CI: sulfonamide allergies, G6PD def

41
Q

sulfasalazine ddi

A

Fe, Abx, warfarin

42
Q

hydroxychloroquine cautions and CI

A

CI: pre-existing retinopathy

43
Q

hydroxychloroquine DDI

A

CYP2C9i: cimetidine
QT prolong: ciprofloxacin

44
Q

leflunomide cautions and CI

A

caution: x2 ULN

CI: pre-exist liver disease
immunodef state

45
Q

leflunomide DDI

A

cholestyramine
charcoal, warfarin, vaccine, alcohol

3154 MSK (9 decks)

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