Drugs Flashcards
Do DMARDs have any analgesic effect?
No
What blood tests should always be checked in a person taking methotrexate?
FBC, U&Es, LFTs
Due to a risk of bone marrow suppression, what drug should not be prescribed alongside methotrexate?
Trimethoprim (+ co-trimoxazole)
What is the advice regarding methotrexate and pregnancy?
Must be stopped at least 6 months prior to conception in both males and females
As well as increased risk of infection, what are some other general side effects of biologics?
Increased risk of cancers (especially melanoma) and exacerbation of heart failure
How can steroids be given?
Oral, IV, IM or IA
In rheumatoid arthritis, patients must have a DAS28 score of greater than what to qualify for treatment with biologics?
> 5.1
Pneumonitis and pulmonary fibrosis can occur as a side effect of which DMARD?
Methotrexate
How long does it typically take for DMARDs to start to work? For this reason, what should always be co-prescribed?
2-3 months, so steroids should always be prescribed alongside them to cover against inflammation in this time
Name two DMARDs which are safe to use in pregnancy?
Sulfasalazine and hydroxychloroquine
What should always be prescribed alongside steroids if they are going to be given long term?
Calcium and vitamin D supplements
Stevens-Johnsons syndrome is a side effect of which DMARD?
Sulfasalazine
Which DMARD can result in coloured tears and stained contact lenses?
Sulfasalazine
Name some examples of TNF inhibitors?
Infliximab, adalimumab, etanercept
NSAIDs should be relatively contra-indicated in individuals with which other condition?
Asthma
What is the mechanism of action of rituximab?
Anti-CD20, resulting in B cell depletion
What is the target serum urate level? What dose can allopurinol be given up to to reach this target?
Below 300 - allopurinol can be given up to 900mg
What must always be co-prescribed alongside methotrexate?
Folic acid (5mg once weekly)
How can methotrexate be given? How often is it given?
Usually given once weekly either orally or subcutaneously
When should febuxostat be used instead of allopurinol in the chronic treatment of gout?
In patients with renal failure
In terms of rheumatology, who are biologics indicated in?
Those who have failed to respond to treatment with at least two DMARDs, one of which must have been methotrexate
What is a common side effect of colchicine?
Diarrhoea
What is the first line DMARD for inflammatory arthropathies?
Methotrexate
Retinopathy, potentially leading to blindness, is a serious side effect of which DMARD?
Hydroxychloroquine
What lifestyle advice is particularly important to give people starting on methotrexate, due to one of its most severe side effects?
Cut down alcohol intake as this medication is hepatotoxic
When should DMARDs be started for the best therapeutic effect?
Within 3 months of symptom onset
As with all immunosuppressants, biologics come with a risk of infection. However, which one in particular? And what should be done to minimise this risk?
TB (reactivation of the latent form) - screen patients for this before starting the drug
Most TNF inhibitors are given subcutaneously. Which is given as an IV injection?
Infliximab
What is usually the second line DMARD if methotrexate is not tolerated?
Leflunomide
When should colchicine be used instead of NSAIDs in the acute treatment of gout?
In those with renal failure, asthma, peptic ulceration or any other reason for NSAIDs to be contra-indicated
If a patient on methotrexate for rheumatoid arthritis is planning a pregnancy, what are some alternative medicines which could be used?
Sulphasalazine, or a biologic if the criteria is met
What drug must not be taken alongside allopurinol and why?
Azathioprine- risk of irreversible bone marrow suppression
What drug class should not be given in enteropathic arthritis as they can worsen the condition?
NSAIDs
If a patient who is taking leflunomide wants to get pregnant, what must happen first and why?
A wash out, since leflunomide has a half life of around 2 years
Temporary oligozoospermia is a side effect of which DMARD?
Sulfasalazine
What is usually the first line DMARD in connective tissue diseases?
Hydroxychloroquine
Are biologics safe to use in pregnancy?
Yes
If an immunosuppressant is required in SLE, what is usually the drug of choice?
Cyclophosphamide
What drug should always be co-prescribed alongside cyclophosphamide and why?
Co-trimoxazole as prophylaxis against pneumocystis pneumonia
Patients with a documented allergy to co-trimoxazole should not be prescribed which DMARD?
Sulfasalazine
The concurrent use of methotrexate and which antibiotic may cause bone marrow suppression and severe or fatal pancytopenia?
Trimethoprim
Is azathioprine safe to use in pregnancy?
Yes
Patients who are allergic to aspirin may react to which DMARD also?
Sulfasalazine
