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308 Clinical pharmacology > Drugs for rheumatological disorders > Flashcards

Drugs for rheumatological disorders Flashcards

1
Q

What are corticosteroids used from?

A

Suppression of inflammatory or allergic disorders

  • asthma and acute allergic reactions
  • IBD and CAH
  • Rheumatic disease - e.g. RA, SLE
  • inflammatory renal disease
  • immunosuppression in transplantation
  • neurological disease
  • cancer
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2
Q

What are the short term risks of corticosteroids?

A 
Hypokalaemia
Fluid retention
Glucose intolerance
Mood disturbance
Hypertension
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3
Q

What are the long-term risks of corticosteroids?

A 
Osteoporosis
Diabetes and hypertension
Accelerated atherosclerosis
Increased infection risk, poor healing
Steroid dependency
Growth retardation
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4
Q

What monitoring should be done for corticosteroids?

A 
High doses (≥40mg prednisone) - electrolytes, fluid balance, BP and glucose
Low doses - BP and glucose
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5
Q

What can corticosteroids interact with?

A 
Rifampicin
Anti-diabetic therapy
Anti-convulsants e.g. phenytoin
Barbiturates
Carbenoxalone
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6
Q

What are DMARDs used for?

A

Rheumatoid and seri-negative arthritis
Psoriasis (methotrexate)
Lupus (hydroxychloroquine)
IBD (sulfasalazine)

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7
Q

Give examples of DMARDs

A 
Azathioprine
Ciclosporin
Cyclophosphamide
Gold
Hydroxychloroquine
Leflunomide
Methotrexate
Mycophenolate mofetil
Penicillamine
Sulfasalazine
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8
Q

What is azathioprine used for?

A 
Rheumatoid arthritis (psoriatic arthritis)
SLE and vasculitis - Wegener's, PAN
IBD and CAH
Myasthenia
Transplant patients
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9
Q

What monitoring is needed for azathioprine

A

FBC profile and urinalysis at 1, 2, 4 and 8 weeks then at 4-weekly intervals for 3 months

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10
Q

What does azathioprine react with?

A

Allopurinol

Rifampicin

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11
Q

What is cyclosporin?

A

fungal metabolite - suppresses cell-mediated (T-cell) immune response

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12
Q

What is cyclosporin used for?

A

Renal, liver, marrow, pancreas and heart transplant patients
Prophylaxis of graft vs host disease
Psoriasis and atopic dermatitis
Rheumatoid arthritis

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13
Q

What does cyclosporin react with?

A 
Allopurinol
Amiodarone
Aminoglycosides, septrin
Quinolones
Colchine
K+ sparing diuretics
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14
Q

What is cyclophosphamide used for?

A

Suppress inflammation and harmful antibody-production in patients with life-threatening ‘vasculitis’ illnesses e.g. SLE, Wegener’s, PAN

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15
Q

What does cyclophosphamide interact with?

A

Allopurinol

Suxamethonium

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16
Q

What are hydroxychloroquine and chloroquine?

A

Anti-malarials

17
Q

What are the risks of hydroxychloroquine and chloroquine?

A

Ocular toxicity

18
Q

What monitoring is needed with hydroxychloroquine and chloroquine?

A

Ocular examination before treatment, 6 months, 1 year then yearly
G6PD screening before treatment

19
Q

What do hydroxychloroquine and chloroquine interact with?

A 
Antacids
Mefloquine
Cardiac glycosides
Cholinergics
Cimetidine
20
Q

What is chlorambucil used for?

A

Rheumatoid arthritis in severe disease
Vasculitis
Amyloid
Membranous nephritis

21
Q

What is colchicine used for?

A

Gout
Behcet’s
Serositis

22
Q

Why can’t colchicine be prescribed in the long term?

A

Nephrotoxic

23
Q

What is thalidomide used for?

A

Behcet’s

SLE

24
Q

What monitoring is needed with thalidomide?

A

6 monthly EMGs

Contraceptive advice

25
Q

What is tacrolimus?

A 
Calcineurin inhibitor - PP2B
Similar to cyclosporin
Neuro, GI and cardio toxic
Raised K+, low phosphate
Hypertension
26
Q

What is tacrolimus mainly used for?

A

Transplantation

27
Q

What is rapamycin?

A

Macrolide

Binds FKBP12 - inhibits mTOR complex

28
Q

What is rapamycin used for?

A

Stents

29
Q

Where does rapamycin come from?

A

Streptomyces hygroscopicus

30
Q

What is sirolimus?

A

Blocks T and B cell activation
Raises lipids, pancreatitis, oedema, acne
Used for renal transplantation

31
Q

What is mycophenolate mofetil?

A

Similar to azathioprine
Used in lupus and vasculitis
CMV and opportunistic infections

32
Q

What are the side effects of mycophenolate mofetil?

A

Arthralgia
Acne
GI upset
LFTs

308 Clinical pharmacology (10 decks)

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