Medicines knowledge, 2 Flashcards
1
Q
Adalimumab
- drug class
A
- TNF- alpha antagonist
- human monoclonal antibody
2
Q
Adalimumab
- common indications
- moa
A
- rhuematoid arthritis
- psoriatic arthritis
- crohns disease
- ulcerative colitis
- adalimumab recognises and binds to a protein which is present at higher levels in some inflammatory diseases, to help reduce an inflammtory response
3
Q
Adalimumab
- dose & directions
A
- rheumatoid arthritis
- SC, 40mg once every 2 weeks
- psoriasis
- SC, 80 mg then, starting 1 week later 40 mg once every 2 weeks
- Crohn’s disease, ulcerative colitis
- SC, 160 mg on day 0 (or 80 mg on day 0 and day 1), then 80 mg on day 14, then 40 mg once every 2 weeks
- For ulcerative colitis, the manufacturer recommends stopping treatment if there is no response after 8 weeks and, for Crohn’s disease, to consider stopping treatment if there is no response after 12 weeks
4
Q
Adalimumab
- key counselling points
- adverse effects
A
- check with your doctor before getting a vaccine- some vaccines should not be given to people receiving a TNF-alpha antagonist
- common adv: nausea, vomitting, abdominal pain, headache rash, itch
- your symptoms may start to improve 1-2 weeks after starting, it can take 12-16 weeks for the medicine to reach its max effect
5
Q
Adalimumab
- referral
A
- if you experience any serious side effects such as fever, spre throat, bruising or bleeding, persistent cough, see Dr
6
Q
Adalimumab
- monitoring
A
- blood count, ALT, AST & creatinine before treatment
- infections
- blood dyscrasias
7
Q
Adalimumab
- lifestyle
A
- fish oil- omega 3 fatty acids in fish oil can reduce joint swelling, joint pain & stiffness caused by RA, take regularly for 2-3 months before sxs improve
- heat therapy- relieve pain & stiffness
- cold therapy- relieve hot & swollen joints
- OT can help with splints & mechanical aids- hand rails, tap turners
- try to avoid things that may worsen psoriasis, avoid using soaps which dry & irritate your skin, use soap free cleanser
- avoid scratching, breaks up the skin- water & blood go up to surface–> blister, itchy
- moisturise!
8
Q
Celecoxib
- drug class
A
- selective cox 2 NSAID
9
Q
Celecoxib
- common indications
- moa
A
- rheumatoid arthritis
- osteoarthritis
- pain due to dysmenorrhoea or injury (postoperative, musculoskeletal or soft tissue)
- used to relieve pain & inflammation
10
Q
Celecoxib
- dose & directions
A
- osteoarthritis
- 200mg daily in 1 or 2 doses
- rheumatoid arthritis
- 100mg BD, may increase to 200mg BD
- can be taken with or without food
- if you get an upset tummy- take it with food
- swallow whole with a glass of water
- similar to OTC anti-inflammatories, avoid taking those aswell
11
Q
Celecoxib
- key counselling points
- adverse effects
A
- if you need to take an antacid, take it atleast 2 hours before or 2 hours after your dose of celecoxib
- don’t take aspirin when taking this medicine because it can increase side effects of this medicine
- don’t take this medicine if you are dehydrated, for example due to vomiting or diarrhoea, because it might increase the likelihood of side effects
- in osteoarthritis, maximal analgesic and anti-inflammatory effects are usually seen within 2 weeks
- paracetamol can be used too
- adv: dyspepsia, headache, nausea, d, pain or discomfort in upper stomach, hypertension
12
Q
Celecoxib
- referral
A
- if you get new or unusual abdominal pain or tenderness, indigestion or heartburn, tell Dr
- signs of allergic reaction- swelling of face, lips or tongue; rash, difficulty breathing
- internal bleeding- dark or bloodstained bowel, coffee- coloured vomit, chest pain, swollen ankles, yellowing of eyes or skin, unusual tiredness- Dr
13
Q
Celecoxib
- monitoring
A
- long term tx
- BP
- renal function
- liver function
- haemoglobin
- complete blood count
14
Q
Celecoxib
- lifestyle
A
- heat or cold packs to relive pain & stiffnes
- learn to rest when your body needs rest
- keep a good posture to reduce stress on joints & muscles
15
Q
Methotrexate
- drug class
A
- folic acid antagonist
- immunisuppressant
16
Q
Methotrexate
- common indication
- moa
A
- rheumatoid arthritis
- psoriasis
- juvenile idiopathic arthritis
- crohns disease
- works by suppressing inflammation & immune responses that cause you discomfort which leads to less pain
17
Q
Methotrexate
- dose & directions
A
- psoriasis, RA
- oral/SC/IM, initially 10-15mg once a week
- maintenance is 10-25mg once a week
- crohns disease
- IM/SC, 25mg once a week
- maintenance is 15-25mg once a week
- TAKEN ONCE A WEEK (same day each week)
- can be taken with food to improve GI tolerability
18
Q
Methotrexate
- key counselling points
A
- must be taken once weekly, once the same day each week, NOT DAILY- calendar marking or reminder alarms encouraged
- 10mg weekly, folic acid supplementation, 24 hours after MTX dose to reduce adv effects of MTX due to folate depletion
- MTX onset of effect is slow, it can take a few months before a benefit is seen
- avoid sun exposure, wear protective clothing and use sunscreen as methotrexate may make you more sensitive to sunlight
- CAL 5, 8, 10a, 20, 21
19
Q
Methotrexate
- adverse effects
- referral
A
- all medicines can cause side effects but not everyone will experience them
- common: photosensitivity, N/V/D, headache, blurred vision and mucosal ulcers are common; folic acid supplmentation will minimise this
- tell your dr if you have nausea, mouth ulcers, bruising, yellowing of skin, or signs of infection (fever, sore throat)
20
Q
Methotrexate
- monitoring
A
- complete blood count
- renal & liver function
- leucopenia
- thrombocytopenia
- baseline hep B & C
21
Q
Methotrexate
- lifestyle
A
- for pain relief
- heat therapy (hot packs, warm baths) can relieve pain & stiffness
- cold therapy (cold packs) can relieve hot and swollen joints
- rest & joint care
- have good posture to limit stress on joints and muscles
- learn to recognise when your body & joints need to rest
- walking aids & splints can help protect joints- OT
- healthy lifetsyle
- keep to a healthy weight to limit stress on joints
- dietician- foods high in omega-3 fatty acids may help reduce joint dwelling
- may make you more sensitive to sunlight, avoid sun exposure, wear protective clothing and use sunscreen
22
Q
Allopurinol
- drug class
A
- xanthine oxidase inhibitor
23
Q
Allopurinol
- common indications
- moa
A
- symptomatic hyperuricaemia (gout)
- chronic symptomatic hyperuricaemia
- works by reducing production of uric acid in the body
- high levels of uric acid may cause gout attacks or kidney stones
- allopurinol is used to prevent gout attacks, not to treat them once they occur
24
Q
Allopurinol
- dose & directions
A
- started at a low dose 100mg daily and increased monthly by 50-100mg daily, aim at serum urate concentration <0.36mmol/L
- maintenance, 300-600mg daily (max 900mg) daily
- may cause an upset tummy, so best taken with or after food to reduce the chances of that
- take at same time each day
25
Q
Allopurinol
- key counselling points
- adverse effects
A
- take with food to reduce likelihood of upset tummy
- this medicine may make you feel dizzy or drowsy, be careful when standing or getting up, don’t drive until you know how it affects you
- you may initially get more gout attacks in the 1st few months of taking this medicine, but it doesn’t mean its not working, this medicine reduces urate in your body & when its low enough, flares will gradually improve & eventually stop if you keep on taking it
- some adv effects: stomach upset, N/V/D
26
Q
Allopurinol
- referral
A
- rash, changes in vision, tingling or numbness of the hands or feet stop and see Dr
27
Q
Allopurinol
- monitoring
A
- serum urate levels
- kidney function
- liver function
- rash
28
Q
Allopurinol
- lifestyle (selfcare)
A
- ice packs can also help with pain caused by gout! hold an icepack against the inflamed joint to ease pain, apply for 20 mins then remove
- do you drink alcohol? limit to 2 standard drinks a day, alcohol can trigger gout, esp beer bcoz of lots of purines which is a precursor to uric acid formation in the body
- NSAIDs or low dose colchicine used for atleast 6m to prevent acute flare when introducing prophylactic tx with ULT in gout
- ensure you drink plenty of water to prevent kidney stone
29
Q
Mesalazine
- drug class
A
- 5-aminosalicylate
- anti-inflammatory, immunosuppressant
30
Q
Mesalazine
- common indications
- moa
A
- ulcerative colitis
- crohns disease
- anti-inflammatory, immunosuppressant to help inflammation of the bowel
31
Q
Mesalazine
- dose & directions
A
- ulcerative colitis adult
- asacol tablet; 2.4g OD or up to 4.8g daily in dividided doses
- enema; rectally 1g daily
- crohns disease adult
- tablet; oral 500mg TDS, maintenance 250mg TDS
- take atleast 30mins before food
- swallow tablets or whole without chewing or crushing them
32
Q
Mesalazine
- key counselling points
- adverse effects
A
- different brands of mesalazine are not interchangeable due to difference of each one
- take doses at regular intervals during the day, if you forget to take a dose, take the next dose at the scheduled time, don’t take a double dose to make up for the dose that you missed
- adv effect: nausea, abdominal pain, diarrhoea, rash and headaches
33
Q
Mesalazine
- referral
A
- if you develop a fever, severe sore throat, unusual bleeding or bruising, severe or bloody diarrhoea, muscle or joint pain stop and see Dr
34
Q
Mesalazine
- monitoring
A
- liver function
- renal function
- diarrhoea
- electrolyte imbalance
35
Q
Mesalazine
- lifestyle (selfcare)
A
*
