ortho,rheum Flashcards
What is the mechanism of action of corticosteroids?
Prednisolone exerts glucocorticoid effects, upregulate anti-inflammatory genes
What are side effects of using prednisolone?
- Cushingoid features of weight gain, moon face.
- Hyperglycaemia due to disturbed carbohydrate metabolism
- Long term use cause loss of bone density which can cause osteoporosis and fractures
- Hyperkalaemia
What are the CI of corticosteroids?
Any viral and fungal infections and people taking vaccines as corticosteroids reduce the immune response to vaccines.
What are the indications of prednisolone?
- autoimmune disease e,g. RA, IBD
- polymyalgia
What are the indications of topical hydrocortisone?
Topical steroid for eczema
What is the Mx for osteoporosis?
Oral bisphosphonates e,g, alendronic acid, calcium and vit D supplements, fall prevention.
What is the mechanism of bisphosphonates?
Bisphosphonates inhibits osteoclast activity (bone cell that breaks down bone tissue) and promotes osteoclast apoptosis,
What are the CI of methotrexate?
Teratogenic, severe AKI.
What are the indications of methotrexate?
RA
What are the drug interactions of prednisolone?
- With use of NSAID can increase risk of peptic ulceration and GI bleeding, must use PPI alongside for gastroprotection in those at high risk of bleeding.
- Methotrexate interferes with the way vitamin B9 folate is broken down so decreases folate levels in body, must take folic acids alongside methotrexate but on alternating days (methotrexate prevents the action of folate)
What are the interactions of methotrexate?
Methotrexate is a Anti-folate agents e.g. others include trimethoprim. and can cause folate deficiency anaemia.
Folic acid must be prescribed with methotrexate but on separate days to avoid interference of action of methotrexate e.g. folic acid 5mg on Fridays, methotrexate on mondays,
