pharmacology

Question 1

is methotrexate safe in preg

Answer 1

no

Question 1

first line med for rheumatoid arthirtis

Answer 1

oral methotrexate

Question 2

side effects of methotrexate

Answer 2

• Leucopenia/ thrombocytopenia
  
  • Hepatitis
  • Pneumonitis
  • Rash/ mouth ulcer
    Nausea/ diarrhoea

Question 3

adverse effects of NSAIDS

Answer 3

Dyspepsia
Oesophagitis
Gastritis
Peptic Ulcer
Small/large bowel ulceration

Question 4

opiate analgesics example

Answer 4

codeine
tramadol

Question 5

side effects of opiates

Answer 5

constipation
nausea
drowsiness, fatigue
risk of opioid
dependence

Question 6

when should DMARD therapy be started in rheumatoid arthritis

Answer 6

As soon as diagnosis of RA confirmed ( ideally within 3 months of symptom onset)

Question 7

treatment of inflammatory arthritis

Answer 7

Early, aggressive DMARD therapy
Introduction of biologic drugs
Increasing recognition of adverse effects of NSAIDs and steroids
Aim to start patients with inflammatory arthritis on DMARD within 3 months of symptom onset

Question 8

benefits of DMARDS

Answer 8

reduce rate of joint damage
improve standard lab tests of inflammation - ESR, CRP

Question 9

commonly used DMARDS

Answer 9

Methotrexate
Sulphasalazine
Leflunomide
Hydroxychloroquine

Question 10

does leflunomide have a long half life

Answer 10

yes

Question 11

what is often used in combo with methotrexate in early inflammatory arthritis

Answer 11

sulfasalazine

Question 12

side effects of sulfasalazine

Answer 12

Nausea
Rash / mouth ulcers
Neutropenia
Hepatitis
Reversible oligozoospermia
Monitoring of FBC and LFTs

Question 13

does hydroxychloroquine have an effect on joint damage

Answer 13

no

Question 14

what is hdroxychloroquine used in

Answer 14

connective tissue disease such as SLE, sjrogens and RA

Question 15

targets if biologics

Answer 15

Tumour Necrosis factor (TNF)
CD 20 B cells
Interleukin 6
Interleukin 17, 12 and 23
Small molecule ( Janus kinase inhibitors)
B cell activating factor ( BAFF)

Question 16

what do biologics target

Answer 16

specific aspects of immune system found to be implicated in inflammatory disease

Question 17

are biologics more effective than dmards

Answer 17

yes

Question 18

role of anti-tnf

Answer 18

pharmaceutical drug that suppresses the physiologic response to tumor necrosis factor, which is part of the inflammatory response

Question 19

what is anti-tnf used in

Answer 19

RA
psoriatic arthritis
ankylosing spondylitis

Question 20

adverse effects of anti-tnf

Answer 20

Risk of infection (esp TB)

Question over risk of malignancy (esp skin cancer)
Contraindicated in certain situations e.g. pulmonary fibrosis, heart failure

Question 21

acute episode of gout medicartion

Answer 21

Colchicine (diarrhoea common)
NSAIDs
Steroids, either oral or IM

Question 22

indications for corticosteroids

Answer 22

Inflammatory arthritis
Polymyalgia rheumatica / giant cell arteritis
Vasculitis

Question 23

adverse effects of corticosteroids

Answer 23

Weight gain - centripetal obesity
Muscle wasting
Skin atrophy
Osteoporosis
Diabetes
Hypertension

Question 24

patient complaining of a cough and some breathlessness when walking up stairs after starting methotrexate for RA

Answer 24

methotrexate pneumonitis

Question 25

dangerous interaction with methotrexate

Answer 25

trimethoprim

Question 26

what is the wash out period for methotrexate before starting pregnancy

Answer 26

6 months

Question 27

Treatment for raynauds phenom

Answer 27

Calcium channel blockers as dilates vessels and promotes blood to digits