pharmacology Flashcards
is methotrexate safe in preg
no
first line med for rheumatoid arthirtis
oral methotrexate
side effects of methotrexate
- Leucopenia/ thrombocytopenia
- Hepatitis
- Pneumonitis
- Rash/ mouth ulcer
Nausea/ diarrhoea
adverse effects of NSAIDS
Dyspepsia
Oesophagitis
Gastritis
Peptic Ulcer
Small/large bowel ulceration
opiate analgesics example
codeine
tramadol
side effects of opiates
constipation
nausea
drowsiness, fatigue
risk of opioid
dependence
when should DMARD therapy be started in rheumatoid arthritis
As soon as diagnosis of RA confirmed ( ideally within 3 months of symptom onset)
treatment of inflammatory arthritis
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
benefits of DMARDS
reduce rate of joint damage
improve standard lab tests of inflammation - ESR, CRP
commonly used DMARDS
Methotrexate
Sulphasalazine
Leflunomide
Hydroxychloroquine
does leflunomide have a long half life
yes
what is often used in combo with methotrexate in early inflammatory arthritis
sulfasalazine
side effects of sulfasalazine
Nausea
Rash / mouth ulcers
Neutropenia
Hepatitis
Reversible oligozoospermia
Monitoring of FBC and LFTs
does hydroxychloroquine have an effect on joint damage
no
what is hdroxychloroquine used in
connective tissue disease such as SLE, sjrogens and RA
targets if biologics
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)
what do biologics target
specific aspects of immune system found to be implicated in inflammatory disease
are biologics more effective than dmards
yes
role of anti-tnf
pharmaceutical drug that suppresses the physiologic response to tumor necrosis factor, which is part of the inflammatory response
what is anti-tnf used in
RA
psoriatic arthritis
ankylosing spondylitis
adverse effects of anti-tnf
Risk of infection (esp TB)
Question over risk of malignancy (esp skin cancer)
Contraindicated in certain situations e.g. pulmonary fibrosis, heart failure
acute episode of gout medicartion
Colchicine (diarrhoea common)
NSAIDs
Steroids, either oral or IM
indications for corticosteroids
Inflammatory arthritis
Polymyalgia rheumatica / giant cell arteritis
Vasculitis
adverse effects of corticosteroids
Weight gain - centripetal obesity
Muscle wasting
Skin atrophy
Osteoporosis
Diabetes
Hypertension
patient complaining of a cough and some breathlessness when walking up stairs after starting methotrexate for RA
methotrexate pneumonitis
dangerous interaction with methotrexate
trimethoprim
what is the wash out period for methotrexate before starting pregnancy
6 months
Treatment for raynauds phenom
Calcium channel blockers as dilates vessels and promotes blood to digits
