RA- Drugs Flashcards
When are nsaids considered for RA
They are considered after
- paracetamol and life style meausres have not worked
- Consider a low dose NSAID for the shortest duration
- If therapy with lower dose doesnt work then increase to a higher does NSAID for shortest term
Precautions/Considerations for NSAIDS
Precautions- (D,A,C,C,S,E)
- Dehydration- nsaids inhibit
prostaglandins that are important in
maintain renal blood flow)
- Asthma- can cause broncho constriction
and precipitate worsening asthma
- Coagulation disorders - increased risk of
bleeding
- Cardiovascular-use with caution
- Renal impairment - use with caution
- Surgery - has a risk of renal impairment
due decreased renal blood flow
especially if patient is dehydrated. Make
sure patient is well hydrated ( via drip)
especially if they are going to be started
on an naiad
- Elderly - increased risk of adverse effects GIVE LOWER DOSE
CONTRAINDICATED- NO USE (G- CHAP)
- Cardio vascular - if patient has heart failure , Post MI (due to increased risk of mortality ),
-Gastric- Patient has active peptic ulcer
or GI bleeding
Avoid it patient has a history of GI
bleeding
- Pregnancy/BREASTFEEDING- AVOID
USE- causes miscarriage
- in Breastfeeding it is okay and safe to
use - ibuprofen recommended short
term
-Hepatic DISEASE- in sever disease stage ( in liver cirosis tage)
-Asthma- if asthma is uncontrolled cease NSAID- can make it worse
what are the doses for nsaids
COx1 and 2
- ibuprofen 200-400mg every 6-8 hours max2400mg
- naproxen 275-550(250-500mg) BD( 1250mg max)
NB- psudoporphyria( skin blistery lesions common)
-Asprin -
-Dicofenac (75mg-150MG) 3-4 divided doses ( every 6-8 hours)
MAX 200mg (8 x25mg or3x50mg) (50 mg t.i.d. or q.i.d., or 75 mg b.i.d.).
- Indomethacin 25-50mg- 2-4 dived dose
(every 6-12 hours) - Mefanamic acid-500mg tds
COx2
- Meloxicam 7.5-15mg ONCE d
- Celecoxib 100 bd initially then can be
increased to 200mg bd short term
* 400mg day 1 then 200mg bd- period pain and post opp pain)*
Cardiovascular events are dose dependent, Don’t use 200mg> more than 5 days
What are the main adverse effects for NSAIDS
Nausea
Dyspepsia
Gi ulceration/ bleeding
LIver enxymes( diclofenac)
Hypertension
Fluid retention
RAre-
hypersentivity ( asthma, angiodema, urticaria)
SJS
Renal imp
Counselling points for NSAIDS
increase hydration due to increase dehydration
MAke sure to check BP
Take with food due to stomach upset
- what are the Corticosteroid available
prednisolone or prednisone
- prednisone gets converted to the active
metabolite prednisolone via liver
enzymes
Prednisolone over prednisone for pt with liver disease
What are the precautions/Contraindications for Steroids
PRECAUTIONS
DGOHT - TH-GOD
-Diabetes- can cause an increase in blood sugar levels
-Glaucoma- Can increase intra ocular pressure
-Osteoporosis- Long term Can increase osteoporotic fractures
-Hypertension/HF- Can cause in crease in bp and worsening of hf( Due to water retention )
-TB- LATENT - may be activated
-Peptic ulcer disease - Can increase risk
PREG/BREASTFEEDING- avoid in first trimester , use alternative if possible-
Old literature suggest steroid usage in early trimester can lead to cleft lip, preterm birth and low birth weight
- Weigh out pros vs cons
-low dose for shortest time
Children- chronic use can retard growth if given to kids earlier
What are the adverse effects corticosteroids steroids
NB - adverse effects occur with prolonged use and with higher doses
- Common- Adrenal suppression
C- cushingiod apperance ( swollen face ,
Hunch back,
central fat
O -oedema
R retardation of growth
T- Thinning on skin , increased bruising delayed would healing, flushing
I - Immunosuppression- increased infection
C-cataracts
O - osteoporosis- ( increase risk of
osteoportatic fracture
due to it decreasing
absorption of calcium
form git
S - suppression of adrenal glands-adrenal crisis if stopped abruptly- need to tapper down doses
T -teratogenic- Avoid in first trimester (first 12 weeks)
E - emotion disturbance- Anxiety,depression, mood swings, sleep disturbances
R - raised blood pressure
O Obesity- weight gain
I-increased body hair, appetite
D- diabetes- hyper glycemia
S- straie- stretch marks that are red / purple
What are the councelling points for Steroids
-Take it with food
-Monitor for increased of infections
-Do not stop abruptly - due to withdrawal and adrenal crisis
-if you are having mood changes, psychiatric effect go to doctor
- At base line - MOnitor - bp, BGL, BMD, Weight,
What are sx of adrenal crisis
MEDICAL EMERGENCY
- lightheadedness / dizziness
- abdominal pain
-weakness
- sweating
- loss of consciouness
- If tapering is conducted too quickly can
have with drawl sx- body aches
- Fatigue
- Weakness
what are the sDMARDS
methotrexate , sulfasalizine, lufonamide, hydrochloroquine
- what is first line treatment
Patient to be started on sulfasalizine or hydroqloroquine at mild disease stage
Sulfasalizine may be better tolerated that hydroqqloroquine
What is sulfasalazine (SULFUR=YELLOW)
Its a 5ASA- amino salicylate
- Belongs to the -Salazine Family
what are the Contraindications of sulfasalazine
Allergy to salicylates -( all the 5-ASA and Aspirin
What are the precautions for Sulfasalizine
Allergy to aspirin
6Gpd (x linked disorder)
Blood dycrasasia- increased risk of
myelosuppression
Asthma- a sever allergy to 5ASA can exacerbate asthma
What is Hydroxychloroquine
it is an ant inflammatory with immunosuppressive effects
