RA + Steroid Drugs Flashcards
1
Q
Corticosteroid
Types + Effects (not examples)
A
Glucocorticoid = Cortisol
- +Gluconeogenesis
- +Glycogen phosphorylase (allowing adrenaline +glycogenolysis)
- -IL2 receptor -Th2 responce (⇒Th1 dominance, and less AB production)
Mineralocorticoid = Aldosterone
- Na/K pump (DT+CD)
- Epithelial Na channel (ENaCs)
- Secretes K+
- Secretes H+ for Na+ (regulating pH, bicarb)
2
Q
Corticosteroid
Examples + SEs
A
High Minero-
- Fludrocortisone
- Hydrocortisone
- Prednisolon
- DXM + Betmethasone
High Gluco-
SEs
High Glucocorticoid (ie Cushings)
- Central obesity +Weight gain
- UUUN face
- Skin - thin, easy bruising, acne, hirsutism
- HyPERglycaemia + DM + HyPERtension
- Insufficient muscles (proximal weakness)
- Neck buffalo + supraclavicular lump
- Gonadal dysfunction +Glaucoma/ Cateracts
- Osteoporosis
- Immunosuppresion + Infections
- Depression
High Mineralocorticoid (ie Conns)
- Hypertension + Fluid retension
- HYPOkalaemia
- Hypotonia, Hyporeflexia, Tetany
- Muscle weakness + Cramps
- Palpitations
3
Q
Corticosteroid
Topical Ladder
A
Mild
- Hydrocortisone 1%
- Fucidin H
- Timodine
- Synalar 1:10
Moderate
- Clobetasone butyrate Eumovate
- Alcometasone diproprionate (Modrasone)
- Trimovate
Potent
- Betamethasome valerate (Betnovate)
- Mometasone furoate (Elocon)
- Hydrocortisone butyrate (Locoid)
- Fluocinolone acetonide (Synalar)
Very Potent
- Clobestasol propionate (Dermovate)
4
Q
RA management
General ladder
A
- NSAID
+ Steroid to bridge gap - Combination of 2 DMARDS (Methotrexate + 1)
- Hydroxychloroquine
- Methotrexate
- Sulfasalazine
- Gold salts
- Azathioprine
- Penicillamine
- Leflunomide
- TNFa inhibitors
- Etenercept (decoy receptor for TNFa)
- Infliximab (monoclonal AB binds TNFa)
- Adalimumab (monoclonal AB)
- Rituximab (anti-CD20 B-Cell)
5
Q
Hydroxychloroquine
SEs + Councilling + Monitoring
A
- Retinopathy due to corneal deposits: visual disturbance (annual optometrist)
- Tinnitus
- Rash + GI
6
Q
Methotrexate
SEs + Councilling + Monitoring
A
-
Myelosuppression
- Sore throat come back
- FBC 3x2wk, monthly
- Hepatotoxic
- LFTs 3x2wk, monthly
- Stop: ALT doubles or >80
- Renal impairment
- U+Es 3monthly
- Teratogenic
- Dont get pregnant
- Low folate
- 5mg Folic acid on non-methotrexate day
- Pneumonitis & Fibrosis
- Rash + GI
CI
- +Trimethoprim (low folate)
- +NSAIDs (inhibits excretion)
7
Q
Sulfasalazine
SEs + Councilling + Monitoring
A
- Myelosuppression + Heinz-body anaemia
- Sore throat come back
- FBC 3x2wk, monthly
- Hepatotoxic
- LFTs 3x2wk, monthly
- Renal impairment
- U+Es monthly
- Azoospermia
- Rash + GI
8
Q
Gold Salts
SEs + Councilling + Monitoring
A
- Proteinuria (nephrotic syndrome)
- Urinalysis at each injection
- Thrombocytopenia
- FBC at each injection
9
Q
Azathioprine
SEs + Councilling + Monitoring
A
- Myelosuppression
- Sore throat come back
- FBC 6x1wk ⇒ 3x2wk, monthly
- Liver impairment
- LFTs 6x1wk ⇒ 3x2wk, monthly
- Renal impairment
- U+Es 3monthly
- Teratogenic
- Dont get pregnant
- Basal Cell Carcinoma
- Lymphoma
- Azoospermia
- GI + rash
10
Q
Penicillamine
SEs + Councilling + Monitoring
A
- Myelosuppresion
- +Aplastic anaemia
- Sore throat come back
- FBC 3x2wk, monthly
- Glomerulonephritis + Proteinuria
- U+Es + Urinalysis 3x2wk, monthly
- SLE
- CI Myasthenia Gravis exacerbation
- GI + rash
11
Q
Leflunomide
SEs + Councilling + Monitoring
A
- Myelosuppression
- Sore throat come back
- FBC 3x2wk, monthly
- Hepatotoxic
- LFTs 3x2wk, monthly
- Interstitial lung disease
- Hypertension
- Measure at appointments
12
Q
RA management in pregnancy
A
- Sulfasalazine + Hydroxychloroquine
- Low dose steroids
*
13
Q
TNF inhibitor
SEs + councilling
A
ALL = TB reactivation
- Etanercept - demyelination
- Infliximab
- Adalimumab
14
Q
Rituximab
SEs + councilling
A
- Infusion reactions
