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Musculoskeletal > Rheum - Drugs > Flashcards

Rheum - Drugs Flashcards

1
Q

What are the absolute contraindications for methotrexate?

A

Pregnancy and breastfeeding (also leflunomide)
eGFR <30
Patients taking trimethoprim

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2
Q

What are the absolute contraindications for sulphasalazine?

A

Allergy to sulphonamide
Allergy to aspirin
Previous Stevens-Johnson syndrome

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3
Q

What is the contraindication for hydroxycholoroquine?

A

Pre-existing maculopathy

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4
Q

What are the main cautions for DMARDs?

A

Severe liver disease (all)
Severe pre-existing lung disease (not HCQ)
eGFR 30-60 (MTX)

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5
Q

What is the most common adverse effect of DMARDs?

A

Nausea and GI symptoms

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6
Q

What is an additional adverse effect of methotrexate?

A

Oral ulceration

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7
Q

What are the adverse effects of leflunomide?

A

Diarrhoea
HTN
Weight loss

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8
Q

What are the adverse effects of sulphasalazine?

A

Neuropsychological symptoms (also HQC)
Skin reactions
Symptoms usually settle if patient persevere with tx

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9
Q

What are the possible complications of methotrexate?

A

Bone marrow suppression and/or acute liver toxicity in early months
Pneumonitis (acute onset SoB)
Acute renal problems causing accumulation and toxicity
Liver disease/cirrhosis

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10
Q

What are the possible complications of leflunomide?

A

Bone marrow suppression and/or acute liver toxicity in early months
Pneumonitis (acute onset SoB)
Peripheral neuropathy

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11
Q

What are the possible complications of sulphasalazine?

A

Bone marrow suppression and/or acute liver toxicity in early months
Pneumonitis (acute onset SoB)
Reduced sperm count

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12
Q

What is the possible complication of hydroxychloroquine?

A

Bulls eye retinopathy - can cause severe progressive and permanent visual change/loss

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13
Q

What is the MoA of methotrexate?

A

Competitive inhibitor of folate dependent enzymes

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14
Q

What is the method of methotrexate delivery?

A

ONCE WEEKLY DOSE
May be oral or injections
Co-prescribe folic acid 5mg 6 days/week

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15
Q

What monitoring is required for methotrexate?

A

Initial: 2 weekly bloods
Stable dose for 6 weeks - once monthly
Then 3 monthly
Baseline CXR and lung function tests

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16
Q

What are the side effects of biologics?

A

Infusion/injection reactions
Immunosuppression (infection reactivation)
ADAs (anti-drug antibodies), improved if continue with DMARD

17
Q

What are things to take note of when using biologics?

A

Recent cancer - should not use TNF drug as can be used for monitoring
Must be screened for TB due to risk of reactivation

18
Q

Give an example of TNF targeting biologics

A 
Infliximab
Adalimumab
Golimumab
Certolizumab
Etanercept

Musculoskeletal (12 decks)

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