Rheumatoid Pharmacology Flashcards
What are the common features of DMARDs?
Slow acting Anti-inflammatory not analgesic Improve lab tests for inflammation Reduce rate of joint damage Regular monitoring for adverse effects required
What is the mechanism of action of methotrexate?
Unknown (folate antagonist).
What are the routes of administration for methotrexate?
Oral or SC.
What are the diseases methotrexate may be used in?
Psoriatic arthritis, RA, connective tissue disease, vasculitis.
What are the adverse effects of methotrexate?
Leucopenia/thrombocytopenia, pneumonitis, hepatitis/cirrhosis, nausea and diarrhoea, rash/mouth ulcers.
FBC and LFT monitoring required!
How long does methotrexate need to be stopped for before conception?
At least 3 months.
What is the mechanism of action for leflunomide?
Inhibits enzyme, resulting in decreased reproduction of rapidly dividing cells e.g. white blood cells.
What is more effective, methotrexate or leflunomide?
Equal efficacy.
What are the side effects of leflunomide?
Similar to methotrexate.
What is a downside to using leflunomide?
Very long half-life requiring washout.
What DMARDs would you use in pregnancy?
Sulfasalazine and hydroxychloroquine.
What are the adverse effects of sulfasalazine?
Nausea Rash/mouth ulcers Neutropenia Hepatitis Reversible oligozoospermia
What is hydroxychloroquine commonly used in?
Connective tissue disease.
What is the main adverse effect of hydroxycholoroquine?
Retinopathy.
Name 2 other DMARDs.
Sodium aurothiomalate (gold) and penicillamine.
How are penicillamine and sodium aurothiomalate administered?
Penicillamine - orally.
Sodium autothiomalate - IM.
What are the side effects of sodium aurothiomalate and penicillamine?
Bone marrow suppression
Glomerulonephritis
Rash
Mouth ulcers
What has anti-TNF therapy been licensed in?
RA, psoriatic arthritis, ankylosing spondylitis.
How effective is anti-TNF therapy in comparison to DMARDs?
1.5x
What are the adverse effects of anti-TNF therapy?
Risk of infection esp TB
May cause malignancy esp skin cancer
Contraindicated in pulmonary fibrosis and heart failure
Name 2 xanthine oxidase inhibitors.
Allopurinol and febuxostat.
What are the adverse effects of allopurinol?
Vasculitis rash
Reacts with azathioprine
Marrow aplasia
What is the adverse effect of febuxostat?
Renal impairment
What drugs cause gout?
Diuretics, anti-hypertensives, aspirin (basically all involved in kidney function somehow).
