Rheumatological Flashcards
TNFα antagonists
MOA- antibody blocks TNFα which inhibits inflammatory and immune responses
I- RA, psoriatic arthritis, ankylosing spondylitis, juvenile idiopathic arthritis, IBD, plaque psoriasis, hidradenitis suppurativa
Adalimumab- SC 40mg every 2 weeks (for RA can be weekly if monotherapy)
Infliximab- 3-7.5mg/kg at 2 and 6 weeks, then every 8 weeks
M-FBE, ALT, AST, Cr (on initiation), malignancy (esp skin cancers), infection
AE- injection site reaction (adalimumab), influsion effects infliximab (headache, vertigo, flushing, NVD, fever, fatigue- can be reduced with pretreatment with paracetamol/antihistamines), nausea, weakness, flulike symptoms, hyperlipidaemia
C- Takes time to work max response around 12-16 weeks, how to use allow to sit at room temp for 30min before rotate injection site inject in thigh or abdomen, see doctor ASAP for signs of infection, check with Dr before getting some vaccinations
Allopurinol
Xanthine Oxidase Inhibitor
I- gout (dont initiate in acute attack), hyperuricaemia, prevention of acute hyperuricaemia due to tumour lysis syndrome
D- 100-900mg od with food
M- Serum urate (to check dose is correct but poor correlation with gout attacks), renal function, LFT
AE- ND (take with food to reduce), taste disturbance, dizziness/drowsiness (more on initiation), allergic reactions (SJS, multiorgan-hypersensitivity reaction),
C- take with or shortly after food, rash swollen lips mouth persistent fever or sore throat- see dr asap, you may notice more flares in first few months- will improve with time, drink at least 1.5-2L fluid per day (prevent uric acid precipitation)
Colchicine
Reduces inflammation by inhibiting neutrophils in inflamed tissue
I- pain relief in acute gout, prophylaxis of flares including when initiating urate lowering therapy, FMF (familial mediterranean fever), acute pericarditis
D- 1mg stat then 500mcg 1 hour later (max 1.5mg per course- should not be repeated within 3 days). For prophylaxis when initiating urate lowering- 500mcg od or bd. Dose for FMF max 3g daily
M- FBC (blood dyscrasias- agranularcytosis, aplastic anaemia, thrombocytopenia), toxicity (GI effects), peripheral neuropathy, rhabdomyolysis (muscle pain and CK), ECG (arrythmias), LFTs (risk of hepatitis), renal function (dose reduction required)
AE- abdo pain, DNV,
C- swallow whole, see dr asap unusual bleeding/bruising, muscle weakness/pain, numbness, tingling fingers or toes or infection, not a pain killer dont use for other types of pain, start at earliest sign of attack best within 24h, ice packs avoid socks shoes and bedding on joint, always tell HCPs youre taking before taking other medications, avoid grapefruit juice
CALs- 5, 18, 21, A
Leflunomide
Immunosuppressant- inhibits dihydro-orotate dehydrogenase which reduces pyrimidine synthesis in leukocytes and rapidly dividing cells
D- 10-20mg od
M- FBE, renal function, LFT, BP, infection, malignancy
AE-ND, dyspepsia, headache, dizziness, hairloss
C- may take time to work 4 weeks before symptoms improvement, see dr asap if signs of infection fever mouth ulcer rash unusual bleeding or bruising coughing jaundice tingling in in fingers toes, avoid alcohol (increased risk of liver damage), check with dr before receiving any vaccines
Methotrexate
C- Folic acid antagonist immunosuppressant
I-Rheumatoid arthritis, Psoriasis, Juvenile idiopathic arthritis, crohns disease, autoimmune diseases
D- Oral/SC/IM- 7.5-25mg once weekly (can be divided in three doses 0, 12 and 24hours)
M- FBE (leucopenia, thrombocytopenia), LFT (hepatotoxic, increased aminotransferases, fibrosis, cirrhosis, liver failure), renal function (dose reduction in impairment), regular chest xray (can cause pulmonary fibrosis), infection (WCC, CRP, clinical infection signs), contraception/pregnancy (Cat X- must be stopped for >3months before conceiving), GI toxicity (signs of bleeding, Hb, NVD, ulceration) serum folate (folic acid supplimentation 1-5mg d or 5-10mg once weekly on other days), baseline hepatits B and C serology
AE- N, mouth ulcers, headache, dizziness, fatigue, drowsiness, blurred vision, eye irritation
M- take strictly as directed once weekly on the same day, can be taken with food to reduce GI AE, swallow whole, dont take every day, see doctor for N,D, mouth ulcers, bruising or infection, tell all HCP you are taking MTX before starting any new medications, alcohol can increase AE of MTX- avoid excessive drinking, may take 1-2 months for improvement, signs of infection unusual bruising or bleeding jaundice dry cough chest pain- see dr asap, CAL 8- avoid excessive or prolonged sun exposure, consider using a calendar/phone reminder for dose reminders, importance of contraception during and for >3months after treatment, dont take NSAIDs unless without drs advice
CALs- 5, 8, 10a, 20, 21, A
NSAIDs
C- COX inhibition, decreased prostaglandin synthesis: anti-inflammatory, antipyretic and analgesic
I- inflammatory arthropaties (RA, OA, gout), pain (esp due to tissue injury and inflammation)
D
Celecoxib: 100-200mg d (can be 100mg bd). Can use 200mg bd short term max 5 days
Diclofenac: 75-150mg daily in 2 or 3 doses (max 200mg/d) (highest CV risk)
Ibuprofen: 200-400mg tds or qid (max 2400mg/d)Child 5-10mg/kg (max 400mg) tds or qid max 30mg/kg/day
Mefaminic acid- 500mg tds with food prn (commonly used in period pain, heavy menstural bleeding)
Meloxicam: 7.5-15mg once daily
Naproxen: IR 500-1250mg daily in 2-4 doses or CR 750-1000mg od (max 1250mg/d) (lowest CV risk)
M (for chronic treatment)- FBC, Hb, BP, CrCl, LFT, renal function, dehydration (NSAIDs reduce renal function), Asthma (bronchospasm), coagulation (increased risk of bleeding)
AE- ND, dyspepsia, GI ulceration/bleeding, raised liver enzymes, headache, dizziness, hypertension, renal function
C- take with food, can continue low dose aspirin, see dr asap for swollen ankles, chest pain, difficulty breathing, blood in stools or vomit, abdo pain, heartburn, dont take if dehydrated, for OA max effect at 2 weeks, can use paracetamol or opioids were required
CALs- 10a, 12, 19, B
