rheumatology drugs Flashcards
when is methotrexate indicated in rheumatology?
humanoid arthritis
ankylosing spondylitis with peripheral disease
psoriatic arthritis
what are the side effects of methotrexate?
teratogenic hepatotoxicity (liver cirrhosis) myelosupression/agranulocitosis pulmonary fibrosis/pnuemonitis mucositis (sore inflamed gums) raises and mouth ulcers
what monitoring is required for methotrexate? when and how often?
FBC and LFTs regularly
checked prior to starting
then repeated weekly until stable
then monitored every 2-3 months
what is the relevance of pregnancy and methotrexate?
teratogenic
need to have stopped methotrexate 6 months prior to conceiving
men need to use contraception for 6 months too before conceiving
how is methotrexate taken?
weekly
what should be co-prescribed with methotrexate? how should it be taken?
folic acid
taken more than 24 hours after methotrexate
what antibiotics should be avoided co-prescribing with methotrexate? and why?
trimethoprim
co-trimoxazole
can increase risk of marrow aplasia
what other drug should be avoided with methotrexate and why?
aspirin
increases risk of toxicity secondary to reduced excretion
how does leflunomide work?
similar to methotrexate
what do you need to be careful of with leflunimoide?
long half life so requires wash out
what are the side effects of sulfasalazine?
hepatotoxicity
rash
reversible oligozoospermia
what is the indication to use azathioprine?
connective tissue disease
vasculitis
what is the side effects of azathioprine?
hepatotoxicity
agranulocytosis
what drug when co-prescribed with azathioprine causes agranulocytosis?
allopurinol
what can gold be used to treat?
rheumatoid arthritis
what are the side effects of gold?
glomerulonephritis
proteinuria
what needs to be monitored with gold?
U&Es
how is gold administered?
IM
what is hydroxychloroquine used for?
connective tissue disease (SLE)
what is a side effect of hydroxychloroquine?
irreversible retinopathy
can hydroxychloroquine be used in pregnant people?
yes
what are the names of anti-TNF drugs?
etanercept
infliximab
golimumab
adalimunab
what are anti-TNF drugs used to treat?
rheumatoid arthritis
psoriatic arthritis
ankolsying spondylitis
what are the side effects of anti-TNF drugs?
reactivation of TB
increased susceptibility of infection
increased risk of skin cancer
what are anti-TNF drugs used in combination with?
methotrexate
in what conditions are anti-TNF drugs contraindicated?
TB
pulmonary fibrosis
heart failure
what it the name of an anti-CD20 antibody?
rituximab
what can rituximab cause?
myelotoxicity
pulmonary toxicity
what is colchicine used for?a
acute gout
what are the side effects of colchicine?
N & D
when is colchicine used in acute gout?
2nd line
when patients can’t take NSAIDs
what is allopurinol used for?
gout prophylaxis
what are the side effects of allopurinol?
vasculitic rash
inhibition of warfarin metabolism
why should you be careful when prescribing for gout?
can precipitate an acute attack
needs to be covered with NSAIDs or colchicine
how does allopurinol work?
works as an xanthine oxidase inhibitor
when are steroids used in rheumatology?
rheumatoid flare ups
immunosuppression while DMARDs get to work
acute gout
what are the side effects of steroids?
weight gain
muscle wasting
osteoporosis
hypertension
