Rheumatology Drugs

Question 1

According to NICE, patient needs DAS assessment for these drugs. Usually in combination with methotrexate as first line biological agents for active RA.

Answer 1

Anti-TNF eg Infliximab, etanercept, Adalimumab, certolizumabpegol and golimumab

Given after failure to respond to 2 DMARDs and DAS28 >5.1

Question 2

Pneumonitis is well recognised but uncommon with this drug.

Answer 2

Methotrexate - idiosyncratic , not everyone gets it

Question 3

All brands of this medication are parenteral.

Answer 3

Anti TNF drugs
Infliximab - IV
Etanercept(Enbrel) and adalimumab(Humira)- SC

Question 4

Inhibit both COX 1 &2

Answer 4

NSAIDS

ibuprofen, naproxen, diclofenax, mefenamic acid, aspirin

Question 5

Causes profound B cell lymphocyte depletion

Answer 5

Rituximab

Question 6

Better GI safety than the older generation of these drugs

Answer 6

COX 2 Selective non steroidal

Question 7

Can cause temporary azospermia in young men

Answer 7

Sulfasalazine

Question 8

Combination therapy may be more effective than mono therapy

Answer 8

DMARDS

Question 9

Increased risk of infections with intracellular pathogens

Answer 9

Anti- TNF

need viral and TB screening before starting

Question 10

Highly teratogenic and abortifacent

Answer 10

Methotrexate

Question 11

Given as adjuvant to treat osteoporosis

Answer 11

Calcium/ vit D

Question 12

Helpful for bone metastasis induced hypercalcaemia

Answer 12

Bisphosphonates- pamidronic acid

Question 13

Also referred to as “pulse” therapy

Answer 13

Methylprednisolone

Question 14

Do not prescribe if allergic to aspirin

Answer 14

Sulfasalazine

Question 15

Very rapid influence on inflammatory arthritis SLE and vasculitis

Answer 15

Methylprednisolone

Question 16

Well recognised to cause infertility

Answer 16

Cyclophosphamide

Question 17

Liver toxicity in overdose

Answer 17

Paracetamol

Question 18

More side effects if TPMT (thiopurine methyltransferase)deficient

Answer 18

Azothiaprine- this is a prodrug of mercaptopurine which is metabolised by TPMT. If someone has TPMT deficiency they could potentially develop life threatening bone marrow toxicity

Question 19

Given to minimise fracture risk in people taking steroids

Answer 19

Bisphosphonates

Question 20

Titration dose to reduce serum urate level

Answer 20

Allopurinol

Question 21

Need regular blood monitoring

Answer 21

DMARDs except hydroxychloriquine

Question 22

What are the side effects of long term corticosteroids

Answer 22

From head to toe-
Depression, anxiety, psychosis
Cataracts, glaucoma
Moon face
Supraclavicular fat pads
Buffalo hump
Hypertension
Tachycardia
Atherosclerosis
Gastritis
Central obesity
Purple striae
Corticosteroid induced diabetes
Fluid retention
Immunosuppression
Osteoporosis 
Thinned skin
Bruising
Proximal muscle weakness

Question 23

Drug interaction with allopurinol

Answer 23

Azathiaprine
Allopurinol inhibits the enzyme xanthine oxidase (XO), which is one of 3 enzymes responsible for inactivating 6-mercaptopurine (active form of azathioprine)

Due to this inhibition, 6-mercaptopurine is shunted down to form metabolites that are incorporated into the DNA resulting in a reduction in WBC replication/activation, as well as inhibition of the activity of Rac1 GTP which stimulates apoptosis of WBCs leading to life threatening leukopenia

Question 24

Risk of haemorrhagic cystitis

Answer 24

Cyclophosphamide

Question 25

Risk of interstitial nephritis and fluid retention

Answer 25

NSAIDs

Question 26

Risk of oesophagitis

Answer 26

Bisphosphonates

Question 27

Key treatment for temporal arteritis and PMR

Answer 27

Oral prednisolone

Question 28

Steroid sparing agent

Answer 28

Azathiaprine

Question 29

Reduces hyperuricaemia

Answer 29

Allopurinol

Question 30

Licensed for treatment of lymphoma and RA

Answer 30

Rituximab

Question 31

Alkylating chemotherapeutic drug

Answer 31

Cyclophosphamide

Question 32

Weekly doses followed by folic acid

Answer 32

Methotrexate

methotrexate competitively inhibits dihydrofolate reductase (DHFR), an enzyme that participates in the tetrahydrofolate synthesis. The affinity of methotrexate for DHFR is about 1000-fold that of folate.