Rheumatology — Drugs Flashcards
NSAIDs: use and S/Es
Use
-Initial Rx - provide symptomatic relief
S/E
- GI problems, renal impairment
- Caution in pts with CVS risk and asthma
Corticosteroids - Use and S/E
Use
- Inflammatory Arthritis: used before DMARDs kick in then weaned
- PMR and GCA: long term rx
S/E
- Steroid induced diabetes
- Skin changes (striae)
- Immune depression
- etc
- use lowest dose possible
DMARDs: main use
Which are C/I in pregnancy/breast feeding?
- Mainly used as Rx for RA, PsA, SLE and vasculitis - take 3 months to start working
- Methotrexate, leflunomide and cyclophosphamide - completely C/I in pregnancy and breast feeding
Methotrexate:
- Dose
- Monitoring requirements
- Supplements needed
- 1/week dose
- Blood tests: FBC/renal function initially 2/52 then can go to 2-3 months
- Effect takes 3 months
- Folic acid: taken a few days after methotrexate pill, helps counteract S/Es (can increase dose if need more cover)
Methotrexate
- Can patients drink?
- S/Es
- Is it advisable in pregnancy?
• No alcohol and need annual vaccination
• S/E:
◦ Common: fever, headache, nausea, vomiting
◦ Rare: BM depression/thrombocytopenia, pneumonitis, hepatic disorders interstitial lung disease , alopecia
• Pregnancy: very teratogenic - must stop 3 months before attempting to conceive
Hydroxychloroquine
- Use
- Monitoring requirements
- S/Es
- Safe in pregnancy?
• 1st line Rx for mild lupus (used as add on to methotrexate if need a bit of additional support in RA)
• Monitoring: eye tests (few weeks after starting medication, then 1/year)
• S/E:
◦ Common: abdo pain, diarrhea, nausea, vomiting
◦ Affects eyes (retinopathy/colour vision/corneal oedema), arrhythmias, can aggravate psoriasis, neuromuscular dysfunction
• Pregnancy: relatively safe
Sulfasalazine
- When must you avoid this drug?
- Moniting requirements
- S/Es
- Safe in pregnancy?
• Cannot be given if patient has an aspirin allergy
• Monitoring:
◦ renal function: before starting, at 3 months and then yearly
• S/E:
◦ Common: arthralgia, cough, fever, diarrhea/GI discomfort
◦ Uncommon: oligospermia in men, can turn sweat orange
• Pregnancy: relatively safe
Azathioprine
- Indication
- Monitoring requirements
- S/Es
• Indication: RA refractory to DMARDs, SLE and other CTDs, Polymyositis in cases of corticosteroid resistance
• Monitoring: FBC weekly for 1st 4 weeks, then reduced to every 3 months (look for myelosuppression), lung function test b/c initiation of drug
• S/E
◦ Common: bone marrow depression (dose related), increased risk of infection/neutropenic sepsis, thrombocytopenia
◦ Rare: pneumonitis
Cyclophosphamide
- Indications
- S/Es
- Safe in pregnancy?
• Indication: RA with severe systemic manifestations
• Pregnancy: avoid
• S/Es
◦ Uncommon: haemorrhagic cystitis (give Mesna) and secondary malignancy
Mycofenolate Mofitil
- Use
- S/E
- Main use: maintaining remission in connective tissue auto-immune diseases
- S/E: extremely toxic - acidosis, BM disorders, GI haemorrhage, neoplasms (huge list)
What must you screen for before starting a patient on biological?
If a patient is feeling unwell, what do you do about weekly dose?
- Hepatitis, varicella, TB and HIV
- Alpha TNF inhibitor: must ensure pt does not have cancer
- If patient is unwell - omit weekly dose
What is the MOA of Rituximab, tocilizumab and eternecept?
- Rituximab: CD-20 inhibitor
- Ticilizumab: IL-6 inhibitor
- Eternecept: TNF alpha inhibitor
What drugs should you prescribe in pts who have osteoporosis?
What important score do you need to consider?
-FRAX score - quantifies pt’s risk of fractures based on age and ethnicity
Drugs
- Co-prescribe Ca2+ and vitamin D
- Oral bisphosphonates: aldendronic acid - must be taken on empty stomach and 30 minutes before food
