Rheumatology Drugs

Question 1

anti TNF antagonists

Answer 1

associated with HF

can reactivate TB

Question 2

What to test prior to starting anti TNF alpha antagonists

Answer 2

TB or anti tuberculin testing

Question 3

What to monitor with methotrexate

Answer 3

CBC (bone marrow suppression),

serum cr (renal toxicity)

No need for a urine microalbumin.

LFTs for risk of hepatotoxocity.

MTX DOES NOT CAUSE PERIPHERAL NEUROPATHY

Question 4

hydroxychloroquine can cause this side effect:

Answer 4

retinal toxicity
can have permanent blindness
needs annual eye exam for high risk patients on hydroxychloroquine

Question 5

what defines high risk for getting retinal blindness from hydroxychloroquine?

Answer 5

treatment >5 years
high body fat level
kidney or liver dx
age >60 years
pre-existing retinal disease.

Question 6

Medications that are extremely teratogenic and not be used with pregnancy:

Answer 6

methotrexate - STOP 3 months prior to pregnancy

leflunomide - extremely tetraogenic - need cholestyramine to remove drug from body and needs to be followed with drug level

mycophenolate mofetil - STOP 3 months prior to pregnancy

also sirolimus and everolimus must be stopped 3 to 6 months before pregnancy.

Question 7

Medications that SAFE to be used with pregnancy:

Answer 7

tylenol
hydroxychloroquine
sulfasalazine

Question 8

Medications that that aren’t great but could be used with pregnancy:

Answer 8

NSAIDs- impede implanation and increased with miscarriage. After 30 weeks can lead to premature closure of ductus arteriosus

Glucocorticoids - increase risk for fetal cleft palate and maternal gestational diabetes

opioids - risk for fetal withdrawal

Question 9

medications that only should be used if there’s a benefit that outweighs risk (not great safety for baby) with pregnancy

Answer 9

azathioprine - not recommended - but safer than some other DMARDs

cyclophosphamide - not recommended unless absolutely necessary

cyclosporine- not recommended unless benefit outweighs risk

tramadol - not recommended for pregnancy.

TNF alpha inhibitors - limited evidence to support use in pregnancy

colchicine - not recommended unless benefit outweighs risk

Question 10

what GOUT medications are safe for pregnant woman?

Answer 10

probenecid has no evidence for adverse impact

rest of the meds are all on a "potential benefit outweighs risk" basis:
allopurinol
febuxostat
colchicine
pegloticase

Question 11

leflunomide side effects

Answer 11

stops lymphocyte activation and so causes cytopenias

GI upset: diarrhea, LFTs

infection
teratogenesis.

Question 12

what medications interactions should be avoided?

Answer 12

colchicine and clarithromycin

• coadministration of colchicine and clarithromycin can result in fatal colchicine toxicity that manifests as rhabdomyolysis, AKI and pancytopenia

Colchicine is metabolized in the liver by CYP3A4 cytochrome and should be avoided in tps taking CYP3A4 inhibitors like clarithromycin

there are fatal outcomes with both given at the same time.

ok to resume colchicine after recovery.