Rheumatology Medications

Question 1

Suggest THREE possible ADRs of methotrexate.

Answer 1

• Mucositis
• Pneumonitis (pulmonary toxicity)
• Bone marrow suppression
• Hepatitis/cirrhosis

Question 2

Suggest THREE possible ADRs of sulfasalazine.

Answer 2

• GI disturbance
• Headache
• Rash

Question 3

Suggest TWO reasons why adherence to taking immunosuppresants may be poor.

Answer 3

• ADRs common
• ADRs severe
• Take 6 weeks to kick in - don’t see benefit
• Many require blood tests/monitoring

Question 4

In which THREE patient conditions must hydroxycholoroquinine be used with caution?

Answer 4

• Neurological disorders
• GI disorders
• G6PD deficiency

Question 5

Describe how methotrexate works in cancer and contrast this to how it works in rheumatoid arthritis.

Answer 5

+ In cancer - inhibits dihydrofolate reductase (DHFR) - prevents formation of FH4 so folates can’t be used in S phase of cell synthesis

+ In RA - inhibitition of purines, produces more adenosine which works as an autocoid inhibiting new vessel formation

Question 6

What important monitoring must be carried out on a patient taking hydroxycholoroquinine?

Answer 6

Visual acuity - ocular toxicity

Question 7

What medication is commonly combined with biologic therapy in rheumatoid arthritis?

Answer 7

Methotrexate (MTX)

Question 8

Suggest THREE possible ADRs of leflunomide.

Answer 8

• GI
• Oral mucosal disorders
• Headache/dizziness
• Haematological - bone marrow suppression, neutropenia
• HEPATOTOXICITY

Question 9

Suggest TWO types of patients in which leflunomide may be contraindicated.

Answer 9

• History of TB
• Impaired liver function

Not suitable in pregnancy

Question 10

Which antibiotics are commonly used for septic arthritis prior to the culture results returning.

Answer 10

2/3 weeks of IV followed by one month oral, to cover staph/strep species:

• Flucloxacillin
• Clindamycin (penicillin allergic)
• Vancomycin (MRSA positive)

Question 11

Suggest THREE ADRs of hydroxychloroquine.

Answer 11

• Irreversible occular toxicity -

Question 12

What are TWO possible indications for the use of cyclophosphamide in SLE.

Answer 12

• Lupus nephritis
• Lupus vasculitis
• Lupus cerebral disease

Question 13

What advice would you give to a patient before initiating them on alendrolate.

Answer 13

Alendrolate (alendronic acid) is a bisphosphonate and therefore can irritate GI tract:

• Once a week
• Take as soon as get up with water
• Take standing or sitting up and remain that way (prone to GORD if you don’t)
• Don’t eat for 30 minutes

Question 14

Explain the broad mechanism of action of MOST bisphosphonates.

Answer 14

Poison osteoclasts and therefore prevent them functioning to remove bone and therefore increasing overall bone density as less is being subtracted

Question 15

Suggest TWO ADRs of bisphosphonates.

Answer 15

• Pathological # - bone not recycled and becomes brittle

- Osteonecrosis of the jaw

Question 16

What are SERMs? Explain why they may be used for the treatment of osteoporosis as an alternative to bisphosphonates.

Answer 16

Selective oestrogen receptor modulators allowing for the actions of oestrogen to be simulated allowing for reduced osteoclast activity.