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Phase 2 - General Medicine > Rheumatology - Medications > Flashcards

Rheumatology - Medications Flashcards

1
Q

What is Allopurinol?

A

It is an anti-urate medication. It inhibits an enzyme which usually oxidates things causing urea to be produced

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2
Q

When do you use Allopurinol?

A

Gout - long term

Chemotherapy (MM)

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3
Q

How do you maintain someone on Allopurinol?

A

You titrate their dose according to their serum urea levels

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4
Q

How do you treat an acute attack of Gout?

A

Rest, analgesia, NSAIDs
Colchicine (causes diarrhoea)
Steroids

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5
Q

What are the side effects of Allopurinol?

A

N+V
Metallic Taste
Headaches

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6
Q

When do you use NSAIDS?

A

Basically all Rheumatoid conditions

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7
Q

How do NSAIDs work?

A

Inhibit COX 1 and 2 to reduce PG synthesis

Inhibit Thromboxane 2

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8
Q

Side effects of NSAIDs?

A

Bleeding
PUD
Worsen Asthma
Renal - Interstitial Nephritis and Fluid retention

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9
Q

What is the alternative to giving Allopurinol?

A

Febuxistat

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10
Q

What can you use instead of NSAIDs?

A

COX 2 inhibitors

Paracetamol

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11
Q

How do Corticosteroids work?

A 
Intracellular receptor
Macrophages
Inhibit pro-inflammatory - IL1, TNF, cytokines)
Promote anti-inflammatory
inhibits IL2 gene

Anti-inflammatory

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12
Q

Which conditions are steroids best in?

A

TA
PMR
Vasculitis
Joint Injections

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13
Q

Examples of Corticosteroids?

A

Prednisolone
Hydrocortisone
Methyprednisolone (IV)

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14
Q

Side effects of Corticosteroids?

A 
Cushingoid Features
Bleeding
Ulcers
Pancreatitis
Stop - Addisons Crisis
Osteoporosis
Demargination of Neutrophils
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15
Q

How long does it take steroids to take effect?

A

a couple of days

If no effect in a couple of weeks, see again

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16
Q

How long are you usually on steroids for?

A

2 years

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17
Q

What do you prescribe with High Dose Steroids?

A

PPI
Calcium
Vitamin D
(Bisphosphonates)

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18
Q

What is Azathioprine?

A 
Immunosuppresant
Anti-metabolite
Inhibits purine synthesis
Cleaved into 6MP
TPMT Enzyme
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19
Q

Why do different levels of TPMT matter?

A

Azathioprine
High = undertreatment (over-broken down)
Low = myelosuppresion

20
Q

Risks of Azathioprine?

A

Pancreatitis
Immunosuppression
Increased infections
Increased malignancy

21
Q

When do you use Azathioprine?

A

Steroid sparing drug

IBD 2nd line

22
Q

How do you monitor someone on Azathioprine?

A

FBCs

LFTs

23
Q

What is Cyclophosphamide?

A

Cytotoxic, alkylating agent

Prevents DNA replication

24
Q

When do you use Cyclophosphamide?

A

Combo with other DMARDs
Severe RA, SLE, vasculitis
Chemotherapy agent

25
Q

Risks of Cyclophosphamide?

A 
Bladder Cancer
Lymphoma 
Leukaemia
Hair Loss
Teratogenic/Infertility
26
Q

How do you monitor Cyclophosphamide?

A

FBC

U&Es

27
Q

Name some DMARDs

5

A 
Methotrexate
Cyclophosphamide
Sulphasalazine
Mycophenalate
Hydroxychloroquine
28
Q

What is Methotrexate?

A

Anti-folate
Prevents protein synthesis
Acts on rapidly dividing cells

29
Q

When do you use Methotrexate?

A

1st DMARD in RA
Steroid Sparing Agent
Psoriatic Arthritis
In combo with other

30
Q

Side Effects of Methotrexate?

A 
Hair Loss
Teratogenic
Abortificant
Infection and Malignancy Risk
Pneumonitis
Hepatitis (NO ALCOHOL)
31
Q

How do you monitor Methotrexate?

A

CXR before start

U&Es, LFTs, FBCs, creatinine every week until stable for 6

Then monthly x 3
Then every 3 months

32
Q

Which antibiotic do you not give to someone on Methotrexate?

Why?

A

Trimethoprim

Both are anti-folates

33
Q

When do you use Hydroxychloroquine?

A

Combo in RA
SLE (skin involvement)
Safe in pregnancy

34
Q

How do you monitor someone on Hydroxychloroquine?

A

Yearly eye tests

Causes Maculopathy

35
Q

Side effects of Hydroxychloroquine?

A

Tinnitus
Blurred Vision
Headaches
Hair Loss

36
Q

What is Sulpha/Mesalazine?

A

Anti-inflammatory
Poorly absorbed so good for IBD
Inhibits T Cells and neutrophils
Sulphapyridine fights infections

37
Q

When do you use Sulpha/Mesalazine?

A

IBD
RA
PA

38
Q

What are the side effects of Sulpha/Mesalazine?

A

Temporary Azospermia
Hepatitis
Rash
GI

39
Q

How do you monitor Sulpha/Mesalazine?

A

Same as methotrexate

FBC, U&Es, LFTs, eGFR

40
Q

Contraindications to Sulpha/Mesalazine?

A

Allergy to Aspirin

41
Q

Name some anti-TNFs?

A

Humira
Adalimumab
Infliximab
Etanocept

42
Q

When can you use anti-TNFs

A

2 x DAS28 of 5 or more

RA after trying 2 DMARDs

43
Q

What are the bad bits about anti-TNFs?

A

Expensive
Parenteral
Hypersensitivity reactions
Infections

44
Q

What are some Biological agents?

How do they work?

A

Rituximab

Inhibits B cells

45
Q

When do you use biologics?

A

When very severe and all other therapy failed

SLE, vasculitis, DMS, RA

46
Q

Side effects of Biologics?

A

Infection (low B Cells)
Wheeze
Progressive multifocal leukoencephalopathy

47
Q

CI to Biological therapy?

A

Current Infection

Immunosuppressed state

Phase 2 - General Medicine (6 decks)

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