Rheumatology - Medications

Question 1

What is Allopurinol?

Answer 1

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

Question 2

When do you use Allopurinol?

Answer 2

Gout - long term

Chemotherapy (MM)

Question 3

How do you maintain someone on Allopurinol?

Answer 3

You titrate their dose according to their serum urea levels

Question 4

How do you treat an acute attack of Gout?

Answer 4

Rest, analgesia, NSAIDs
Colchicine (causes diarrhoea)
Steroids

Question 5

What are the side effects of Allopurinol?

Answer 5

N+V
Metallic Taste
Headaches

Question 6

When do you use NSAIDS?

Answer 6

Basically all Rheumatoid conditions

Question 7

How do NSAIDs work?

Answer 7

Inhibit COX 1 and 2 to reduce PG synthesis

Inhibit Thromboxane 2

Question 8

Side effects of NSAIDs?

Answer 8

Bleeding
PUD
Worsen Asthma
Renal - Interstitial Nephritis and Fluid retention

Question 9

What is the alternative to giving Allopurinol?

Answer 9

Febuxistat

Question 10

What can you use instead of NSAIDs?

Answer 10

COX 2 inhibitors

Paracetamol

Question 11

How do Corticosteroids work?

Answer 11

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

Anti-inflammatory

Question 12

Which conditions are steroids best in?

Answer 12

TA
PMR
Vasculitis
Joint Injections

Question 13

Examples of Corticosteroids?

Answer 13

Prednisolone
Hydrocortisone
Methyprednisolone (IV)

Question 14

Side effects of Corticosteroids?

Answer 14

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

Question 15

How long does it take steroids to take effect?

Answer 15

a couple of days

If no effect in a couple of weeks, see again

Question 16

How long are you usually on steroids for?

Answer 16

2 years

Question 17

What do you prescribe with High Dose Steroids?

Answer 17

PPI
Calcium
Vitamin D
(Bisphosphonates)

Question 18

What is Azathioprine?

Answer 18

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

Question 19

Why do different levels of TPMT matter?

Answer 19

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

Question 20

Risks of Azathioprine?

Answer 20

Pancreatitis
Immunosuppression
Increased infections
Increased malignancy

Question 21

When do you use Azathioprine?

Answer 21

Steroid sparing drug

IBD 2nd line

Question 22

How do you monitor someone on Azathioprine?

Answer 22

FBCs

LFTs

Question 23

What is Cyclophosphamide?

Answer 23

Cytotoxic, alkylating agent

Prevents DNA replication

Question 24

When do you use Cyclophosphamide?

Answer 24

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

Question 25

Risks of Cyclophosphamide?

Answer 25

``` Bladder Cancer Lymphoma Leukaemia Hair Loss Teratogenic/Infertility ```

Question 26

How do you monitor Cyclophosphamide?

Answer 26

FBC | U&Es

Question 27

Name some DMARDs | 5

Answer 27

``` Methotrexate Cyclophosphamide Sulphasalazine Mycophenalate Hydroxychloroquine ```

Question 28

What is Methotrexate?

Answer 28

Anti-folate Prevents protein synthesis Acts on rapidly dividing cells

Question 29

When do you use Methotrexate?

Answer 29

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

Question 30

Side Effects of Methotrexate?

Answer 30

``` Hair Loss Teratogenic Abortificant Infection and Malignancy Risk Pneumonitis Hepatitis (NO ALCOHOL) ```

Question 31

How do you monitor Methotrexate?

Answer 31

CXR before start U&Es, LFTs, FBCs, creatinine every week until stable for 6 Then monthly x 3 Then every 3 months

Question 32

Which antibiotic do you not give to someone on Methotrexate? | Why?

Answer 32

Trimethoprim Both are anti-folates

Question 33

When do you use Hydroxychloroquine?

Answer 33

Combo in RA SLE (skin involvement) Safe in pregnancy

Question 34

How do you monitor someone on Hydroxychloroquine?

Answer 34

Yearly eye tests | Causes Maculopathy

Question 35

Side effects of Hydroxychloroquine?

Answer 35

Tinnitus Blurred Vision Headaches Hair Loss

Question 36

What is Sulpha/Mesalazine?

Answer 36

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

Question 37

When do you use Sulpha/Mesalazine?

Answer 37

IBD RA PA

Question 38

What are the side effects of Sulpha/Mesalazine?

Answer 38

Temporary Azospermia Hepatitis Rash GI

Question 39

How do you monitor Sulpha/Mesalazine?

Answer 39

Same as methotrexate | FBC, U&Es, LFTs, eGFR

Question 40

Contraindications to Sulpha/Mesalazine?

Answer 40

Allergy to Aspirin

Question 41

Name some anti-TNFs?

Answer 41

Humira Adalimumab Infliximab Etanocept

Question 42

When can you use anti-TNFs

Answer 42

2 x DAS28 of 5 or more | RA after trying 2 DMARDs

Question 43

What are the bad bits about anti-TNFs?

Answer 43

Expensive Parenteral Hypersensitivity reactions Infections

Question 44

What are some Biological agents? | How do they work?

Answer 44

Rituximab | Inhibits B cells

Question 45

When do you use biologics?

Answer 45

When very severe and all other therapy failed | SLE, vasculitis, DMS, RA

Question 46

Side effects of Biologics?

Answer 46

Infection (low B Cells) Wheeze Progressive multifocal leukoencephalopathy

Question 47

CI to Biological therapy?

Answer 47

Current Infection | Immunosuppressed state