Rheumatology Treatments Flashcards
What is methotrexates mode of action
Suppressing the immune system
Reducing inflammation
How often do you take methotrexate
Once a week, at the same time every week
What must you prescribe with methotrexate
Folic acid
Taken three days apart from methotrexate
How do you monitor methotrexate
U and E
Liver function
FBC before you start
Then 2-3 weeks
Then 2 monthly
What are the side effects of methotrexate?
- Sore throat
2. GI upset
What are the warnings about methotrexate?
- Suppresses the immune system, which leaves you at high risk of infection.
* If you feel unwell, have a fever* go to doctor - Liver toxicity
* If you get nausea and vomitting* go to A and E - Lung toxicity
* Breathlessness* go to A and E
Who should not be prescribed methotrexate?
Women of child bearing age / pregnant
Severe renal impairment
Severe liver impairment
What advice would you give patients taking methotrexate?
Drink as little as possible
Name DMARDS available
Sulphasalizine
Hydroxycholochine
Methotrexate
When do you prescribe allopurinol?
- More than 2 gout attacks a year
- 1 gout attack + high risk factors
high risk factors : renal impairment, long term diuretic use, tophi present
What should you prescribe with allopurinol?
Naproxen or colchicine for a least one month to prevent gout attacks
What is second line if allopurinol is contra indicated?
febuxostat
How long do patients take allopurinol for?
Life long
What must you warn patients of when you prescribe allopurinol?
They may get attacks of gout in the first few weeks. This is why we also prescribe an NSAID
What is the most common bisphosphonate?
Alendronic acid
