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
What is the indication for bisphosphonates?
Osteoporosis
How should you take alendronic acid?
Oral once a day
30 min before food and other tablets
dont lie down straight away to reduce oesophageal irritation
any side effects to allopurinol?
Rashes (allergic reaction)
How do you take bisphosphonates?
70mg oral daily
Side effects of bisphosphonates?
Oseophagitis
Rare complication of bisphosphonates
Necrosis of the jaw - you need to have good dental hygiene
Fracture neck of femur
Who cannot be given bisphosphonates?
Low calcium - must be corrected first
Severe renal impairment
Upper GI disorders impairs oral preperation
How must you monitor bisphosphonates?
Yearly DEXA scan
Check vitamin d and calcium levels before prescribing
When prescribing steriods, what may need to be prescribed along side them?
PPI - gastro protection from gastritis
Bisphosphonates - osteoporosis
How do we monitor steriods?
BP, BM and lipids must be monitored
Due to risk of hypertension, diabetes and hypercholestrolaemia
