treatment of rheumatic disease Flashcards
what are the drugs used for the treatment of rheumatic disease ?
NSAIDs conventional DMARDS biological DMARDS corticosteroids immunosuppressive treatment
what is the mechanism of NSAIDs ?
inhibition of cox 1
so prevents the formation of prostaglandins
what are the side effects of NSAIDs?
1.GIT : dyspepsia
ulcers
bleeding and perforation
2. cardiovascular :
edema
HTN
Congestive heart failure
3. nephrotoxicitywhat are the drug interactions with NSAIDs?
warfarin and other anti coag anti platelets - aspirin ACE inhibitor ARB beta blocker ( almost all anti hypertensives) calcium channel blockers corticosteroids diuretics methotrexate digitalis
what are the indications for NSAIDs ?
inflammatory arthritis osteoarthritis gout and pseudo gout tendinitis pleurisy and pericarditis
what is the main mechanism of glucocorticoids ?
change inn gene expression
what are the different doses of glucocorticoids?
low : less than 7.5 mg prednisolone medium : 7.5 mg -30 Mg prednisolone high : 30mg - 100 mg prednisolone very high : more than n100 mg pulse :>250 mg pulse
what are the conventional DMARDs?
methotrexate
Leflunomide
hydroxychloroquine
Sulfasalazine
what is the mechanism of action of methotrexate ?
folate pathway antagonist by inhibiting DHFR
blocks the formation of purine
anti proliferative effect
what is the dosage of methotrexate ?
7.5 mg to 25 mg per week
what are the side effects of methotrexate ?
Nausea and vomiting
hepatic toxicity
megaloblastic anemia
pneumonitis
what can be given alongised methotrexate to lower the side effects ?
folic acid
when should methotrexate be avoided ?
should be avoided inn severe renal failure
pregnancy and lactation
when is methotrexate indicated ?
RA juvenile idiopathic arthiritis seronegative SPA Poly/dermatomyositis SLE ANCA associated vasculitis uveitis
what is the mechanism of leflunomide ?
inhibition of pyrimidine synthesis
what type of cells are affected by leflunomide ?
activated lymphocytes
what are the side effects of leflunomide ?
nausea vomiting teratogenic hepatotoxicity hypertension peripheral neuropathy
what are the indications for leflunomide ?
anything that is indicated for methotrexate
what is the mechanism of hydroxycholorquine ?
an anti malarial drug that increases the lysosomal pH
what is the dose of leflunomide ?
20 mg per day
what is the dose of hydroxycholorquine ?
5mg per kg per day
what are the indications for hydroxycholorquine ?
SLE
RA, palindromic rheumatism
antiphospholipid syndrome
sjorgen’s syndrome
what are the side effects of hydroxycholorquine ?
renal toxicity
skin hyper pigmentation
bleaching of the hair
myopathy 👴🏿
retinopathy - bulls eye appearance on fundoscopy
what is the dose for sulfasalazine ?
1-3 grams per day starting by 500mg and increased 500 mg every week
what are the indications for sulfasalazine ?
seronegative spondyloarthropies
RA
juvenile idiopathic arthiritis
what are the side effects of sulfasalazine ?
skin rashes hemolysis in patients with G6PD neutropenia azospermia pulmonary infiltrates hepatic enzyme elevation
what are the immunosuppressive agents ?
azathioprine
mycophenolate mofetil
cyclophosphamide
cyclosporine
what is the mechainsm of action of azathioprine ?
decreases purine levels
what is the risk with usage of azathioprine ?
myelosuppression
what are the indications for gout ?
SLE Behcets disease ANCA vasculitis polymyositis/dermatomyositis steroid sparing drug
what is the dose for azathiopurine ?
1-2.5mg/kg/day
what are the side effects of azathiopurine ?
bone marrow suppression infections especially herpes zoster hepatotoxicity nausea, vomiting skin rash hypersensitivity syndrome pancreatitis
what is hypersensitivity syndrome ?
fever
rash
hepatitis
renal failure
what are the indications for the use of methotrexate and lefulonomide in pregnancy ?
should bbee stopped 3 months before conceptioinn
how should lefulonmide washout be done ?
washout by cholestyramine
what are the contraindications to anti-TNF agents ?
active TB
interstitial pulmonary fibrosis
demyelinating disease
congestive heart failure
what must be done before starting anti-TNF therapy ?
tuberculin skin test
