Week 2 - C - Rheumatoid drug side effects

Question 1

What is the treatment stages of rheumatoid arthritis?

Answer 1

NSAID + steroid Add DMARD 1,2,3

Question 2

What is the first disease modifying rheumatoid arthritic drug (DMARD)?

What should be given with this?

Answer 2

Methotrexate

Folic acid 5mg once weekly should be co-prescribed

Question 3

What is DMARD 2 and 3?

Answer 3

DMARD 2 - sulfasalazine
DMARD 3 - Hydroxychloroquine

Question 4

What criteria is used for the diagnosis of rheumtoid arthritis and what is the score for defininte arthritis?

Answer 4

ACR and Eular score
Greater than or equal to 6 is definite rheumatoid arthritis

Question 5

What are the four different ACE and EULAR diagnosing criteria?

Answer 5

Number of joints involved
Antibodies (anti-CCP or RF) present
An acute phase reactant - CRP or ESr
Duration of symptoms - less or more than 6 weeks

Question 6

In rheumatoid treatment, drugs are added until the patient maintains remission What is the DAS 28 score for remission in rheumatoid arthritis?

Answer 6

The score for clinical remission is less than 2.6 on the DAS 28 score

Question 7

Name 3 NSAIDs?

Answer 7

Non-steroidal anti-inflammatory drugs
Diclofenac
Aspirin
Naproxen (ibuprofen)

Question 8

What are some of the presenting symptoms of side effects due to NSAIDs?

Answer 8

Anaemia
Peptic ulcer
Malaena (due to the upper GI bleed)

Question 9

What steroid is usually used in rheumatoid?

Answer 9

If intra-articular injections - methylprednisolone
If oral steroids - prednisolone

Question 10

What are side effects of steroids?

Answer 10

Steroids can cause increased osteoporosis - leading to increased risk of eg wedge fractures
Delay in wound healing
Striae
Bruising

Question 11

What are the two main causes of avascular necrosis of the femoral head?

Answer 11

Steroids and alcohol

Question 12

What is the side effects of methotrexate?

Answer 12

Can cause pneumonitis leading to pulmonary fibrosis
It is hepatotoxic
Teratogenic
Can also cause myelosuppresiion
Leukopenia and thrombocytopenia

Measure FBCs, LFTs and do a CXR

Question 13

When should both males and females be stopped from methotrexate before having a child?

Answer 13

Stop 6 months before conception and use the oral contraceptive pill for the 6 months

Question 14

Which DMARD is safe to be given during pregnancy?

Answer 14

Sulfasalazine is safe

Question 15

What are side effects of sulfasalzine?

Answer 15

Can cause a rash and ulcers
Can cause severe depression and temporary oligospermia

Question 16

Which rheumatoid drug can cause irreversible retinopathy?

Answer 16

Hydroxychloroquine - third line DMARD

Pre-treatment and annual eye screen therefore required

Question 17

Which 4 th line DMARD can cause interstitial lung disease?

Answer 17

Leflunomide

Question 18

What are the end stage drugs usualy given in very active (DAS 28) failing to achieve remission that all can cause a reactivation of TB?

Answer 18

Anti-TNF drugs eg adalumumab or inflixamab

Question 19

What is the criteria for prescribing anti-TNF drugs in rheumatoid arthritis?

Answer 19

The patinet must have a DAS28 score of greater than 5.1 so disease is highly active
Also must have failed to achieve remision whilst trying a ocmination of at least 2 previous DMARDs

Question 20

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Answer 20

1. F - diclofenac - NSAIDs are associated with upper GI bleeds which can cause anaemia and malaena
2. G - prednisolone - associated with factors such as osteoporosis which can increase the risk of wedge fractures
3. H - anti-malarial drug which can cause retinopathy (usually last line before Anti-TNF)

Question 21

Which rheumatoid drug can be used in the treatment of ulcerative colitis? (not stron enough for crohns)

Answer 21

5-ASA - Sulfasalazine

Question 22

Which two do prednisolone cause and which two do Hydroxychloroquine cause? Glaucoma Retinopathy Corneal deposits Cataracts

Answer 22

Prednisolone - glaucoma and cataracts
Hydroxychloroquine - retinopathy and corneal deposits

Question 23

Which of the Anti-TNF drugs is given IV? Adalimumab Certdizumab Infliximab Etanercept

Answer 23

Infliximab

Question 24

What are the side effects of hydroxychloroquine?

Answer 24

Irreversible retinopathy and corneal deposits

Question 25

What connective tissue disorders are hydroxychloroquine also used in?

Answer 25

given in connective tissue diseases such as SLE and sjorgens

Question 26

• Interstitial lung disease • Teratogenic • Hepatotoxic • Hypertension What is this?

Answer 26

Leflunomide

Question 27

Gold and penicillamine have the same adverse affects What are they?

Answer 27

Glomerulonephritis causing proteinuria
GI upset and anaemia

Question 28

What type of glomerulonephritis do gold and penicillamine tend to cause hence the proteinuria?

Answer 28

They causes membranous glomerulonephritis which is a cause of nephrotic syndrome

Question 29

What are side effects of anti-TNF therapy? When are they contra-indicated?

Answer 29

Side effects - reactivation of latent TB and potential skin cancer
Contraindicated in pulmonary fibrosis and heart failure

Question 30

Random question, which drug is given for a paracetamol overdose?

Answer 30

N-acetylcysteine