Week 2 - C - Rheumatoid drug side effects Flashcards
What is the treatment stages of rheumatoid arthritis?
NSAID + steroid Add DMARD 1,2,3
What is the first disease modifying rheumatoid arthritic drug (DMARD)?
What should be given with this?
Methotrexate
Folic acid 5mg once weekly should be co-prescribed
What is DMARD 2 and 3?
DMARD 2 - sulfasalazine
DMARD 3 - Hydroxychloroquine
What criteria is used for the diagnosis of rheumtoid arthritis and what is the score for defininte arthritis?
ACR and Eular score
Greater than or equal to 6 is definite rheumatoid arthritis
What are the four different ACE and EULAR diagnosing criteria?
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
In rheumatoid treatment, drugs are added until the patient maintains remission What is the DAS 28 score for remission in rheumatoid arthritis?
The score for clinical remission is less than 2.6 on the DAS 28 score
Name 3 NSAIDs?
Non-steroidal anti-inflammatory drugs
Diclofenac
Aspirin
Naproxen (ibuprofen)
What are some of the presenting symptoms of side effects due to NSAIDs?
Anaemia
Peptic ulcer
Malaena (due to the upper GI bleed)
What steroid is usually used in rheumatoid?
If intra-articular injections - methylprednisolone
If oral steroids - prednisolone
What are side effects of steroids?
Steroids can cause increased osteoporosis - leading to increased risk of eg wedge fractures
Delay in wound healing
Striae
Bruising
What are the two main causes of avascular necrosis of the femoral head?
Steroids and alcohol
What is the side effects of methotrexate?
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
When should both males and females be stopped from methotrexate before having a child?
Stop 6 months before conception and use the oral contraceptive pill for the 6 months
Which DMARD is safe to be given during pregnancy?
Sulfasalazine is safe
What are side effects of sulfasalzine?
Can cause a rash and ulcers
Can cause severe depression and temporary oligospermia
Which rheumatoid drug can cause irreversible retinopathy?
Hydroxychloroquine - third line DMARD
Pre-treatment and annual eye screen therefore required
Which 4 th line DMARD can cause interstitial lung disease?
Leflunomide
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?
Anti-TNF drugs eg adalumumab or inflixamab
What is the criteria for prescribing anti-TNF drugs in rheumatoid arthritis?
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
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- F - diclofenac - NSAIDs are associated with upper GI bleeds which can cause anaemia and malaena
- G - prednisolone - associated with factors such as osteoporosis which can increase the risk of wedge fractures
- H - anti-malarial drug which can cause retinopathy (usually last line before Anti-TNF)
Which rheumatoid drug can be used in the treatment of ulcerative colitis? (not stron enough for crohns)
5-ASA - Sulfasalazine
Which two do prednisolone cause and which two do Hydroxychloroquine cause? Glaucoma Retinopathy Corneal deposits Cataracts
Prednisolone - glaucoma and cataracts
Hydroxychloroquine - retinopathy and corneal deposits
Which of the Anti-TNF drugs is given IV? Adalimumab Certdizumab Infliximab Etanercept
Infliximab
What are the side effects of hydroxychloroquine?
Irreversible retinopathy and corneal deposits
What connective tissue disorders are hydroxychloroquine also used in?
given in connective tissue diseases such as SLE and sjorgens
• Interstitial lung disease • Teratogenic • Hepatotoxic • Hypertension What is this?
Leflunomide
Gold and penicillamine have the same adverse affects What are they?
Glomerulonephritis causing proteinuria
GI upset and anaemia
What type of glomerulonephritis do gold and penicillamine tend to cause hence the proteinuria?
They causes membranous glomerulonephritis which is a cause of nephrotic syndrome
What are side effects of anti-TNF therapy? When are they contra-indicated?
Side effects - reactivation of latent TB and potential skin cancer
Contraindicated in pulmonary fibrosis and heart failure
Random question, which drug is given for a paracetamol overdose?
N-acetylcysteine
