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ICC2 > treatment of rheumatic disease > Flashcards

treatment of rheumatic disease Flashcards

1
Q

what are the drugs used for the treatment of rheumatic disease ?

A 
NSAIDs
conventional DMARDS
biological DMARDS 
corticosteroids 
immunosuppressive treatment
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2
Q

what is the mechanism of NSAIDs ?

A

inhibition of cox 1

so prevents the formation of prostaglandins

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3
Q

what are the side effects of NSAIDs?

A 
1.GIT : dyspepsia 
           ulcers
           bleeding and perforation 
2. cardiovascular :
           edema 
           HTN 
           Congestive heart failure 
3. nephrotoxicity
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4
Q

what are the drug interactions with NSAIDs?

A 
warfarin and other anti coag
anti platelets - aspirin
ACE inhibitor 
ARB 
beta blocker ( almost all anti hypertensives)
calcium channel blockers
corticosteroids 
diuretics 
methotrexate 
digitalis
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5
Q

what are the indications for NSAIDs ?

A 
inflammatory arthritis 
osteoarthritis 
gout and pseudo gout 
tendinitis 
pleurisy and pericarditis
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6
Q

what is the main mechanism of glucocorticoids ?

A

change inn gene expression

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7
Q

what are the different doses of glucocorticoids?

A 
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
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8
Q

what are the conventional DMARDs?

A

methotrexate
Leflunomide
hydroxychloroquine
Sulfasalazine

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9
Q

what is the mechanism of action of methotrexate ?

A

folate pathway antagonist by inhibiting DHFR
blocks the formation of purine
anti proliferative effect

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10
Q

what is the dosage of methotrexate ?

A

7.5 mg to 25 mg per week

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11
Q

what are the side effects of methotrexate ?

A

Nausea and vomiting
hepatic toxicity
megaloblastic anemia
pneumonitis

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12
Q

what can be given alongised methotrexate to lower the side effects ?

A

folic acid

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13
Q

when should methotrexate be avoided ?

A

should be avoided inn severe renal failure

pregnancy and lactation

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14
Q

when is methotrexate indicated ?

A 
RA 
juvenile idiopathic arthiritis 
seronegative SPA 
Poly/dermatomyositis 
SLE 
ANCA associated vasculitis 
uveitis
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15
Q

what is the mechanism of leflunomide ?

A

inhibition of pyrimidine synthesis

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16
Q

what type of cells are affected by leflunomide ?

A

activated lymphocytes

17
Q

what are the side effects of leflunomide ?

A 
nausea vomiting 
teratogenic 
hepatotoxicity 
hypertension 
peripheral neuropathy
18
Q

what are the indications for leflunomide ?

A

anything that is indicated for methotrexate

19
Q

what is the mechanism of hydroxycholorquine ?

A

an anti malarial drug that increases the lysosomal pH

20
Q

what is the dose of leflunomide ?

A

20 mg per day

21
Q

what is the dose of hydroxycholorquine ?

A

5mg per kg per day

22
Q

what are the indications for hydroxycholorquine ?

A

SLE
RA, palindromic rheumatism
antiphospholipid syndrome
sjorgen’s syndrome

23
Q

what are the side effects of hydroxycholorquine ?

A

renal toxicity
skin hyper pigmentation
bleaching of the hair
myopathy 👴🏿
retinopathy - bulls eye appearance on fundoscopy

24
Q

what is the dose for sulfasalazine ?

A

1-3 grams per day starting by 500mg and increased 500 mg every week

25
Q

what are the indications for sulfasalazine ?

A

seronegative spondyloarthropies
RA
juvenile idiopathic arthiritis

26
Q

what are the side effects of sulfasalazine ?

A 
skin rashes 
hemolysis in patients with G6PD
neutropenia 
azospermia 
pulmonary infiltrates 
hepatic enzyme elevation
27
Q

what are the immunosuppressive agents ?

A

azathioprine
mycophenolate mofetil
cyclophosphamide
cyclosporine

28
Q

what is the mechainsm of action of azathioprine ?

A

decreases purine levels

29
Q

what is the risk with usage of azathioprine ?

A

myelosuppression

30
Q

what are the indications for gout ?

A 
SLE 
Behcets disease 
ANCA vasculitis 
polymyositis/dermatomyositis 
steroid sparing drug
31
Q

what is the dose for azathiopurine ?

A

1-2.5mg/kg/day

32
Q

what are the side effects of azathiopurine ?

A 
bone marrow suppression 
infections especially herpes zoster 
hepatotoxicity 
nausea, vomiting 
skin rash 
hypersensitivity syndrome 
pancreatitis
33
Q

what is hypersensitivity syndrome ?

A

fever
rash
hepatitis
renal failure

34
Q

what are the indications for the use of methotrexate and lefulonomide in pregnancy ?

A

should bbee stopped 3 months before conceptioinn

35
Q

how should lefulonmide washout be done ?

A

washout by cholestyramine

36
Q

what are the contraindications to anti-TNF agents ?

A

active TB
interstitial pulmonary fibrosis
demyelinating disease
congestive heart failure

37
Q

what must be done before starting anti-TNF therapy ?

A

tuberculin skin test

ICC2 (42 decks)

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