clinical pharmacology of rheumatology Flashcards
(27 cards)
drugs used in inflammatory arthritis can be classified as either
symptoms relieving drugs or disease modifiers
symptoms relieving drugs used
- paracetamol
- NSAIDS
- opiate compounds
- atypical analgesics
disease modifiers can be divided into
DMARDS and biologics
DMARDS used
methotrexate, sulfasalazine, azathioprine
biologics used
anti-TNF, rituximab, ustekinumab, secukinimab
paracetamol
- purely analgesic with little anti-inflammatory action
- very well tolerated at therapeutic doses and safe in pregnancy
- but very dangerous in overdose, the antidote is acetylcysteine
NSAIDS
- have both analgesic and anti-inflammatory affect
- good for short term use but not long term due to their side effects
adverse effects of NSAIDS
- dyspepsia
- oesophagitis and gastritis
- peptic ulceration
- small intestine ulceration
- renal impairment
- fluid retention
- wheeze in aspirin sensitivity asthma
methotrexate
- can be given orally or subcutaneously
- methotrexate is a folate antagonist so everyone being prescribed it must be given folic acid supplements
adverse effects of methotrexate
- leucopenia and thrombocytopenia
- pneumonitis
- drug induced hepatitis/ cirrhosis
- rash/ mouth ulcers
- nausea and diarrhoea
- needs regular FBC and LFT monitoring
whats the issue with methotrexate especially in females
its teratogenic so if a female wants to become pregnant they must be taking off it 3 months prior to conception and they must never become pregnant until this point so require 2 forms of contraception
sulfasalizine adverse affects
- cause
- stephen johnson syndrome
- neutropenia
- hepatitis
- reversible reduction in male sperm count called oligozoosermia
- colours body fluids yellow
whats a plus of sulfasalazine
its completely safe to use in pregnancy
hydroxychloquine
pretty well tolerated but it does exacerbate psoriasis and a rare complication is retinopathy which is irreversible
anti-tnf biologic examples
infliximab, adalimumab, etanercept
What are anti-TNF drugs licensed for use in
rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis
whats the criteria for prescribing a biological agent in rheumatoid arthritis
patient must have tried at least 2 DMARDS (one being methotrexate) for at least 6 months and the DAS28 scoring system must be greater than 5.1 on 2 occasions 4 weeks apart
adverse affects of anti-TNF treatment
- reactivation of latent tuberculosis
- contra-indicated in people with pulmonary fibrosis and heart failure
- thought to increase risk of skin cancer
other biological agents
- rituximab used in SLE, polymyositis and dermatomyositis)
- ustekinimab and secukinimab used exclusively in psoriatic arthritis that fails to respond to anti-TNF treatment
rituximab targets
B cells
ustekinumab targets
IL-12 and IL-23
Secukinimab targets
IL-17
allopurinol
never ever give in acute attacks of gout as the rapid reduction in uric acid levels can exacerbate gout
adverse effects of allopurinol
- drug induced vasculitis mainly in the elderly and those with renal impairment (so use at a lower dose)
- NEVER EVER GIVE ALLOPURINOL TO SOMEONE ON AZATHIOPRINE IT CUASES AN IRREVERSIBLE BONE MARROW SUPPRESSION
