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Flashcards in DMARDs Deck (18):
1

What are the general features of DMARDs?

➢ Slow acting - weeks to months
➢ Pure anti-inflammatory with no direct analgesic effect
➢ Improve standard laboratory tests of inflammation e.g.ESR, CRP
➢ Reduce rate of joint damage
➢ Most need regular monitoring for adverse effects

2

Methotrexate:
-what is this
-how can this be used
-what conditions is this used in?

➢ Mode of action unknown
➢ Folate antagonist
➢ First choice DMARD in most patients
➢ Can be given orally or subcutaneously
➢ Often used in combination
➢ Used in RA, Psoriatic arthritis, Connective Tissue Disease and Vasculitis

3

What are the adverse effects of methotrexate?

➢ Leucopenia / thrombocytopenia
➢ Hepatitis / cirrhosis (alcohol intake must be limited)
➢ Pneumonitis (dont give in pulmonary fibrosis or existing lung conditions)
➢ Rash / mouth ulcers
➢ Nausea / diarrhoea (can give an injection to lessen this)
➢ Needs monitoring of FBC and LFTs
➢ Teratogenic. Must be stopped in males and females at least 3 months before conception

4

Sulphasalazine: when is this used?
-what is it?

➢ An azo ester of sulfapyridine and 5-aminosalicylic acid
➢ Mode of action unknown
➢ Often used in combination with methotrexate in early inflammatory arthritis

If methotrexate hasn’t worked or can’t be tolerated use this

5

What are the adverse effects of sulphasalazine?

➢ Nausea
➢ Rash / mouth ulcers
➢ Neutropenia
➢ Hepatitis
➢ Reversible oligozoospermia
➢ Monitoring of FBC and LFTs

6

When is hydroxychloroquine used?

➢ No effect on joint damage
➢ Used in connective tissue disease such as SLE (helps skin, joints and general malaise) Sjogren’s syndrome and RA

7

What is the adverse effects of hydroxychloroquine?

➢ Retinopathy - recognised but rare

This doesn’t suppress immune system so don’t use in psoriatic arthritis = flare up

8

What is the side effects of leflunomide?

hepatotoxicity
myelotoxicitiy
hypertension

9

What are the side effects of gold salts?

hypersensitivity reactions
nephritis
fibrosing alveolitis

10

what are the cautions of anti-TNF drugs?

➢ Major risk of infection (esp TB)
➢ Question over risk of malignancy (esp skin cancer)
➢ Contraindicated in certain situations e.g. pulmonary fibrosis, heart failure

Strict criteria for use:
➢ High disease activity score
➢ Use of previous standard DMARDs

11

What are the side effects of colchicine?

-diarrhoea and vomiting
-moderate doses
-can be given in a low dose for 6mths

12

What are the cautions of allopurinol

➢ Rapid reduction in uric acid level may result in exacerbation of gout - do not commence during acute attacks, always co-prescribe anti-inflammatory for first few weeks

Caution
➢ Rash (vasculitis) commoner in elderly and in renal impairment, therefore use lower doses
➢ Azathioprine interaction
➢ May inhibit warfarin metabolism
➢ Rarely marrow aplasia

13

When is febuzostat used? what are the cautions?

➢ Those who cannot tolerate allopurinol
➢ Renal impairment
➢ Used with caution in patents with ischaemic heart disease

14

Which antirheumatic drugs should be discontinued 3 mths before pregnanct?

methotrexate

15

Which antirheumatic drugs should be discontinuedwhen planning pregnancy and washout before pregnancy?

leflunomide

16

Which antirheumatic drugs should be discontinued 10 weeks before pregnanct?

abatacept

17

Which antirheumatic drugs should be discontinued 12 mths before pregnanct?

rituximab

18

Which antirheumatic drugs should be discontinued at missed period or after a positive pregnancy test?

Infliximab
Etanercept
Adalimumab
bisphosphonates