Drugs

Question 1

Do DMARDs have any analgesic effect?

Answer 1

No

Question 2

What blood tests should always be checked in a person taking methotrexate?

Answer 2

FBC, U&Es, LFTs

Question 3

Due to a risk of bone marrow suppression, what drug should not be prescribed alongside methotrexate?

Answer 3

Trimethoprim (+ co-trimoxazole)

Question 4

What is the advice regarding methotrexate and pregnancy?

Answer 4

Must be stopped at least 6 months prior to conception in both males and females

Question 5

As well as increased risk of infection, what are some other general side effects of biologics?

Answer 5

Increased risk of cancers (especially melanoma) and exacerbation of heart failure

Question 6

How can steroids be given?

Answer 6

Oral, IV, IM or IA

Question 7

In rheumatoid arthritis, patients must have a DAS28 score of greater than what to qualify for treatment with biologics?

Answer 7

> 5.1

Question 8

Pneumonitis and pulmonary fibrosis can occur as a side effect of which DMARD?

Answer 8

Methotrexate

Question 9

How long does it typically take for DMARDs to start to work? For this reason, what should always be co-prescribed?

Answer 9

2-3 months, so steroids should always be prescribed alongside them to cover against inflammation in this time

Question 10

Name two DMARDs which are safe to use in pregnancy?

Answer 10

Sulfasalazine and hydroxychloroquine

Question 11

What should always be prescribed alongside steroids if they are going to be given long term?

Answer 11

Calcium and vitamin D supplements

Question 12

Stevens-Johnsons syndrome is a side effect of which DMARD?

Answer 12

Sulfasalazine

Question 13

Which DMARD can result in coloured tears and stained contact lenses?

Answer 13

Sulfasalazine

Question 14

Name some examples of TNF inhibitors?

Answer 14

Infliximab, adalimumab, etanercept

Question 15

NSAIDs should be relatively contra-indicated in individuals with which other condition?

Answer 15

Asthma

Question 16

What is the mechanism of action of rituximab?

Answer 16

Anti-CD20, resulting in B cell depletion

Question 17

What is the target serum urate level? What dose can allopurinol be given up to to reach this target?

Answer 17

Below 300 - allopurinol can be given up to 900mg

Question 18

What must always be co-prescribed alongside methotrexate?

Answer 18

Folic acid (5mg once weekly)

Question 19

How can methotrexate be given? How often is it given?

Answer 19

Usually given once weekly either orally or subcutaneously

Question 20

When should febuxostat be used instead of allopurinol in the chronic treatment of gout?

Answer 20

In patients with renal failure

Question 21

In terms of rheumatology, who are biologics indicated in?

Answer 21

Those who have failed to respond to treatment with at least two DMARDs, one of which must have been methotrexate

Question 22

What is a common side effect of colchicine?

Answer 22

Diarrhoea

Question 23

What is the first line DMARD for inflammatory arthropathies?

Answer 23

Methotrexate

Question 24

Retinopathy, potentially leading to blindness, is a serious side effect of which DMARD?

Answer 24

Hydroxychloroquine

Question 25

What lifestyle advice is particularly important to give people starting on methotrexate, due to one of its most severe side effects?

Answer 25

Cut down alcohol intake as this medication is hepatotoxic

Question 26

When should DMARDs be started for the best therapeutic effect?

Answer 26

Within 3 months of symptom onset

Question 27

As with all immunosuppressants, biologics come with a risk of infection. However, which one in particular? And what should be done to minimise this risk?

Answer 27

TB (reactivation of the latent form) - screen patients for this before starting the drug

Question 28

Most TNF inhibitors are given subcutaneously. Which is given as an IV injection?

Answer 28

Infliximab

Question 29

What is usually the second line DMARD if methotrexate is not tolerated?

Answer 29

Leflunomide

Question 30

When should colchicine be used instead of NSAIDs in the acute treatment of gout?

Answer 30

In those with renal failure, asthma, peptic ulceration or any other reason for NSAIDs to be contra-indicated

Question 31

If a patient on methotrexate for rheumatoid arthritis is planning a pregnancy, what are some alternative medicines which could be used?

Answer 31

Sulphasalazine, or a biologic if the criteria is met

Question 32

What drug must not be taken alongside allopurinol and why?

Answer 32

Azathioprine- risk of irreversible bone marrow suppression

Question 33

What drug class should not be given in enteropathic arthritis as they can worsen the condition?

Answer 33

NSAIDs

Question 34

If a patient who is taking leflunomide wants to get pregnant, what must happen first and why?

Answer 34

A wash out, since leflunomide has a half life of around 2 years

Question 35

Temporary oligozoospermia is a side effect of which DMARD?

Answer 35

Sulfasalazine

Question 36

What is usually the first line DMARD in connective tissue diseases?

Answer 36

Hydroxychloroquine

Question 37

Are biologics safe to use in pregnancy?

Answer 37

Yes

Question 38

If an immunosuppressant is required in SLE, what is usually the drug of choice?

Answer 38

Cyclophosphamide

Question 39

What drug should always be co-prescribed alongside cyclophosphamide and why?

Answer 39

Co-trimoxazole as prophylaxis against pneumocystis pneumonia

Question 40

Patients with a documented allergy to co-trimoxazole should not be prescribed which DMARD?

Answer 40

Sulfasalazine

Question 41

The concurrent use of methotrexate and which antibiotic may cause bone marrow suppression and severe or fatal pancytopenia?

Answer 41

Trimethoprim

Question 42

Is azathioprine safe to use in pregnancy?

Answer 42

Yes

Question 43

Patients who are allergic to aspirin may react to which DMARD also?

Answer 43

Sulfasalazine