Drugs for rheumatological disorders Flashcards
(32 cards)
What are corticosteroids used from?
Suppression of inflammatory or allergic disorders
- asthma and acute allergic reactions
- IBD and CAH
- Rheumatic disease - e.g. RA, SLE
- inflammatory renal disease
- immunosuppression in transplantation
- neurological disease
- cancer
What are the short term risks of corticosteroids?
Hypokalaemia Fluid retention Glucose intolerance Mood disturbance Hypertension
What are the long-term risks of corticosteroids?
Osteoporosis Diabetes and hypertension Accelerated atherosclerosis Increased infection risk, poor healing Steroid dependency Growth retardation
What monitoring should be done for corticosteroids?
High doses (≥40mg prednisone) - electrolytes, fluid balance, BP and glucose Low doses - BP and glucose
What can corticosteroids interact with?
Rifampicin Anti-diabetic therapy Anti-convulsants e.g. phenytoin Barbiturates Carbenoxalone
What are DMARDs used for?
Rheumatoid and seri-negative arthritis
Psoriasis (methotrexate)
Lupus (hydroxychloroquine)
IBD (sulfasalazine)
Give examples of DMARDs
Azathioprine Ciclosporin Cyclophosphamide Gold Hydroxychloroquine Leflunomide Methotrexate Mycophenolate mofetil Penicillamine Sulfasalazine
What is azathioprine used for?
Rheumatoid arthritis (psoriatic arthritis) SLE and vasculitis - Wegener's, PAN IBD and CAH Myasthenia Transplant patients
What monitoring is needed for azathioprine
FBC profile and urinalysis at 1, 2, 4 and 8 weeks then at 4-weekly intervals for 3 months
What does azathioprine react with?
Allopurinol
Rifampicin
What is cyclosporin?
fungal metabolite - suppresses cell-mediated (T-cell) immune response
What is cyclosporin used for?
Renal, liver, marrow, pancreas and heart transplant patients
Prophylaxis of graft vs host disease
Psoriasis and atopic dermatitis
Rheumatoid arthritis
What does cyclosporin react with?
Allopurinol Amiodarone Aminoglycosides, septrin Quinolones Colchine K+ sparing diuretics
What is cyclophosphamide used for?
Suppress inflammation and harmful antibody-production in patients with life-threatening ‘vasculitis’ illnesses e.g. SLE, Wegener’s, PAN
What does cyclophosphamide interact with?
Allopurinol
Suxamethonium
What are hydroxychloroquine and chloroquine?
Anti-malarials
What are the risks of hydroxychloroquine and chloroquine?
Ocular toxicity
What monitoring is needed with hydroxychloroquine and chloroquine?
Ocular examination before treatment, 6 months, 1 year then yearly
G6PD screening before treatment
What do hydroxychloroquine and chloroquine interact with?
Antacids Mefloquine Cardiac glycosides Cholinergics Cimetidine
What is chlorambucil used for?
Rheumatoid arthritis in severe disease
Vasculitis
Amyloid
Membranous nephritis
What is colchicine used for?
Gout
Behcet’s
Serositis
Why can’t colchicine be prescribed in the long term?
Nephrotoxic
What is thalidomide used for?
Behcet’s
SLE
What monitoring is needed with thalidomide?
6 monthly EMGs
Contraceptive advice
