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PR3154 > MSK Dosing > Flashcards

MSK Dosing Flashcards

1
Q

What is the dosing of methotrexate?

Initiation dose, dose increment, target dose, max dose

A
  • Initiation: 7.5mg/w
  • Dose increment: ↑2.5-5mg/w every 4-12w, based on response
  • Target dose: 15mg/w within 4-6w of initiation
  • Max: 25mg/w
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2
Q

Does methotrexate require renal/ liver dose adjustments? What are the parameters?

A
  • AST/ALT >3xULN: 75% of dose
  • CrCl<50: 50% of dose
  • CrCL<30: avoid use
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3
Q

What is the dosing of sulfasalazine?

Initiation dose, dose increment, maintenance dose, max dose

A
  • Initiation: 500mg OD/BD
  • Dose increment: ↑500mg/w
  • Maintenance: 1g BD
  • Max: 3g/d
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4
Q

Does sulfalazine require renal/ liver dose adjustments? What are the parameters?

A
  • eGFR<60: initiate at lower dose
  • Dialysis: 250mg OD, up to 1g/d
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5
Q

What is the dosing of hydroquinolone?

Initiation dose, max dose

A
  • Initiation: 200-400mg daily in one/two divided doses
  • Max: 5mg/kg/d
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6
Q

Does hydroxychloroquine require renal/ liver dose adjustments? What are the parameters?

A

No adjustments required, use with caution

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7
Q

What is the dosing of leflunomide?

Optional loading, maintenance dose

A

Optional loading: 100mg/d x3d
Maintenance: 20mg/d

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8
Q

Does leflunomide require renal/ liver dose adjustments? What are the parameters?

A

ALT >2x ULN: avoid

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9
Q

What is the dosing of prednisolone?

A

≤ 7.5mg/d, up to 3m

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10
Q

What RA drugs are contraindicated in pregnancy?

A

Methotrexate, leflunomide

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11
Q

What RA drugs must be used in caution in G6PD deficiency?

A

Sulfasalazine, hydroxychloroquine

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12
Q

A 50yo female patient is newly diagnosed with RA of low disease activity. Patient does not have any other medical conditions. Doctor decided to initiate her on methotrexate. What dose should she be given?

A. 7.5mg OD
B. 7.5mg once a week
C. 7.5mg twice a week
D. 7.5mg once a month

A

B

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13
Q

A 65yo patient is newly diagnosed with RA. She also has moderate renal impairment (CrCl = 24ml/min). What medication and dose is most appropriate for her?

A. Methotrexate 7.5mg once a week
B. Methotrexate 3mg once a week
C. Sulfasalazine 250mg OD
D. Hydroquinolone 200mg OD
E. Leflunomide 20mg OD

A

E

Methotrexate: avoid in CrCl < 30
Sulfasalazine: though dose is already reduced from the usual 500mg OD, which is recoemmended for renal impairment, it is not the best choice
Hydroxychloroquine: metabolites are excreted unchanged in urine, so should be avoided in renal impairment
Leflunomide: majority is hepatically metabolised and even undergo enterohepatic circulation, there is no dose adjustments for renal impairment required. Hence out of the 4 drugs, it is the best option

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14
Q

What is the dosing of colchicine? Include normal and prophylaxis dose

A

Normal: 1mg loading dose + 0.5mg 1hr later OR 0.5mg BD/TDS until flare resolves
Prophylaxis: 0.5mg OD for 3-6m

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15
Q

Colchicine has risk of GI ADRs (N/V/D) at doses ________

A

> 1.5mg/d

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16
Q

What is the dosing of allupurinol?

Initiation, dose increment, maintenance, max

A
  • Initiation: ≤100mg/d, start w lower doses in CKD stage ≥3
  • Dose increment: ↑50-100mg every 2-8w
  • Maintenance: >300mg/d (ok in CKD)
  • Max: 800-900mg/d (normal renal function)
17
Q

What is the dosing of febuxostat?

Initiation, dose increment, max

A
  • Initiation: ≤40mg/d
  • Dose increment: increase up to 80mg/d if tx target not met after 2-4 weeks
  • Max: 80mg/d
18
Q

What is the dosing of probenecid?

Initiaiton, deose increment, maintenance

A
  • Initiation:; 250mg BD x1w, then 500mg BD
  • Dose increment: ↑500mg every 4w as tolerated
  • Maintenance: ≤2g/d
19
Q

Avoid probenecid if CrCl = ___________

A

CrCl<50ml/min

20
Q

What are the dosing and duration of the following drugs for prophylaxis of gout?
* Celecoxib
* Prednisolone
* Naproxen

A
  • Celecoxib 200mg OD for 3-6m
  • Prednisolone 5-7.5mg OD for 3-6m
  • Naproxen 550mg BD for 3 days (non-OTC)
21
Q

What is the dosing of riserdronate?

A

35mg per week

22
Q

What is the dosing of alendronate?

A

70mg per week

23
Q

What is the dosing of zoledronic acid?

A

5mg per year as 30-min IV infusion

Ensure adequate hydration before infusion

24
Q

How often is denosumab taken?

A

Once every 6m

25
Q

What is the dosing of raloxifene?

A

60mg OD

26
Q

What is the dosing of teriparatide?

A

20ug OD

27
Q

How often is romosozumab taken?

A

Once a month for 12 months

PR3154 (9 decks)

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