MSR Pharm Cases Flashcards
(44 cards)
Your patient has RA. What is your first line DOC?
Methotrexate (Rheumatrix); one pill weekly
When prescribing methotrexate, what must you also prescribe?
Folic Acid (5mg weekly)
What are the special instructions for Rxing methotrexate and folic acid together?
Folic acid must not be taken on the same day as methotrexate; take it the day after.
How long does it take for methotrexate to respond initially and respond fully?
initially - 3-4 weeks; fully - 3-6 months
What is methotrexate’s PG category?
X
What is the one thing you should definitely be sure to monitor when Rxing methotrexate?
CXR - both before and after treatment (side effect of pulmonary fibrosis)
What can you use as a “bridge therapy” while waiting for any RA DMARD to kick in?
Non-steroidals (e.g. ibuprofen) unless contraindicated. If contraindicated, can put on short-term (one month) steroid (prednisone) use.
Your RA patient is unresponsive to methotrexate. What is your next line of therapy?
Add a non-biologic DMARD to therapy. (In our class example, we prescribed Etanercept [Enbrel] because the pt had CKD and COPD)
Which drug would you use for a patient who is trying to manage RA?
Sulfasalazine (Azulfidine) unless sulfa allergy
Are you going to crush this exam?
You’re damn right!
What is the major side effect that we must monitor with hydroxychloroquine (Plaquinil)?
It is bound in melanin-containing tissues like the eyes. Must get ophthmology f/u every 6-12 months. Recommended eye exams every 4-6 weeks.
Your pt. is on Etanercept (Enbrel) and presents with a raging fever and joint problems. What could be going on, and what should you do?
She probably has an infection. DMARDS are C/I for people with infections, so you need to stop the DMARD. Biologic DMARDS are known to reactivate sepsis, hepatitis, and lymphoma, so screen for these conditions.
An elderly woman with glaucoma has chronic rhinorrhea. What is it and how to you treat?
Woahhhh let’s take it back to summer! Vasomotor rhinorrhea - treat with cromolyn sodium because it’s the only NS not C/I for glaucoma.
Pt. is having first episode of acute gout. How do you treat?
NSAIDs around the clock for about a week.
Your patient has a stomach ulcer and cannot be put on an NSAID for his first episode of gout. What is your next step?
Colchicine
What side effect can your patient expect to see with colchicine?
Abdominal pain/diarrhea (80%)
Your patient has had 3 episodes of gout in the last year and is sick of it. What should you do for him?
Put him on a prophylactic med for gout - allopurinol (Zyloprim)
What drugs predispose you to gout?
Thiazide diuretics, HCTZ, aspirin, niacin - all increase uric acid levels
If you have kidney stones, which gout medication are you not indicated to use? Why?
The uricosurics like Probenecid (Benemid). This blocks proximal convoluted tubule reabsorption of uric acid, thus increasing risk for kidney stones.
Your patient is currently on Lisinopril (an ace-inhibitor). He is having recurring episodes of gout, so you want to prescribe him allopurinol. What do you need to be aware of?
Allergic reaction with these 2 meds may occur. Changing his HTN med alone may decrease his uric acid level.
Your patient has arthralgias. Sure, you COULD prescribe an NSAID, but what OTC medication is just as effective?
OTC oral analgesics
Your patient has OA and frequent GI bleeds. What can you prescribe her for her OA?
NOT NSAIDS. Rx acetaminophen instead. If that doesn’t work, try Tramadol If you MUST rx an nsaid, then Celebrex has a lower risk of GI bleeds
If you prescribe an NSAID, how long can you expect for anti-inflammatory relief?
2-3 weeks
What lifestyle modifications can you make to reduce your chances of getting gout?
Avoid alcohol, purine-rich foods like red meat
