rheumatology drugs Flashcards
(74 cards)
what is the hierachy of ra prescription with time
- methotrexate +steroid
- DMARD combination
- Anti-TNF
- Abatacept, rituximab, tocilizumab, anti TNF2
plus alongisde nsaid and analgesics, steroid injections either muscular or articular
what management needs to be considered with RA in pregnancy
- immuno most patients go into remission during pregnancy
- methotrexate and leflunomide discontinue 3 months prior
- nsaid and cox-2 can only be used up till last trimester
- steroids may be used but risk highbp, glucose intoler and osteop
what drugs must be avoided in pregnancy with RA 6 and when should they be discontinued
methotrexate 3 months mycophenylate 3 months leflunomide 2 years cyclophosphamide gold and penicillamine
what drugs must be avoided when breastfeeding with RA 7
methotrexate leflunomide cyclophosphamide ciclosporin azathioprine sulfasalzine hyrodxychloroquine
action of methotrexate
inhibits dna synthesis and cell divsion
maintenance dose of methot. also what is the iniital dose and how it increases
5-25mg week
-starts 7.5-10mg and increases every 2-4 weeks by 2.5mg
side effects of methot 6
gi upset, nausea and vomiting and malaise seen in first 24-48hrs stomatitis rash alopecia hepatoxicity acute pneumonitis
monitoring requirenments for methot and frequency
FBC AND LFT u and e
initially two weekly (ie every 2 weeks) until dose stable for 6 months,
then monthly for 12 months and
then every 3 months
maintenance and starting dose of sulfasalazine
2-4 grams daily
500mg initially
side effects of sulfasalazine 6
nausea, gi upset rash, hepatiits neutropenia pancytopenia
what drug must methot be given with (dose and when) and why
folic acid (5mg day after) as methot is a dihydrofolate reductase inhibitor
what is CI when on methotrexate and why for each 2
- sulphonamides (same pathway folic acid)
2. avoid excess alcohol as enhances methotrexate pneumonitis
what should be done if a patient develops methot pneumonitis
stop the methot and give high dose steroids instead
what needs to be monitored when on sulfasalazine and how often
fbc and lft
Monthly for the first 3 months, then every three months for the next 9 months,
then 6 monthly thereafter.
what should patients be warned about when on sulfasalazine
orange staining of urine and contact lenses
what is the dose for hydroxychloroquine
200-400mg daily
what are the SE of hydroxychloroquine 6
rash, nausea, diarrhoea, headache, corneal depositis, retinopathy
what monitoring and how often does it need to be done for Hydroxychloroquine
visual acuity and fundoscopy every 12 months
what dmards can be used in pregnancy 3
hydroxychloroquine
sulfasalasine and azathioprine but must be risk assessed first
mechanism of action of sulf and and hydroxy
unknown mechanism
Sulfasalazine is a 5ASA
what drugs can cause an abnormal LFT and at what level ALT should drug be stopped and started again
methot, sulf, leflunomide, mycophen, azathioprine
if ALT is twice the upper limit ie >100 and only continued when ALT below 50
what drugs can cause a reduce white blood cell count and at what levels of neutrophil and WCC should treatment be stopped
methot, sulfasalzine, mycophenylate, leflunomide, azathioprine
<1.5 neutrophils
<3 for WCC
What drugs cause a reduced platelet count and at what level should treatment stop
methotrexate, sulfasalazine, mycophenylate, leflunomide, azathioprine
100-150 stop treatment
if <100 then contact rheum
at what level eGFR should should DMARD be reduced by 50%
eGFR <50 that was not present when commenced on DMARD
