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50 Cards in this Set
- Front
- Back
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dihydrofolate reductase inhibitor - interrupts purine biosynthesis
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methotrexate
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reduced IgM - rheumatoid factor production
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methotrexate
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reduced polymorphonuclear chemotaxis
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methotrexate
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dose-dependant absorption
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methotrexate
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drugs which cause stomatitis
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methotrexate and gold
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how to avoid methotrexate-induced dyspepsia
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take with food or split the dose
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onset of methotrexate
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6-8 weeks
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explain hepatotoxicity of methotrexate
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a transient elevation of LFTs usually just during the first few days of tx
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what should you do if your patient is on methotrexate and presents with SOB, cough, fever...
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d/c and begin steroids; 17% can die from pulmonary adrs
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nsaid / methotrexate drug interaction (explain)
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nsaids elevate methotrexate levels by competing for renal elimination
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why to use caution with parenteral methotrexate
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anaphylaxis (uncommon with po tx)
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when to do a cxr or pfts with a patient on mtx
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only when pt is symptomatic
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mtx should be supplemented with __ for a 50% reduction in adrs (gi and lfts)
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folic acid, 1 mg po qday
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histamine antagonist
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hydroxychloroquine
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has antiserotonin effects
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hydroxychloroquine
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inhibits prostaglandins and chemotaxis
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hydroxychloroquine
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onset of hydroxychloroquine
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2-4 months
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hydroxychloroquine's place in RA tx
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hydroxychloroquine is for mild cases of RA or for use in combo with something else
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how hydroxychloroquine causes retinopathies
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it concentrates in the retina
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hydroxychloroquine / retinopathy risk factors
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age > 60, dose > 6 mg/kg/day, tx > 10 years
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patients on hydroxychloroquine should get an eye exam every...
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3-6 months
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how hydroxychloroquine causes blurred vision
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won't allow eye to accomodate or see distances
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may cause bleaching of hair or blue-black skin discolorations
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hydroxychloroquine
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can cause psoriasis (usually RA meds can tx this!)
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hydroxychloroquine
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how hydroxychloroquine interacts with dig
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increased digoxin levels
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why you can't use hydroxychloroquine and gold / phenylbutazone
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increased incidence of rash
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wait __ until d/c from no effect with hydroxychloroquine
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8 months
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chelating agent
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penicillamine
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inhibits collagen formation and can therefore cause wrinkles
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penicillamine
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depresses t-cell but NOT b-cell activity
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penicillamine
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depolymerizes some macroglobulins (rheumatoid factors)
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penicillamine
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has 30% of unknown elimination
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penicillamine
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penicillamine's place in RA tx
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refractory patients
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onset of penicillamine
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1-3 months
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penicillamine works the best on
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scleroderma
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can be used to tx Wilson's disease
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penicillamine - chelated copper in the body
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33% will experience allergic reaction
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penicillamine
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explain why pts on penicillamine should be adherent to tx
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allergic reactions occur with increased incidence when tx is interrupted
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most common rash associated with penicillamine
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early rash
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seen with penicillamine during first 6 months of tx, general, red, itchy, all over body
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early rash
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tx for early rash
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d/c, antihistamines, steroids; start lower and titrate slowly... may not happen again
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seen with penicillamine after first 6 months fo tx; scaly, extremely itchy, concentrated on trunk
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late rash
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tx for late rash
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won't respond to tx; do not rechallenge with penicillamine... 100% will get rash again, takes weeks / months to resolve
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increased friability of the skin
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penicillamine
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treatment for oral ulcers seen with penicillamine
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decrease the dose
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how to admin supplement with penicillamine
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admin iron to overcome anemia; stagger dose (chelater)
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treatment for n/v/d with penicillamine
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decrease the dose
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can cause lack of taste for sweet / salty foods or a metallic taste in mouth
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penicillamine
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can rarely see myasthenia gravis
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penicillamine
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drug interaction with penicillamine and gold / phenylbutazone
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decreased renal function
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