dosing

Question 1

celecoxib dose acute & prophylaxis

Answer 1

acute: 400mg LD -> 200mg
200mg BD (5-7d, until sx resolve)

Prophylaxis: 200mg OD

Question 2

CS prednisolone dose acute & prophylaxis

Answer 2

• acute: 30-40mg OD (or divide to 2 dose), 2-5d until sx resolve
• Prophylaxis: 5-7.5mg OD

Question 3

CS prednisolone taper

Answer 3

• Taper by half dose over 7d (discontinue)
  
  • (weight) 0.5mg/kg OD 2-5 d –> taper

Question 4

colchicine dose (acute flares)

Answer 4

max 1.5mg/day
* 1mg LD –> 0.5 mg 1hr later
* OR 0.5mg BD-TDS

Question 5

colchicine prophylaxis dose

Answer 5

adjunct with ULT:
0.5mg OD/ BD (max 1.2mg/day)

If flare up occurs: incr dose to acute flare dose

Question 6

allopurinol dose initiate and titrate

Answer 6

• Initiate: ≤100mg/day
  
  • CKD stage ≥3, <50ml/min: ≤50mg/day
• Titrate: 50-100mg incr every 2-8wks
  
  • Monitor SU, clinical resp (dose adj to target), drug toxicity SCAR

Question 7

allopurinol maintain and max dose

Answer 7

• maintain: > 300mg/day

Max 800/day

Question 8

febuxostat dose

Answer 8

40-80mg OD

Initiate: ≤40mg/day
Titrate: 80mg/day
If target not met after 2-4 wks

Question 9

probenecid dose

Answer 9

• Initiate: 250mg BD 1wk –> 500mg BD
• Titrate: 500mg every 4wks
  
  • As tolerates, to reach target
• Maintain: ≤2g/day

500-3000mg/ day

Question 10

PO bisphosphonate dose

Answer 10

alendronate: 70mg once per week (same day)

risendronate: once a mth
(5yrs)

Question 11

bispho IV dose

Answer 11

Zoledronic acid (IV: 5mg 30min infusion per yr)
Once a yr (15-30mins via cannula vein)

(3yrs)

Question 12

romosozumab DOA

Answer 12

SC inj (once a mnth)
- Fatty tissue of abdomen

USED FOR 12MNTHS (1 yr)

Question 13

denosumab DOA

Answer 13

SC inj every 6mnths
- Fatty tissue of abdomen

+ 1000mg Ca + (=/> 400 IU vit D) daily

Question 14

raloxifene dose

Answer 14

raloxifene (60mg OD)

Question 15

calcitonin

Answer 15

Inj (IV, SC, IM), nasal spray

Question 16

teriparatide

Answer 16

SC inj 20mcg OD
- Fatty tissue of abdomen
MAX DURATION 24MNTHS in lifetime (2yrs)
Longer tx incr risk of osteosarcomas (mice)

Question 17

vit D range

Answer 17

≥ 20-30ng/mL (800-1200IU)
and
≤ 50-100ng/mL (4000IU)

Question 18

vit D daily intake

Answer 18

600IU/d (51-70yo)
800IU/d (>70yo)

Question 19

vit D suppl dose

Answer 19

600-800IU/day cholecalciferol

Question 20

vit D DDI

Answer 20

decr vit D: rifampicin, anticonvulsants (PT, VA, CBP)

cholestyramine, orlistat (binds to fat, vit D is fat soluble) = SPACE OUT

Al containing pdts

Question 21

Ca normal range

Answer 21

> 2.2-2.7 mmol/L

Question 22

Ca daily intake

Answer 22

1000 mg/day (>51yo)
800mg/day (19-51yo)

Indication: give suppl if dietary < 700 mg/day

Question 23

vit Ca DDI

Answer 23

• Decr Ca absorption (incr pH): PPI, high fibre diet
• Decr other drug absorption: Fe, tetracycline, FQ, bisphosphonate, thyroid suppl.
  = Space apart from bisphophonate!!

Question 24

MTX dose

Answer 24

initiate 7.5mg once weeklu

titrate: 2.5-5mg/wkly (every 4-12wks based on resp)

TARGET: 15mg/day (within 4-6wks of initiate)
max: 25mg/wk

Question 25

MTX dose adj

Answer 25

crcl < 30ml/min (<50ml = 50% dose) pre-exist liver disease/ AST/ALT > 3X ULN (75% dose)

Question 26

folic acid dose

Answer 26

5mg/ wk

Question 27

add CS with DMARD bridge

Answer 27

7.5mg mg/d up to 3mnths * taper and discont within 3mnths

Question 28

dose adj for csDMARD

Answer 28

MTX adj for renal (<50ml/min, AVOID in <30) and liver sulfa adj for renal < 60ml/min hydroxychloroquine no adj, caution leflunomide adj for liver (AVOID ALT >2xULN)

Question 29

ROA for bDMARD

Answer 29

* anti-TNF (infliximab (IV), adalimumab (SC), etanercept (SC)) * IL1R antagonist: Anakinra (SC) * Anti CTLA4 IG: Abatacept (IV, sc) * Anti-CD20: rituximab (IV) * Anti-IL6 receptor mAb: tocilizumab (IV) * JAKi tofacitinib (PO)

Question 30

naproxen dose

Answer 30

More effective in women (Fu >40%, lower dose more potent) T1/2: 12-14hrs Indication: dysmenorrhea, MSK * LD: 220-500mg * Maintain: 220-250mg tab Q8H – Q12h * max 750mg/d

Question 31

indomethacin

Answer 31

Strongly anti-inflamm due to additional steroid-like Phospholipase A inhibition * indication: gout * ADR: 15-25% report confusion, depression, psychosis, hallucination also occur

Question 32

diclofenac

Answer 32

Short plasma t1/2: < 2hr Indication: MSK (RA, OA). Accumulates in synovial fluid, longer t1/2 * ADR: low GI risk

Question 33

celecoxib dose acute pain

Answer 33

400mg initial, 200mg later 12h 200mg BD prn

Question 34

paracetamol dose

Answer 34

500mg-1g QDS (narrow TI for liver toxicity)

Question 35

paracetamol monitor what dose - Can lead to liver damage

Answer 35

- Refer =/> 10g / 24hr to ED - Incr risk of harm with doses =/> 4g/ 24hr

Question 36

tramadol dose mod-severe pain

Answer 36

acute pain * initiate 50mg q4-6h~ 100mg * max 400mg/d chronic pain * initiate 25-50mg q6h ~ 100mg * max 400mg/d

Question 37

* TNFa * IL6i * IL1RA * anti CD20 * anti CTLA4

Answer 37

* TNFa * infliximab * etanercept * adalimumab * IL6i * tocilizumab * IL1RA * anakinra * anti CD20 * rituximab * anti CTLA4 * abatacept

Question 38

methotrexate caution, ci

Answer 38

caution: CRCL < 30 (avoid) >3x ULN CI: PREEXISTING LIVER DISEASE immunodef syndrome blood dyscrasia teroteogenic

Question 39

methotrexate DDI

Answer 39

NSAID, COX2i PPI probenecid vaccines alcohol

Question 40

sulfasalazine cautions and CI

Answer 40

caution (<60ml/min) CI: sulfonamide allergies, G6PD def

Question 41

sulfasalazine ddi

Answer 41

Fe, Abx, warfarin

Question 42

hydroxychloroquine cautions and CI

Answer 42

CI: pre-existing retinopathy

Question 43

hydroxychloroquine DDI

Answer 43

CYP2C9i: cimetidine QT prolong: ciprofloxacin

Question 44

leflunomide cautions and CI

Answer 44

caution: x2 ULN CI: pre-exist liver disease immunodef state

Question 45

leflunomide DDI

Answer 45

cholestyramine charcoal, warfarin, vaccine, alcohol