RA drug monitoring
Hydroxychloroquine
- macular changes
Sulfasalazine
- myelosuppressiom LFT
MTX
- myelosuppression, LFT, pneumonitis, mouth ulcers
- folic acid
Leflunomide
- myelosuppression, LFT, diarrhoea
Biological side effects and screens
- TB
- viral hepatitis - can be treated but need to be treated
- shingles
- malignancy - stop smoking, skin checks, stop if malignancy confirmed
- demyelination’s conditions
- not teratotogenic
- usually continue medications straight through. Case by case zzz
Pregnancy and immunosuppression
Should ensure no active disease
Check guidelines
No MTX or leflunamide
Biological generally ok
SLE key features
Cutaneous Renal Raynauds Arthritis Serositis Haematological Oral ulcers Alopecia
SLE antibodies
ANA titre > 1:80
Antiphospholipid antibodies
Low complement levels
Specific
Anti- dsDNA
Anti- smith
SLE drugs
HCQ
Vit D
For all^
Steroids usually
immunosuppression if worse - MTX
Glucocorticoid
Striae Hirsutism Acne HTN BSL Mood / sleep OP
Azathioprine toxicity
Liver
GI
Haem
CNI inhibitors (cyclosporin/tacro) Toxicity
HTN lipids Kidney impairment Tremor Hyperglycaemia Gingival hyperplasia
Mycophenalate
Toxicity
GI
Haematological
Infection
Cyclophosphamide
Haem
Bladder - cancer, cystitis
Gonadal toxicity
Pred dose to consider PJP prophylaxis
Pred dose > 30mg
HbA1c aims
<7%
In pregnancy <6
But if hypo unawareness <8
Perioperative aim <9
Micro vascular DM complications
Retinopathy
Neuropathy
Nephropathy
Misc DM complications.
Autonomic dysfunction Impotence Ulcers Gastro paresis Mobility/falls risk
HIV OI prophylaxis
Trimethoprim/sulfamethoxazole -PJP and toxo if CD 4 <200
Azithromycin - MAC CD <75
Cease when CD4 > 200 and VL <50 copies
ART
Descovy (tenofavir, emtricitabine)
and Integrase inhibitor (dolutegravir, bictegrovir, raltegrovir)
Or
Lamividine/dolutegravir
ART and SEs
Integrase inhibitors - weight gain
