What is the treatment of acute attack of gout?
Colchicine
What is the maintenance treatment of gout?
Allopurinol, NSAIDs & (PPI for gastric protection)
Other than gout, what other condition can allopurinol be used to treat?
Kidney stones
How should bisphosphonates be taken?
- Taken once a week
- Have it on a empty stomach - can cause GI symptoms
- Take the tablet sitting up and stay upright for extra 30mins
What are some warnings of bisphosphonates?
- Osteonecrosis of the jaw (ask about jaw pain)
- Atypical femoral fractures (due to long term use)
- Oesophageal irritation
What is an example of a bisphosphonate?
- Risedronate
- Alendronate
- Zoledronic Acid
- Pamidronate
What is the MOA of NSAIDs?
- Inhibits COX-1 and COX-2 isoforms of cyclooxygenase
- This inhibits prostaglandin synthesis (responsible for inflammation and pain)
What are biologics?
These are drugs that change the operation of natural biologic intracellular and cellular actions
- Sometimes referred to as personalised medicine
What are some indications for biologics?
- Rheumatoid arthritis
- Psoriatic disease
- IBD
- Cystic fibrosis
What trimester of pregnancy should colchicine be avoided?
- First trimester & Breastfeeding
Risk of chromosomal damage in the foetus
What is the indication for methotrexate?
- Chemotherapy agent - to treat certain cancers (lymphoma, leukaemia)
- Autoimmune diseases (Rheumatoid arthritis, Chrons , Psoriasis)
Side effects of methotrexate?
- Bone marrow suppression - risk of neutropenia
- Methotrexate fog - usually the day after drug administration
- Mucosal damage
- GI symptoms
What are some contraindications of methotrexate?
- Pregnancy (teratogenic)
- Severe renal impairment
How should methotrexate be taken?
- Only taken once a week
- Folic acid can be prescribed to be taken on the other 6 days
What are examples of Disease-modifying antirheumatic drugs (DMARDs)?
- Methotrexate
- Hydroxychloroquine
