rheuma/immuno characteristic

allopurinol drug class

xanthine oxidase inhibitor

allopurinol indication

gout, hyperuricemia, tumor lysis syndrome, kidney stones

allopurinol DDI

XO substrates (azathioprine, didanosine, mercaptopurine), cyclophosphamide, fluorouracil, warfarin, pegloticase, HLA-B 5801+

allopurinol cadr

rash, maculopapular eruption, acute attacks of gout with initiation

allopurinol radr

SJS, toxic epidermal necrolysis, aplastic anemia, agranulocytosis, thrombocytopenia, renal failure, granulomatous hepatitis, hepatotoxicity, immune hypersensitivity reaction

allopurinol counsel

take after meals to alleviate GI symptoms, drink plenty of water to prevent kidney stones, avoid alcohol and caffeine

febuxostat drug class

xanthine oxidase inhibitor

febuxostat indication

hyperuricemia

febuxostat DDI

XO substrates (azathioprine, didanosine, mercaptopurine), rosuvastatin (max 20mg/ day), pegloticase

febuxostat bbw

increased risk of death

febuxostat cadr

rash, nausea, elevated LFTs, arthragia

febuxostat radr

ECG abnormalities, hypersensitivity, stroke, mood changes, DRESS

febuxostat counsel

take with food, seek medical attention for severe mood swings, rashes, or abnormal heartbeat

colchicine drug class

antigout agent

colchicine indication

gout, familial mediterranean fever

colchicine DDI

CYP3A4/5 and P-gp substrates- monitor, adjust doses or avoid, lipid lowering agent (statins, fibrates)

colchicine cadr

diarrhea, nausea, vomiting

colchicine radr

agranulocytosis, rhabdomyolysis (esp. w lipid lowering agent)

colchicine counsel

take as instructed, acute doesn’t mean chronic, dosing titration may be limited by onset of symptoms (diarrhea), this drug may interact with your other medication

gout medications counsel

weight loss and limiting alcohol/ purine rich food consumption will reduce gout attacks

methotrexate drug class

antimetabolite

methotrexate indication

rheumatoid arthritis, psoriasis, non-hodgkin lymphoma

methotrexate contraindication

alcohol use disorder, chronic liver disease, pregnancy, nursing, preexisting blood dyscrasias in patients treated for psoriasis and rheumatoid arthritis, NSAIDs

methotrexate DDI

drug secreted via renal tubules- decrease dose or avoid

live vaccines- avoid

leucovorin- avoid unless needed for ADE reversal

methotrexate bbw

pregnancy, BMS, renal impairment, hepatotoxicity, pneumonitis, GI toxicity, secondary malignancy, tumor lysis syndrome, dermatologic toxicity, opportunistic infections, radiotherapy, hypersensitivity

methotrexate cadr

N/V/D/stomatitis, alopecia/ hair loss, photosensitivity, rash, LFT abnormalities, myelosuppression

methotrexate radr

opportunistic infections, interstitial lung disease, SJS, acute renal failure, liver failure, secondary malignancies (lymphoma)

methotrexate counsel

once weekly for rheumatic conditions, daily folic acid to lessen risk of common adrs, avoid live vaccine, must use contraception during and after treatment, avoid direct sun exposure

azathioprine drug class

immunosuppresant

azathioprine indication

renal transplantation, rheumatoid arthritis

azathioprine contraindication

pregnancy (if using for RA treatment), prior alkylating therapy (cyclophosphamide, ifosfamide, melphalan)

azathioprine DDI

XOIs (allopurinol, febuxostat)- avoid or reduce dose

vaccine- reduce vaccine efficacy, wait 2 weeks after vaccine before therapy initiation

azathioprine bbw

malignancy

azathioprine cadr

nausea, leukopenia, infection, diarrhea, malaise, myalgia, increased LFTs

azathioprine radr

pancreatitis, neoplastia

azathioprine counsel

take with food, do not crush tablet, can increase risk of infections, report any new mass, fatigue, easy bruising symptoms, may decrease vaccine efficacy

hydroxychloroquine drug class

aminoquinoline

hydroxychloroquine indication

RA, lupus, malaria

hydroxychloroquine contraindication

retinal or visual field changes from prior hydroxychloroquine, long term use in children, gold compound

hydroxychloroquine DDI

digoxin- increase digoxin level, monitor level, or avoid

metoprolol, aurothioglucose (gold compound), ammonium chloride

hydroxychloroquine cadr

N/V/C/D, abd pain, hyperpigmentation, headache, dizziness

hydroxychloroquine radr

retinopathy, QT prolongation/ arrhythmias/ cardiomyopathy, SJS, agranulocytosis, seizures, psychosis

hydroxychloroquine counsel

take with food or milk, daily or weekly (same day same time), heart palpitations, severe rash, unusual bruising or bleeding, or difficulty seeing or changes in visual field

etanercept drug class

tumor necrosis factor inhibitor

etanercept indication

RA, psoriatic arthritis, ankylosing spondylitis, polyarticular juvenile idiopathic arthritis

etanercept contraindication

hypersensitivity, sepsis

etanercept DDI

TNFi (adalimumab, infliximab)- increase risk of infection, avoid

immunosuppressants- profound immunosuppression

live vaccines- avoid

etanercept bbw

serious infections, malignancies

etanercept cadr

injection site reaction, headache, skin rash, infections

etanercept radr

serious infections, reactivation of latent infections (hep B/C, TB), malignancies, heart failure

etanercept counsel

do not administer dose if symptoms of active infections, refrigerate, do not use if frozen then thawed, keep in carton to protect from light, do not shake, follow proper handling and disposal (aseptic technique, site rotation, sharp container), contact doctor if shortness of breath, infections, signs of cancer

glucocorticoids brands

prednisone, methylprednisolone, dexamethasone, prednisolone

glucocorticoid indication

allergic states, dermatologic diseases, endocrine disorders, GI diseases, hematologic disorders, neoplastic disease, nervous system disorders, renal diseases, respiratory diseases, rheumatic disorders

glucocorticoid contraindication

systematic fungal infections, live vaccines

glucocorticoid DDI

antacids- decreased absorption of corticosteroids, separate by at least 2 hours

CYP3A4/5 substrate- adjust dose

fluoroquinolones- incr. risk of tendons eruption, monitor or avoid

phenytoin- monitor, incr. prednisone metabolism

warfarin- monitor INR

glucocorticoid cadr

GI side effect, HTN, atrophic condition of skin, impaired skin healing, osteoporosis, depression, euphoria, pulmonary tuberculosis, hyperglycemia

glucocorticoid radr

primary adrenocortical insufficiency, cushing’s syndrome, decrease body growth, increase risk of infection

glucocorticoid counsel

take with food or milk to prevent GI upset, take in morning to prevent insomnia, for high doses or longer term treatment, monitor for signs of hyperglycemia, osteoporosis, adrenocortical insufficiency and infection, avoid abrupt discontinuation treatment duration> 2 weeks and dose >20mg prednisone equivalent

anastrozole drug class

antineoplastics

anastrozole indication

breast cancer (post menopausal)

anastrozole contraindication

pregnancy, breastfeeding

anastrozole DDI

tamoxifen- avoid, decrease anastrozole level

methadone- increase methadone level

anastrozole cadr

N/V/GI tract disorder, edema, hypertension, arthralgia, arthritis, osteoporosis, hot flashes, depression

anastrozole radr

MI, endometrial cancer, cerebrovascular accident

anastrozole counsel

may lead to bone loss and increase risk of fracture, seek medical attention if shortness of breath, swelling, chest pain, vaginal bleeding, blistering rash, rapid weight gain, severe N/V, yellowing of the eyes or skin

tamoxifen drug class

antineoplastic

tamoxifen indication

breast cancer (pre and post menopausal)

tamoxifen contraindication

pregnancy, breastfeeding, concurrent warfarin, history of DVT or PE

tamoxifen bbw

stroke, PE, uterine malignancies

tamoxifen DDI

CYP2D6 inhibitors (paroxetine, fluoxetine), CYP3A4/5, CYP2C9 substrates

tamoxifen cadr

flushing HTN, edema, hot flashes, vaginal discharge, amenorrhea, rash, nausea

tamoxifen radr

endometrial hyperplasia, uterine cancer, retinopathy

tamoxifen counsel

seek medical care if symptoms of thrombotic event (shortness of breath, leg pain), irregular menstruation, abnormal vaginal bleeding, pelvic pain or pressure, avoid black cohosh as supplement

tacrolimus drug class

antineoplastic

tacrolimus indication

rejection prophylaxis (heart, lung, liver, kidney)

tacrolimus contraindication

ziprasidone, hypersensitivity to polyoxyl 60 hydrogenated castor oil

tacrolimus bbw

infection malignancies, increased mortality in female transplant patients, astagraf XL in liver cancer

tacrolimus DDI

CYP3A4, P-gp substrates. amiloride, potassium sparing diuretics- avoid (incr. hyperK)

aminoglycosides, amphotericin, cisplatin, ganciclovir- avoid (incr. nephrotoxicity)

QTc prolonging medications- avoid (ziprasidone), monitor

live vaccine

tacrolimus cadr

chest pain, HTN, alopecia, diabetes, hyperglycemia, hyperkalemia, hypomagnesemia, hyperlipidemia, constipation, diarrhea, nausea, anemia, leukopenia, thrombocytopenia, infection, arthralgia, dizziness, headache, insomnia, neuropathy, myoclonus, seizure, nephrotoxicity, dyspnea, pleural effusions

tacrolimuc radr

arrhythmia, cardiomegaly, SJS, malignancy, pancreatitis, acute renal failure

tacrolimus counsel

drug absorption is affected by food, be consistent with how you take your dose (w/o meal is preferred) may take with meal to mitigate GI symptoms, avoid grapefruit juice and alcohol, many OTC/Rx meds and food may interact with this medication

hematopoietic medications

epoetin, darbepoetin

hematopoietic indication

anemia secondary to kidney disease or chemotherapy

epoetin indication

perioperative collection of blood for allogeneic infusion

hematopoietic contraindication

uncontrolled HTN, pure red cell aplasia

epoetin contraindication

albumin

hematopoietic bbw

increased CV, stroke, mortality risk, cancer recurrence, thromboembolic event

epoetin DDI

thalidomide- avoid or add anticoagulant

albumin- avoid

hematopoietic cadr

injection site thrombosis, myalgia, fatigue, diarrhea, edema, hypertension

darbepoetin cadr

dyspnea, cough

epoetin cadr

skin rash, pruritus

hematopoietic radr

pure red cell aplasia, seizures, tumor progression

hematopoietic counsel

do not shake, dilute, or expose to light, store in box in refrigerator, do not freeze. single use vial/ syringe do not combine remainder from different vials/ syringes. it may take several weeks to see the maximum effects of these medications