Here's a question on my Step 1......

[Anonymous]

A patient with CHF was prescribed DMARDs. What is the most common side effect? I still couldn't find the answer.

[ttranmd]

I believe that the most common side effect is CHF exacerbation. A lot of the newer DMARDs, not to mention NSAIDs, are notorious for causing CHF because of their effects on the kidneys.

Tony

[asadxyz]

The Q is whether NSAIDS are included in the DMARDS or not.As far as I know NSAIDS are anti-inflammatory and not included in DMARDS which include

Gold
Pecillamine
Methotrexate
Salfasalazine
Infliximab
Etanercept
Leflunomide
Hydroxychoroquine
corticosteroids

None of them apparently seem to affect the cardiac function directly except Corticosteroid ( which I will discuss in the end) and chloroquine whose derivative is Hydroxychloroquine is accumultated in muscles but ,whether it affcts myocardial contractility , that is not known. If there is some inter -action , somebody should come forward and explain.
However long term use of corticosteroids have toxic effects and can cause hypertension, fluid retention , hypokalemia and sodium retention. And of course this is indirectly aggraving the CHF but no direct effect on myocardium

[ttranmd]

Actually, I wasn't including NSAIDs as part of DMARDs. I was just making the point that NSAIDs are also known to cause CHF.

The DMARDs that have been shown to exacerbate CHF include Infliximab, Cyclophosphamide, and steroids. The rest of the class is also known to cause elevated liver enzymes, lupus-like symptoms, and renal toxicity.

[Neuro4u]

I looked this up in the PDR, nothing is mentioned about CHF. What was the exact Question, something very important is missing from this picture, Infliximab is treatment for Crohn Disease, Cyclophosphamide Tx for Bl ca. and so on.

I also looked in lippincott and did not find anything like what you are saying.

Good Luck

[Neuro4u]

With Infliximab infections leading to pnuemonia have been reported....but I think the question still has major clues missing.

[asadxyz]

Dear
I am unable to understand that infliximab and cyclophosphamide exacerbate the CHF. Will you pl explain the mechanism and source of your information with complete ref.


Because Ketzung and Goodman and Gilman have not mentioned any effect or side effect of inflixibab and cyclophosphamide which cand exacerbate the CHF. I will be highly grateful if you guide us with ref of source and page No. Thanking in advance

[moveon]

My thinking is the same like Neuro4u. Malochean Hand, could you please recall more details of the question? Thank you.

[Anonymous]

I am retarded... Could someone give me the word for DMARDs?

[Anonymous]

Unfortunately, I can't remember the answer choices I was given but I do recall specifically that the question was a one-line stem about the patient with CHF being prescribed DMARDs (Disease Modifying Antirheumatic Drug), no other clues were given to me. Initially, I thought it would be easy since it was short but I reread the question for 2 minutes and couldn't even make an educated guess. Thank you for everyone trying to help me solve this puzzle.