MEDICAIA ANTIREUMATIC DE FOND

CONSIDERAII GENERALE PRIVIND MEDICAIA ANTIREUMATIC DE FOND

Terapia antireumatic cuprin e ! tipuri e me ica"ii# FAAID $ Fast Acting Antiinflammatory Drugs care inc%u e AINS &i '%uc(c(rtic(i)ii* SAAIS $ Slow Acting Antiinflammatory Drugs care cuprin e me ica"ia antireumatic +peci,ic

CLASIFICAREA MEDICAIEI ANTIREUMATICE DE FOND# -. ANTIMALARICE e SINTE/ !. SRURI e AUR 0. COMPU1I TIOLICI 2. IMUNOMODULATOARE 3. IMUNOSUPRESOARE 4. DERIVAI ai MESALA/INEI
Medicaia antireumatic de fond se uti i!ea! cu "recdere #n tratamentu "o iartritei reumatoide$

-. ANTIMALARICE DE SINTE/ ;DERIVAI DE AMINOC<INOLIN=

e,ectu% terapeutic +e in+ta%ea) %ent -du" 894 uni de a iniierea tratamentu ui.$ CLOROC<INA

Farmac(t(?ic(%('ie#

pr(@(ac ,rec@ent reac"ii a

Farmac(cinetic#
a%sor%ie %un ora & 'D de cca( )*+$
pic plasmatic a cca( 4 5$ distri%uie tisu ar ar,& stocare #n esuturi$ T-6! 7i(%('ic %un' -28 59.

@er+e# a ni:e cutanat 2 "rurit& pigmentarea crmizie a micoaselor i unghiilor, decolorarea prului; a ni:e di,esti: 2 anorexie, greuri, vom, diaree; a ni@e% (cu%ar $ c/eratit& retin(patie -"oate "ro,resa 6i du" #ntreru"erea medicaiei;. 2 contro ofta mo o,ic "eriodic o% i,atoriu$ a ni:e /emato o,ic< anemie& euco"enie Chloroquine phosphate sirop 1,6%;

Farmac( inamie#
in/i% ,unc"ia ,a'(citar a fa,ocite or mononuc eare$ in/i% e i%erarea I01 de ctre monocite$

C(ntrain ica"ii#

sarcin$
retino"atii$ "soria!is& "orfirie$

Farmac(terapie#
p(%iartrita reumat(i 2 !88:288 m'6)i
-#n 3 "ri!e. ca tratament de #ntreinre$ a #nce"utu tratamentu ui 2 4** m,5!i$ ca!uri u6oare de %upu+* antima aric sc/i!ontocid /ematic$ "rofi a7ia ma ariei$

<IDRO>ICLOROC<INA
mai e,icace dec=t c oroc/ina #n >AR$ indicaii simi are ca antima aric$ t(?icitate (cu%ar mai re u+ dec=t i!ro"iclorochin# c oroc/ina cpr$ %&& mg

!. SRURI DE AUR ;CRI/OTERAPIA=

Farmac(cinetic#
a%sor%ie ora redus& a%sor%ie i(m(
ent& dar %un$ distri%uie "referenia #n +i+temu% reticu%(:en (te%ia%A ficat& rinic5iA m u@a 5emat(p(eticA articu%a"ii%e a,ectate -conc( du% e fa de articu aii e norma e.$ e,are de "roteine #na t$ e iminare e?trem e %entA rena% -du" un tratament de durat& "oate "ersista un an #n or,anism.$

Farmac(t(?ic(%('ie#

pr(@(ac ,rec@ent reac"ii a

@er+e# a ni:e cutanat& a ni:e u mucoase or 2 eru"ii cutanate& "rurit& stomatite& eritrodermie ; a ni:e rena 2 proteinurie, afectare renal, adesea ire:ersi%i ; a ni:e /emato o,ic9 trom%ocito"enie& aplazie medular; e!iuni /e"atice& "u monare& di,esti:e$

C(ntrain ica"ii# Farmac( inamie#

in/i% cito i!a eucocite or stimu at de anticor"i$ in/i% e i%erarea en!ime or i!o!oma e$ aciunea farmacodinamic se insta ea! ent - uni.$

sarcin$
insuficien rena $ insuficien /e"atic$ insuficien cardiac$ u"us&dermato!e e:o uti:e$

9
e necesar contro "eriodic /emato o,ic& /e"atic& rena

Farmac(terapie#
p(%iartrita reumat(i re)i+tent %a
AINS -forme acti:e& "ro,resi:e.$ dermatit %u oas$

Aurotiomalat !e so!iu ' (aure!on 'fiole 1& mg)ml; administrare 1*93* m,5s"tm=n$ Auronofin' *i!aura 'cpr$ + mg; administrare ora 4 m,5!i -'D 2 1?98*+. #n 193 "ri!e -T153 de cca(1@ !i e.$

0. COMPU1I TIOLICI
PENICILAMINA

Farmac(t(?ic(%('ie#

Farmac(cinetic#
a%sor%ie %un ora & 'D de cca( 4*+
-?*9@*+.$ distri%uie tisu ar ar,& stocare "referenia #n esutu conAuncti:$ e iminare "re"onderent "rin feca e -B*+.& urin -3*+.$

pr(@(ac ,(arte ,rec@ent reac"ii a

Farmac( inamie#
mecani+m e ac"iune nee%uci at $ scade CDE& I,F& I,M$ efecte e a"ar du" G9 4 uni de tratament$ este c5e%at(r a% cupru%ui*

@er+e# a ni:e cutanat 2 eru"ii& "rurit& stomatite ; a ni:e di,esti: 2 diaree; a ni:e rena $ "roteinurie$ a ni:e /emato o,ic< trom%ocito"enie& a,ranu ocito!$ ma formaii a nou9nscut$ sindrom u"oid$ "o imio!ite$

C(ntrain ica"ii#

sarcin$
u"us$ miastenia ,ra:is$ a er,ie a "enici ine$ nefro"atii$

Farmac(terapie#
p(%iartrita reumat(i 2 088 m'6)i - a
#nce"ut.& se cre6te "=n a )** m,5!i$ ciro! %i iar "rimar$ %oa a Hi son

Cuprenil cpr$ %,& mg;

2. IMUNOMODULATOARE
LEVAMISOL

Farmac(cinetic#
a%sor%ie di,esti: com" et$
e iminare "re"onderent "rin urin$

Farmac(t(?ic(%('ie#

Farmac( inamie#
anti/e mintic -"e nematode.$ imun(m( u%at(r*

a ni:e cutanat 2 eru"ii& fotosensi%i i!are ; a ni:e di,esti: 2 ,reuri& :om; a ni:e /emato o,ic< euco"enie$ fe%r& a tra ,ii& mia ,ii

C(ntrain ica"ii#

Farmac(terapie#
p(%iartrita reumat(i 2 -38 m'6)i - a
#nce"ut. "=n a ame iorare& a"oi 1?* m, 8 !i e consecuti: s"tm=na $ ascaridio! -medicaie de e ecie. 2 do! unic

in+u,icien" 5epatic$
in+u,icien" rena%*

Decaris cpr$ ,& mg; 1,& mg

3. IMUNOSUPRESOARE
-. Imun(+upre+(are +e%ecti@e# In5i7it(are a%e pr( ucerii &i e%i7errii e %im,(Bine $ ciclosporina In5i7it(are a%e +inte)ei pirimi inei $ leflunomi!a Antic(rpi m(n(c%(na%i anti TNF : infli"ima A%te imun(+upre+(are cu e,ecte +peci,ice : etarnecept Imun(+upre+(are ne+e%ecti@e -. Antimeta7(%i"i purinici $ a.atioprina !. Anti,(%ice : metotre"at

!.

IMUNOSUPRESOARE SPECIFICE
Farmac(cinetic#
a%sor%ie di,esti: incom" et 2 'D 8*+$
"ic " asmatic a 3 ore& meta%o i!are intens$ e iminare "re"onderent "rin %i 6i feca e$

CICLOSPORINA ' San!imun

Farmac(terapie#
tran+p%ant e (r'ane
p(%iartrita reumat(i 2forme ,ra:e$ "soria!is se:er

Farmac( inamie#

Farmac(t(?ic(%('ie#

in/i% transcri"ia ,enic a I03& I08& IFN9$

/i"eruricemie& afectare /e"atic$ /i"ertrofie ,in,i:a $ sindroame mie o"ro iferati:e

INFLI>IMAC $ *emica!e pul0$ in1$ 1&& mg anticorp

monoclonal uman'murin anti (/F

Farmac(cinetic#
adm( i(:($ T153 )91* !i e$ distri%uie "redominant intra:ascu ar$

Farmac(t(?ic(%('ie#

&i

Farmac( inamie#
+e %ea' e ,(rme%e +(%u7i%e tran+mem7ranare a%e (/F *

infecii virale, microbiene, micotice; boli de colagen; tulburri hematologice (anemie, leucopenie) i neurologice

Farmac(terapie#
p(%iartrita reumat(i $
%oa a Cro/n< s"ondi ita anc/i o"oetic cu sim"tome se:ere$ *emica!e perf$ i$0$ , mg)2gc, timp !e % ore la %, respecti0 6 s#pt#m3ni

IMUNOSUPRESOARE SPECIFICE
LEFLUNOMIDA Ara0a cpr$ 1&; %&; 1&& mg

Farmac(cinetic#
a%sor%ie di,esti: %un& dar incom" et$

Farmac(terapie#
p(%iartrita reumat(i 2forme ,ra:e

Farmac( inamie#
in/i% sinte!a "irimidinei$ medicament anireumatic modificator al bolii;

Farmac(t(?ic(%('ie#

ETA& /i"ertrofie ,in,i:a $ sindroame mie o"ro iferati:e

ETARNECEPT $ En7re% pul0$ in1$ %, mg

Farmac(cinetic#
adm( s(c($

Farmac(t(?ic(%('ie#

Farmac(terapie#
p(%iartrita reumat(i acti@$
"o iartrita cronic e:o uti: Au:eni care nu a rs"uns a metrote7at$

infecii virale, microbiene, micotice; erupii; dureri abdominale *en-rel %, mg)2gc !e % ori pe s#pt#m3n#

4. DERIVAI AI MESALA/INEI
SULFASALA/INA
e+te un eri@at care cuprin e Dn m(%ecu% +tructura me+a%a)inei ;aci u% 3: amin(+a%ici%ic= &i ( +u7+tan" purtt(are ;+u%,apiri ina=*

Farmac(cinetic#

a ni:e di,esti: se desface #n mesa a!in care nu se a%soar%e 6i acionea! ca antiinf amator oca -%oa Cro/n& co ita u ceroas. 6i su fa"iridina cu a%sor%ie di,esti: %un& cu efecte #n >AR$

Farmac(terapie#

p(%iartrita reumat(i 2efecte e:idente du" 198 uni de tratament$ co ita u ceroas$ %oa a Cro/n

Farmac(t(?ic(%('ie#

Sala.opirin cpr$ ,&& mg, 1'% g).i

,rea& anore7ie$ eru"ii cutanate$ Ei"ersensi%i i!are$ tu %urri /emato o,ice& /e"atic

afectare

Salofal2, 4entasa cpr$ enterosolu-ile, sup$, susp$ rectal# cu %,&, ,&& mg mesala.in#