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Zorluk: OrtaRheumatology and Immunology

In the management of systemic autoimmune and inflammatory diseases, disease-modifying antirheumatic drugs (DMARDs) and biologic therapies are mainstays of treatment. However, their use is associated with unique adverse effects that require specific screening and monitoring strategies. Match each medication below with its most characteristic adverse effect profile or required screening parameter.

  • HydroxychloroquineRetinopathy requiring regular ophthalmologic screening
  • MethotrexateHepatotoxicity, stomatitis, and macrocytic anemia
  • CyclophosphamideHemorrhagic cystitis and increased risk of bladder carcinoma
  • AdalimumabReactivation of latent tuberculosis or fungal infections

Cevap

Hydroxychloroquine matches with retinopathy; Methotrexate matches with hepatotoxicity, stomatitis, and macrocytic anemia; Cyclophosphamide matches with hemorrhagic cystitis; Adalimumab matches with reactivation of latent tuberculosis.
The correct pairings align each rheumatologic medication with its well-established mechanism of toxicity and corresponding monitoring requirement. Hydroxychloroquine accumulates in the retina, causing maculopathy. Methotrexate depletes folate, leading to mucosal and hepatic toxicity. Cyclophosphamide's metabolite acrolein damages the bladder mucosa. Adalimumab inhibits TNF-alpha, which is essential for maintaining granulomas, thus risking the reactivation of latent tuberculosis.

Adım Adım Çözüm

1
Identify the primary toxicity profile of Hydroxychloroquine.
Matches with retinopathy requiring regular ophthalmologic screening.
The drug binds to melanin in the retinal pigment epithelium, causing cumulative and potentially irreversible damage.
2
Identify the primary toxicity profile of Methotrexate.
Matches with hepatotoxicity, stomatitis, and macrocytic anemia.
It is a folate antimetabolite; its adverse effects are often mitigated by concurrent folic acid supplementation.
3
Identify the primary toxicity profile of Cyclophosphamide.
Matches with hemorrhagic cystitis and increased risk of bladder carcinoma.
The toxic metabolite acrolein concentrates in the urinary bladder. Mesna and adequate hydration are used for prophylaxis.
4
Identify the primary toxicity profile of Adalimumab.
Matches with reactivation of latent tuberculosis or fungal infections.
As a TNF-alpha inhibitor, it disrupts granuloma integrity, making pre-treatment screening for latent tuberculosis (e.g., interferon-gamma release assay) essential.

Anahtar Kavram

Pharmacologic adverse effects and monitoring requirements of DMARDs and biologic agents in rheumatologic diseases.
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Konular

Rheumatology and Immunology

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