Rheumatoid Arthritis Drugs Flashcards
What are the 4 general classes of drugs used in the treatment of RA?
NDAIDs
Steroids
Nonbiological DMARDS
Biological DMARDs
How does Methotrexate work?
It’s a nonbiological DMARD
It blocks dihydrofolate reductase so that you don’t get pyrimidine and purine synthesis - why it’s great for cancer, but it also works against immune cells, so it dampens the immune response
How does Hydrosychoroquine work?
Originally for malaria
It prevents acidificaiton of macrophage cytosol
and
binds to the TLR9 receptor on dendritic cells to suppress their action
dampens the immune response
How does Luflunomiade (Arava) work?
It inhibits pyrimidine synthesis in the orotate pathway - primarily affecting T cells and potentially B cells (less of an immune response and fewer RF antibodies)
How does Sulfasalazine work?
It’s a nonbiological DMARD
It’s metabolized in the colon to two active substances:
sulfapyridine - a free radical scavenger
5 amino-salicylic acid - a COX antagonist
Why do we rather use methotrexate than sulfasalazine?
sulfasalazine tends to be more toxic with rash, neutropenia and myelosuppression
What does Gold suppress in the treatment of RA?
phagocytosis by macrophages and maybe development of T cells
it’s the least tolerated of all the DMARDS due to side effects
How does Azathioprine work against RA?
It’s a nonbiological DMARD
a purine analog use to block DNA synthesis - primary mechanism of action appears to be on the T cell
How does cyclosporine work in treatment of RA?
a nonbiological DMARD
it’s an immunosuppressant by inhibiting calcineurin - affects the T cells
What are the two main biologic DMARDs that inhibit TNF?
Etanercept (a fake receptor for TNF alpha)
Inflixumab (antibody against TNF alpha)
What is the biological DMARD that acts as an IL1 receptor antagonist?
Anakinra
not really all that effective
What does Rituximab do?
It binds to DN20 on B cells to suppress their activity
Which biological DMARD binds to CD80 on The APC to prevent activation of the T cells?
Abatacept
