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Flashcards in 3 DMARDs Deck (26):
1

How long does it take for DMARDs to take clinical effects?

6 weeks to 6 months

(Some within 2 weeks)

2

What is the first choice to treat rheumatoid arthritis?

Methotrexate

3

What is the MOA for methotrexate?

Inhibits AICAR transformylase

4

What does AICAR transformylase do?

Catalyzes the penultimate and final steps in de novo purine biosynthesis which leads to synthesis of IMP

5

Inhibition of AICAR transformylase results in the accumulation and release of what?

Adenosine

6

How does adenosine act as a potent anti-inflammatory mediator?

Acts on A2b receptors and suppresses NF-kB activation induced by TNF and other inflammatory stimuli

7

Besides blocking IMP, what other pathway does Methotrexate affect?

Thymidylate synthase pathway

8

What are the MOST COMMON adverse effects of Methotrexate?

Nausea and mucosal ulcers

9

How is Methotrexate toxicity reduced?

Leucovorin or folic acid

10

Can methotrexate be used in pregnancy?

No.

Contraindicated

11

Cyclosporine binds to what?

Cyclophilin (an immunophilin)

12

Cyclosporin-Cyclophilin complex inhibits what?

Calcineurin

13

What is the dose limiting adverse affect of cyclosporine?

Nephrotoxicity

14

Which drug is a purine antimetabolite?

Azathioprine

15

What is Azathioprine converted to?

6-mercaptopurine

16

What is the action of 6-mercaptopurine?

inhibits de novo synthesis if purine synthesis

17

What is azathioprine used for?

Refractory rheumatoid arthritis

18

What is the MOA of cyclophophamide?

Cross links DNA, thereby preventing cell replication

19

What are the gold compounds?

-Gold sodium thiomalate
-Auranofin

20

Gold salts are taken up by what? Resulting in?

-Macrophages
-Supress phagocytosis and lysosomal enzymes

21

Which are the anti-TNF drugs?

1) Adalimumab
2) Infliximab
3) Entanercept

22

What must be done before putting a patient on a anti-TNF drug?

Screen for TB

(before and during treatment)

23

Which is the anti-interleukin drug?

Anakinra

24

What is the MOA of anakinra?

IL-1 receptor antagonist?

25

Leflunomide in combination with methotrexate increases risk of what?

Hepatotoxicity

26

The combination of different biological agents increases risk of what?

Neutropenia and infections