Test 4 - Rheumatoid Arthritis Meds (Josh)

Question 1

Rheumatoid Arthritis is an —– disease.

Answer 1

Autoimmune

Question 2

Pathophysiology of RA?

Answer 2

Inflammation causes synovial membrane to grow, replacing cartilage and eventually fusing the join together

Question 3

The hands of RA clients will have which noticeable feature?

Answer 3

Ulnar drift

Fingers will drift towards the Ulnar bone

Question 4

Three major groups of RA meds?

Answer 4

• NSAIDS
• Glucocorticoids
• Disease-modifying Anti-rheumatic Drugs (DMARDs)

Question 5

Which class is rapid relief an which is slower?

Answer 5

NSAIDs (rapid)
Glucocorticoids (rapid)
DMARDs (slower)

Question 6

—- do NOT slow down the disease process.

Answer 6

NSAIDs

Question 7

—- DO slow down the disease process.

Answer 7

Glucocorticoids

• but have lots of S/E so don’t want to stay on them long-term

Question 8

DMARDs we talked about?

Answer 8

• Methotrexate
• Hydroxychloroquine
• TNF Blockers

Question 9

MOA: Methotrexate

Answer 9

Block DHFR enzyme that converts Folic Acid into DNA, thus taking away ability to make WBCs, thus decreasing # of cytokines

Question 10

S/E w/ Methotrexate:

Answer 10

• Nausea/Diarrhea (biggest S/E)
• GI ulceration
• decrease bone marrow
• Pneumonitis
• Hepatotoxicity
• Renal Failure
• Infection
• Severe Rash

Has 11 BBW!!!!

Question 11

S/E w/ Hydroxychloroquine

Answer 11

• severe N/V/D if taken W/OUT Food

- Retinal Damage

Question 12

Take which med w/ food?

Answer 12

Hydroxychloroquine

Question 13

Watch for vision changes with which med?

Answer 13

Hydroxychloroquine

Question 14

MOA: TNF Blockers

Answer 14

Block TNF, on elf the major cytokines of the inflammatory process

Question 15

TNF Blockers we studied:

Answer 15

• infliximab
• adalimumab
• etanercept

All are IV or subQ

Question 16

Common A/E of TNF Blockers?

Answer 16

• injection site reactions

- infections

Question 17

Rare A/E of TNF Blockers?

Answer 17

• Severe Allergic Reactions (Steven’s Johnson)
• HF
• Hepatotoxicity
• Cancer

Question 18

—- are drugs of first choice in treating RA b/c of their rapid onset.

Answer 18

NSAIDs

Question 19

What periodic blood work is needed for a client taking Methotrexate?

Answer 19

Methotrexate Test

Question 20

How often should Methotrexate be taken?

Answer 20

Once a week

Question 21

Which S/E of Methotrexate is most likely to occur?

Answer 21

Nausea & Diarrhea

Question 22

Which exam should a client taking hydroxychloroquine take regularly?

Answer 22

Exe exam

• due to the risk of retinal damage
• report any VISION CHANGES

Question 23

Why check immunization status before beginning TNF-Inhibitors?

Answer 23

Increases risk of infections due to its immunosuppressant properties

Question 24

A client taking which drug should report exposure to a communicable disease?

Answer 24

TNF-Inhibitor

• because of the risk for serious infections do to suppressed immune system by blocking TNF