DMARDS

Question 1

DMARD, Cancer Chemotherapeutic Drug
Inhibits AICAR transformylase and Thymidilate synthetase

Used in Rheumatoid Arthritis, Wegener’s granulomatousis

SE: Pseudolymphomatous reaction

Answer 1

Methotrexate

Question 2

First choice DMARD in Rheumatoid Arthritis

Answer 2

Methotrexate

Question 3

Rescue Agent for Methotrexate

Answer 3

Leucovorin (Folinic Acid)

Question 4

DMARD, Binds to TNF-a and prevents its activation
Used for CHRONs disease
SE: URTI, Reactivation of latent TB, Reactivation of Hepa B, Demyelination

Answer 4

Infliximab/ Etanercept

• Inflicts B (tB, Hep B) demyelimation

Question 5

Synergistic effect with Methotrexate

Answer 5

Infliximab

Question 6

Forms 6 THIOguanine
Bechet’s Disease, SLE, Polymyositis
SE: Bone marrow suppression
Cannot give with allopurinol

Answer 6

Azathioprine

Question 7

DMARD, Antimalarial
Suppression of T lymphocytes, Inhibition of RNA and DNA synthesis, Trapping of free radicals

For SLE, Sjorgens and Malria

SE: Nightmares and Ocular Toxicity

Answer 7

Chloroquine/ Hydroxychloroquine

Question 8

DMARD, Cancer chemotherapeutic drug
Forms phosphoramide mustard
Also Wegener’s granulomatosis - with Methotrexate and Cyclosporine
SE: Hemorrhagic Cystitis

Answer 8

Cyclophosphamide

Question 9

Rescue Agent of Cyclophosphamide

Answer 9

MESNA

Question 10

DMARD, Inhibits IL1 and IL2
Used in Tissue Transplantation
SE: Hirsutism. Gingival Hyperplasia, Bladder CA

Answer 10

Cyclosporine

Question 11

DMARD, Forms Mycophenolic acid that inhibits inosine monophosphate dehydrogenase
For SLE Nephrits -> Least Nephrotoxic and Neurotoxic DMARD
SE: Reversile Myosuppression

Answer 11

Mycophenolate Mofetil

Question 12

DMARD, Active product Sulfapyridine that inhibits release of cytokines
SE: Reversible infertility, Pulmonary Toxicity

Answer 12

Sulfasalazine

Question 13

Co-Stimulation modulator, binds to CD80 and CD86 on APC
For RA (Combination or Mono Therapy)
Concomitant use of TNF - a blocker is not recommended due to increased incidence of serous infection

Answer 13

Abatacept

Question 14

Non Biologic DMARD, inhibits Dihydrooroate dehydrogenase
For RA - As effective as Methotrexate
SE: Weight gain, Alopecia
Converted to its active form A77 1726

Answer 14

leflunomide

Question 15

Monoclonal ab, Depletes B Cells

For Mod to Sev RA (with methotrexate) with inadequate response to TNF - a

Answer 15

Rituximab

Question 16

Monoclonal ab, Binds to IL6
RA with inadequate response to TNF - a
SE: Opportunistic infections
Screening for TB should be done prior to beginning Tocilizumab
Do not use with patients with Diverticulitis

Answer 16

Tocilizumab

Question 17

Decreases Rheumatoid factor and prevents collagen crosslinking

Answer 17

Penicillamine

Question 18

Janus Kinase Inhibitor used for RA

Answer 18

Tofacitinib

Question 19

Sphingosine -1 - phosphate receptor modulator for Multiple SCLEROSIS

Answer 19

Fingolimod

Question 20

Monoclonal ab against IL - 17 for Psoriasis and Ankylosing Spondylitis

Answer 20

Secukinunab

Question 21

Monoclonal ab against IL - 2 used to prevent rejection during organ transplant

Answer 21

Basiliximab

Question 22

Monoclonal ab against IL - 12 and IL -23 used for Chrons and PSORIASIS

Answer 22

Ustekinumab