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Pharmacology - Locomotor Module > Anti-Rheumatic Agents > Flashcards

Anti-Rheumatic Agents Flashcards

(53 cards)

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1
Q

__________ is generally prefered when doing monotherapy with traditional DMARDs (disease-modifying antirheumatic drugs)

A

Methotrexate

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2
Q

Methotrexate (MTX) is a folic acid antagonist that inhibits cytokine production and _________ (purine/pyrimidine) synthesis.

A

purine

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3
Q

Response to methotrexate (MTX) usually occurs within _________ weeks

A

3-6 weeks

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4
Q

If monotherapy with MTX gives an inadequate response, what should we do?

A

Combine MTX with other traditional DMARDs/TNF inhibitors/non-TNF biologic agents

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5
Q

How often should MTX be administered?

A

Once weekly

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6
Q

MTX is contraindicated in ____________

A

pregnancy

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7
Q

_____________ syndrome may occur with chronic administration of MTX

A

acute pneumonia-like syndrome

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8
Q

____________ (leukocytosis/leukopenia) may occur with chronic administration of MTX

A

leukopenia

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9
Q

Periodic liver function tests are recommended because chronic administration of MTX can cause __________ of the liver

A

cirrhosis

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10
Q

What are the GI-related adverse effects?

A

mucosal ulceration and nausea

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11
Q

Supplementation of __________ may improve tolerability of MTX and reduce GI and hepatic adverse effects.

A

Folic acid

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12
Q

Hydroxychloroquine (HCQ) is used for tx of early and mild RA. Its onset of effects is ____________

A

6 weeks to 6 months

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13
Q 
A 34-year-old woman with RA is planning for pregnancy. Which RA agents are absolutely contraindicated in pregnancy?
A. Abatacept and rituximab
B. Adalimumab and certolizumab
C. Infliximab and etanercept
D. Methotrexate and leflunomide
A

Methotrexate and leflunomide

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14
Q

Which traditional DMARD produces irreversible retinal damage?

A

Hydroxychloroquine

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15
Q

Where does hydroxychloroquine form deposits?

A

In the cornea

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16
Q

Hydroxychloroquine causes __________ (ocular toxicity/ototoxicity)

A

ocular toxicity

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17
Q

What are the adverse effects of MTX?

A 
Nausea
Mucosal ulcerations
Cytopenias
Cirrhosis
Acute pneumonia-like syndrome
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18
Q

Leflunomide is contraindicated in ____________

A

pregnancy

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19
Q

Leflunomide causes cell arrest of the autoimmune lymphocytes through its action on ___________

A

Dihydroorotate dehydrogenase (DHODH)

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20
Q

DHODH is an enzyme responsible for _________ (purine/pyrimidine) synthesis

A

pyrimidine

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21
Q

What does DHODH do?

A

It converts dihydroorotate to orotate (removes hydrogen and puts a double bond in the ring)

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22
Q

After biotransformation, leflunomide becomes a _________ (reversible/irreversible) inhibitor of DHODH

23
Q

When can leflunomide be used as monotherapy

Study These Flashcards
A

Patients who have contraindications and intolerance to the use of MTX

{Remember, leflunomide is also contraindicated in pregnancy}

24
Q

Routine CBC and monitoring for signs of infection is important when giving ____________ (MTX/hydroxychloroquine)

25
What are the adverse effects of hydroxychloroquine?
``` Ocular toxicity Corneal deposits Irreversible retinal damage CNS disturbances GI upset skin discoloration and eruptions ```
26
___________ is not recommended in liver disease as it can be hepatotoxic
Leflunomide
27
Hairless Ariel Wobbled Reluctantly. Mnemonic for adverse effects of leflunomide.
Headache Allergic reactions Weight loss Rash
28
Fat Astronauts Demeaned Hermione Naughtily. Mnemonic for adverse effects of leflunomide.
``` Flu-like syndrome Alopecia Diarrhea Hypokalemia Nausea ```
29
What things should we monitor if a patient is being given leflunomide?
CBC Signs of infection Liver enzymes (because of hepatotoxicity) Electrolytes (because of hypokalemia)
30
The onset of activity of sulfasalazine is ____________
1-3 months
31
What are the adverse effects of sulfasalazine?
Nausea Vomiting Anorexia Leukopenia
32
The onset of action of traditional DMARDs is long so what should be done in the meantime?
Glucocorticoids should be given for symptomatic relief.
33
How should glucocorticoids be given?
the lowest dose for the shortest duration to avoid adverse effects
34
``` Which agent for RA competes with CD28 to prevent full T-cell activation? A. Sarilumab B. Abatacept C. Golimumab D. Adalimumab ```
Abatacept is a costimulation modulator that competes with CD28 to prevent its binding on CD80/CD86 protein, resulting in reduced T-cell activation
35
Golimumab and adalimumab are both ______ | inhibitors
TNF-α inhibitors
36
Sarilumab is ____ inhibitor
IL-6 inhibitor
37
``` Which statement correctly represents the mechanism of action of tofacitinib in the treatment of RA? A. TNF-α inhibitor B. Janus kinase inhibitor C. IL-6 receptor blocker D. Dihydrofolate reductase inhibitor ```
Janus kinase inhibitor
38
Methotrexate inhibits _____________
dihydrofolate reductase
39
Etanercept is an example of ________ inhibitor
TNF-α
40
Tocilizumab is an example of ______ inhibitor
IL-6
41
Rituximab is a monoclonal antibody against ________
CD20 antigen on B cells
42
What are the names of TNF-α inhibitors?
``` Adalimumab Certolizumab Etanercept Golimumab Infliximab ```
43
What are the names of non-TNF biologic agents?
Abatacept Rituximab Tocilizumab Sarilumab
44
What is the function of TNF-α?
Stimulate synovial cells to proliferate and synthesize collagenase -> degrading cartilage Stimulate bone resorption Inhibiting proteoglycan synthesis
45
Clinical response with TNF-α inhibitors can be seen within _______ of therapy
2 weeks
46
When are TNF-α inhibitors used?
Used after a patient has an inadequate response to traditional DMARDs
47
TNF-α should be used cautiously in those with __________ as it can worsen the condition.
heart failure
48
A risk of _________ (type of cancer) has been observed with the use of TNF-α inhibitors
lymphoma
49
Patients receiving biologic DMARDs (TNF-α inhibitors and non-TNF agents) are at risk of infections. Give examples of infections.
tuberculosis fungal opportunistic infections sepsis
50
Non-TNF agents and ___________ should not be used in combination because of high risk of infections.
TNF-α inhibitors
51
Reactivation of ___________ can occur with the use of biologic DMARDs
hepatitis B
52
____________ should not be administered to patients taking biologic DMARDs
Live vaccinations
53
Name some other uses of TNF-α inhibitors.
Ulcerative colitis Crohn disease Psoriasis Ankylosing spondylitis

Pharmacology - Locomotor Module (5 decks)

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