Autoimmune Flashcards
1
Q
What is the goal within 3 months of a diagnosis of RA?
A
start the patient on a DMARD
2
Q
what are the non biologic DMARDs?
A
MTX - Rhematrex, Trexall, Otrexup sulfasalazine-Azulfidine, Sulfazine minocycline-Minocin, Dynacin, Solodyn hydroxychloroquine-Plaquinel Leflunomide- Arava Tofacitinib- Xeljanz (Not sure may be biologic)
3
Q
What are the antiTNF alfa drugs for RA?
A
adalimumab certolizumab etanercept golimumab infliximab
4
Q
what are the nonTNF agents for RA?
A
abatacept rituximab and tocilizumab
5
Q
methotrexate brand
A
Rheumatrex; Trexall, Otrexup
6
Q
Otrexup
A
SC weekly methotrexate injection
7
Q
How long can it take to see benefit from MTX?
A
up to 12 weeks
8
Q
What are the common SEs associated with MTX?
A
N/V increased LFTs stomatitis alopecia photoxensitivity
9
Q
What should be done at baseline when using MTX?
A
Hep B and C testing
10
Q
What are some BB warnings with MTX?
A
hepatitis BMS mucositis Dermatologic conditions renal pneumonitis
11
Q
What are SEs associated with Plaquenil?
A
N/D rashes pigmentation of skin and hair weakness vision changes
12
Q
What SEs are associated with sulfasalazine?
A
HA anorexia dyspepsia N/V/D oligospermia rash folate deficiency
13
Q
What RA drug can cause yellow/orange coloration of skin/urine?
A
sulfasalazine
14
Q
leflunomide
A
Arava
15
Q
What do you have to screen for prior to starting leflunomide?
A
Tb and pregnancy (category X)
16
Q
tofacitinib
A
Xeljanz
17
Q
What should you screen for prior to starting Xeljanz?
A
latent Tb should be treated prior to using
18
Q
________ is a REMS drug which also has to be given once daily if given with a strong 3A4/2C19 inhibitors
A
Tofacitinib
19
Q
renal excretion is decreased when MTX is given with what drugs
A
NSAIDS probenacid beta lactams aspirin
20
Q
what combination should be avoided due to both concentrations increasing when coadministered?
A
MTX and cyclosporine
21
Q
etanercept
A
Enbrel
22
Q
Which RA drugs are only given in combo with MTX in RA?
A
infliximab and golimumab rituximab
23
Q
adalimumab
A
Humira
24
Q
golimumab
A
Simponi
25
Remicade
infliximab
26
Which drug has the possiblility of a delayed hypersensitivity reaction?
infliximab; 3 to 10days later (fever rash myalgia sore throat)
27
What are the BB warnings with the TNF drugs?
serious infections. lymphomas and other malignancies reactivation of latent Tb
28
What are the warnings with the TNF drugs?
can cause hep B reactivation, HF, hepatotoxicity, LLS
29
When dispensing TNF inhibitors you must give a _____
medguide
30
Which drugs carry the potential to cause progressive multifocal leukoencephalopathy?
rituximab(Rituxan) & natalizumab (Tysabri)
31
anakinra brand name &MOA
Kineret; IL1 antagonist
32
abatacept
Orencia
33
abatacept MOA
inhibits T cell activation by binding CD80 and 86
34
toclizumab
Actemra
35
toclizumab MOA
IL6 receptor antagonist
36
How should biologics be stored?
refrigerated!
| etanercept(Enbrel) may be kept at RT up to 14 days
37
What drugs are commonly associated with drug induced Lupus?
```
procainamide,
propylthiouracil
methimazole
methyldopa
hydralazine,
isoniazid,
terbinafine
quinidine
antiTNF agents
```
38
Which two antimalarial drugs are used in Lupus?
hydroxychloroquine & chloroquine for mild disease; may take up to 6 months to see effect
39
What cytotoxic drugs are used in severe Lupus disease?
cyclophosphamide,
cyclosporine,
azathioprine,
mycophenolate,
40
Sandimmune/Neoral
cyclosporine
41
Cellcept
mycophenolate
42
What is the drug that is an antibody that binds Blys protein reducing the activity of B cell mediated immunity?
belimumab/ BenLysta
43
belimumab
Benlysta
44
What are SEs associated with mycophenolate?
diarrhea GI upset vomiting hypotension tachycardia pain hyperglycemia hypomagnesemia hypocalcemia hypercholesterolemia tremor acne
45
Which form of cyclosporine has been modified to incrase bioavailability?
Neoral; not interchangable with sandimmune
46
What are common SEs with cyclosporine
HTN and nephropathy
47
glatiramer
Copaxone daily SC
48
What are the administration differences between the interferon betas for MS?
Avonex is IM weekly; Rebif is three times a week; betaseron/Extavia is every other day; All are SC except Avonex is IM
49
What MS drug is given IV every 4w?
natalizumab (Tysabri)
50
Which drug is only available through the TOUCH REMS program?
Tysabri
51
Which drug for MS has a CI with HF, heart block, MI, unstable agnina etc.?
fingolimod (Gilenya) ; *can decrease HR
52
gluten is a protein found in
wheat barley and rhye
53
Where can the phone # to a drug information line of a MNF be found
RedBook drug facts and comparisons
54
what eye drop can be used in Sjogrens if OTC drops are not working
cyclosporine (Restasis)
55
What prescription products are available to treat dry mouth?
pilocarpine (Salagen) Cevimeline (Evoxac)
56
What are the side effects of Gilenya (fingolimod)?
Influenza, back pain, cough, increased LFTs
57
How long after Gilenya (fingolimod) should one wait to get MMR or zoster vaccines?
more than 2months
58
What must be monitored hourly for 6 hours after the 1st dose of Gilenya (fingolimod)
HR, BP & signs of Bradycardia
59
How often is a Hysabri (natalizumab) infusion given
every 4 weeks
60
What are the side effects of natalizumab (Tysabri)?
depression, pain in extremities, abdominal discomfort, infection
61
What are Inteferon betas used for
Relapsing MS
62
List the interferon betas, their rout & frequency of administration & dosage forms
Inteferon beta-1a: Avonex IM once wkly powder, pre-filled syringe & pen
Inteferon beta-1a: Rebif & Rebif ebidose SC 3x week pre-filled syringes
Interferon beta-1b: Betaseron & Extavia SC EOD powder
63
How long can Copaxone (glatiramer acetate) be kept at room temp
up to 1 month
64
All MS medications are pregnancy C except
Copaxone (glatiramer acetate) pregnancy B
| Aubagio (teriflunomide) pregnancy X
65
What are the contraindications of Aubagio (terflunomide)
sever liver impairment, pregnancy, current leflunomide use
66
What are the side effects of Aubagio (teriflunomide)
increased LFTs, alopecia, influenza, hypophosphatemia, paresthesia,
rare: renal impairment, hyperkalemia, peripheral neuropathy
67
What is the manor side effect of dimethyl fumarate (Tecfiera) and how is it managed?
Flushing, treat with aspirin 30 minutes before
68
What is the mechanism of action of Ampyra (dalfampridine
potassium channel blocker which may increase nerve signal conduction
69
What is the contradiction for using Amyra (dalfampridine
history of seizures & CrCl < 50ml/min
70
What are the side effects of Amyra (dalfampridine)
UTI, insomnia, dizziness, back pain
71
how long does it take for Ampyra (dalfampridine) to take effect & what symptom does it improve?
up to 6 weeks & mainly improves walking
72
What are additional symptoms of MS & how are they managed ?
Incontinence- anticholinergics--> worsen cognition
Constipation- laxatives
diarrhea-loparamide
muscle spasms- skeletal muscle relaxants or opioids
localized pain-botox
tremors-propranolol--> worsen cognition, depression, sexual function
depression- antidep., SNRI for neuropathic & depression--> worsen libido
fatigue-modafinil or stimulants
dizziness & vertigo-meclizine & scopolamine--> worsen cognition
cognitive function- donepazil or acetylcholinesterase inhibitors
Erectile dysfunction-PDE-inhibitors
79
Azulfidine, sulfazine
Sulfasalazine
80
Minocycline
Minocin, Dymacin, Solodyn
81
JAK inhibitor used in moderate- severe RA, not to be used with biologics or potent immunosuppressants
Xeljanz-tofacitinib
82
Which RA therapies can be used in liver disease
```
Minocyclin-Minocin
Sulfasalazine- sulfazine, azulfidine
Hydroxychloroquine - plaquenil
Rituximab-rituxan
Anakinra-kineret
Abatacept- orencia
```
83
All biologics have a warning for
Increased infections
Activation of latent TB
NO live vaccines
84
Leflunomide-Arava side effects a NDASI contraindications
Contraindicated: pregnancy-X
SE: Hepatotoxicity, URTI, hypertention, alopecia, blood dyscrasias
85
What warnings make Xeljanz-tofacitinib unique
Opertunistic infections
| GI perforations
86
Orencia- abatacept is not a good option for RA in pts with what condition?
COPD
87
What are the special warnings and side effects of Actemra- tocilizumab
May cause GI PERFORATION
DO NOT give if LFTs >1.5. ULN
increases LDL
88
BBW of Rituxan- Rituximab
```
Serious/ fatal infusion rxtn: monitor heart & vitals during & after infusion eps. 1st
Causes PML
Tumor lysis- this usually when for NHL
SJS/TENS
Angioedema (more SE)
```
89
What specific monitoring must be done with plaquenil
Eye exam
