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NAPLEX 21 > Autoimmune Conditions: RA > Flashcards

Autoimmune Conditions: RA Flashcards

(57 cards)

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1
Q

What are the non-specific lab blood tests that can be useful in detecting inflammation?

A

ESR

CRP

FR

ANA

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2
Q

The use of strong immunosuppressants can increase the risk of certain conditions including:

A

re-activation of TB, hep B, hep C; testing needs to be done prior to start

viruses - live vaccines must be given before start

lymphomas and certain skin cancers

infections

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3
Q

This autoimmune disease is a chronic, progressive autoimmune disorder that primary affects the joints

A

rheumatoid arthritis

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4
Q

Articular symptoms of RA

A

joint swelling - bilateral

pain

stiffness

bone deformity

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5
Q

Is stiffness and pain worse or better after rest in RA?

A

worse!

“morning stiffness” common

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6
Q

What are useful lab tests in diagnosing RA?

A

Anti-citrullinated peptide antibody (ACPA) and rheumatoid factor (RF)

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7
Q

What is the non-drug treatment for RA?

A

rest

physical therapy

occupational therapy

exercise, diet, weight control

joint replacement

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8
Q

Patients with symptomatic RA should be started on what, regardless of the severity of the disease?

A

disease-modifying anti rheumatic drug (DMARD)

they slow the disease process and prevent further joint damage

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9
Q

What is the preferred initial therapy for most patients with RA?

A

methotrexate

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10
Q

For patients with mod-high disease activity, despite methotrexate, a combination of what is recommended?

A

DMARDs

OR

TNF inhibitor biologic

OR

non-TNF biologic

(with or without MTX) +/- steroid

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11
Q

What should you never use in combination due to the risk of fatal infections?

A

two biologic DMARDs

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12
Q

What drug is commonly used in RA flares and should be used at the lowest dose & shortest duration

A

steroids (<10mg/day prednisone or equiv)

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13
Q

What is used to “bridge” DMARDs?

A

low dose steroids and in patients with DMARD failure

NSAIDs are a weaker option, but less toxic – higher doses needed

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14
Q

Brand: Trexall

A

generic: methotrexate

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15
Q

What drug?

dosed 7.5-20mg once weekly (PO, SC, IM)

NEVER dosed daily for RA – liver damage

BW: hepatotoxicity, myleosuppression, mucositis/somatitis, pregnancy

A

methotrexate

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16
Q

What are the SC auto-injectors of MTX?

A

Otrexup and Rasuvo

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17
Q

This drug works by irreversibly binding and inhibiting dihydrofolate reductase, inhibiting folate, thymidylate synthetase and purine

A

MTX

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18
Q

What drug?

CBC, LFTs, chest x-ray, hepatitis B & C serologies

A

MTX

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19
Q

MTX - what can be give to dec hematological, GI and hepatic side effects

A

folate

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20
Q

List traditional (non-biologic) disease-modifying anti rheumatic drugs (DMARDs)

A

methotrexate

hydroxychloroquine

sulfasalazine

leflunomide

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21
Q

Brand: Plaquenil

A

generic: hydroxychloroquine

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22
Q

What traditional DMARD has a warning for irreversible retinopathy?

A

hydoxychloroquine

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23
Q

What traditional DMARD has a contraindication in patients with a sulfa or salicylate allergy?

Study These Flashcards
A

sulfasalazine

24
Q

What traditional DMARD can cause skin/urine to turn yellow/orange?

Study These Flashcards
A

sulfasalazine

25
Brand: Arava
generic: leflunomide
26
This traditional DMARD's MOA inhibits pyrimidine sythnesis
leflunomide
27
This traditional DMARD has a boxed warning for use in pregnancy (must wait two years after d/c) and hepatoxicity. It also has an accelerated drug elimination option
leflunomide
28
tofacitinib/Xeljanz baricitnib/ Oluminant upadacitinib/ Rinvoq drug class?
Janus Kinase Inhibitors (JAK)
29
Can you use JAK inhibitors and DMARDs together?
NO!
30
This drug class has a boxed warning for serious infection (TB, OI); malignancy; thrombosis
JAK inhibitors
31
Methotrexate should not be taken with ____, this combo can increase the risk of liver toxicity
alcohol
32
Are needles included with the anti TNF biologics (TNF alpha inhibitors)?
yes! each drug also has its own pregnancy registry
33
Brand: Enbrel
generic: Etanercept
34
Brand: Humira
generic: adalimumab
35
Brand: Remicade
generic: infliximab
36
Brand: Cimiza
Brand: certolizumab pegol
37
Brand: Simponi
generic: golimumab
38
This anti TNF biologic is dosed 50mg SC weekly
etanercept/ Enbrel
39
This anti TNF biologic is dosed SC every OTHER week
Humira (40mg), Cimiza (200mg)
40
This anti TNF biologic is dosed only with IV
Remicade 0,2,6,8 weeks; delayed hypersensitivity, 3-12 days after NS ONLY
41
This anti TNF is dosed SC monthly
Simponi *requires a filter
42
This drug class has a boxed warning for serious infection and malignancies. Warnings for demyelinating disease, hep B reactivation, heart failure, hepatoxicity, lupus-like syndrome
anti TNF biologics *do not shake, freeze -- requires fridge!
43
Can you use anti TNF biologics with biologic DMARDs or with live vaccines?
no!!!!
44
anti TNF biologics monitoring
TB test, HBV, signs of infection If TB test is positive, must treat prior to starting
45
What is first line for RA? what's add on therapy?
1st - methotrexate add-on - anti TNF biologics UNLESS presentation is severe
46
Rituximab Abatacept Anakinra drug class?
Biologic DMARDs -- non-TNF inhibitors single-dose profiled syringe needles come w drug preg registry
47
This non-TNF inhibitor's MOA is depletes CD20 B cells
rituximab
48
This non-TNF inhibitor is premeditated with a steroid, Tylenol, and an anthistamine
rituximab
49
This non-TNF inhibitor has boxed warnings for infusion-related reactions, HBV reactivation
rituximab
50
This non-TNF inhibitor has warnings for malignancies, and serious infections
anakinra
51
What DMARDs are given WITH methotrexate?
Remicade/ infliximab Simponi/ golimumab Rituxan/ rituximab
52
Brand: Rituxan
generic: rituximab
53
What drug? dosed once weekly for RA and psoriasis. Can cause liver damage, infection, mouth sores, GI blood Take folic acid to decrease side effects
MTX
54
What two drugs are single-use auto-injectors (abdomen or upper thigh only)
Rasuvo (5 seconds) Otrexup (3 seconds)
55
These medications are administered subQ and can cause infection, liver damage, and heart failure. the medication should be stored in the fridge with protection from light and sources of heat.
Adalimumab - room temp for 14 days ok etanercept - room temp for 14 days ok golimumab
56
adalimumab, etanercept, or golimumab? abdomen or thigh for SC injection
adalimumab
57
adalimumab, etanercept, or golimumab? abdomen, upper arm, or thigh for SC injection
etanercept & golimumab

NAPLEX 21 (60 decks)

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