Ch. 77- Drugs Therapy of Rheumatoid Arthritis Flashcards
(30 cards)
What type of disorder is rheumatoid arthritis (RA)?
Autoimmune, inflammatory disorder
What are the main treatment goals for rheumatoid arthritis?
- Relieve symptoms
- Maintain joint function & range of motion
- Minimize systemic involvement
- Delay progression of disease
What are the classes of antiarthritic drugs used for rheumatoid arthritis?
- NSAIDs
- Glucocorticoids
- DMARDs (Disease-modifying antirheumatic drugs)
- Nonbiologic DMARDs (traditional DMARDs)
- Biologic DMARDs
What is the first-line treatment for immediate pain and inflammation relief in rheumatoid arthritis?
NSAIDs
When should DMARD therapy be initiated after rheumatoid arthritis diagnosis?
Within 3 months of diagnosis
What is the role of glucocorticoids in rheumatoid arthritis treatment?
They may be added until DMARDs take effect if symptoms are not controlled with NSAIDs and are used to control symptom flare-ups.
What are the two generations of NSAIDs?
- First-generation NSAIDs: Inhibit COX-1 & COX-2
- Second-generation NSAIDs (coxibs): Selectively inhibit COX-2
What safety warnings are associated with prescription-strength NSAIDs?
Risk of thrombotic events and gastrointestinal (GI) ulceration & bleeding
What are the general forms of glucocorticoids used in rheumatoid arthritis?
- Oral glucocorticoids for generalized symptoms
- Intra-articular injections for one or two joints affected
List the major nonbiologic DMARDs.
- Methotrexate (Rheumatrex, others)
- Sulfasalazine (Azulfidine)
- Leflunomide (Arava)
- Hydroxychloroquine (Plaquenil)
- Minocycline (Minocin)
What is the most rapid-acting nonbiologic DMARD?
Methotrexate
What is the expected therapeutic effect time frame for methotrexate?
3 to 6 weeks
What are some adverse effects of methotrexate?
- Hepatic fibrosis
- Bone marrow suppression
- GI ulceration
- Pneumonitis
- Alopecia
What is the dosing schedule for methotrexate?
Given once weekly
What should be administered alongside methotrexate to reduce GI and hepatic toxicity?
~5 mg/week of folic acid
What are tumor necrosis factor (TNF) inhibitors used for?
They suppress immune function by neutralizing TNF.
List some examples of TNF inhibitors.
- Etanercept (Enbrel)
- Infliximab (Remicade)
- Adalimumab (Humira)
- Certolizumab pegol (Cimzia)
- Golimumab (Simponi)
What is the route of administration for etanercept (Enbrel)?
Subcutaneous injection
What are some adverse effects of etanercept (Enbrel)?
- Serious infections (e.g., tuberculosis, bacterial sepsis)
- Severe allergic reactions (e.g., SJS, TEN)
- Heart failure
- Cancer (e.g., lymphoma)
- Hematologic disorders
- Liver injury
- CNS demyelinating disorders
What is the function of rituximab (Rituxan)?
Reduces the number of B lymphocytes
What are some adverse effects of rituximab (Rituxan)?
- Infusion reactions
- Mucocutaneous reactions
- Hepatitis B reactivation
- Progressive multifocal leukoencephalopathy (PML)
- Flu-like symptoms initially
- Transient neutropenia
What is the mechanism of action for abatacept (Orencia)?
Inhibits activation of T lymphocytes
What are the common adverse effects of abatacept (Orencia)?
- Headache
- Upper respiratory infection
- Nasopharyngitis
- Nausea
What risk is associated with abatacept regarding infections?
Increased risk for serious infections (e.g., pneumonia, bronchitis)
