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DMARDs Flashcards

1
Q

Is RA symmetrical or asymmetrical

A

Symmetrical

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2
Q

Do DMARDs affect RA disease progression

A

Yes

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3
Q

What are DMARDs combined with to treat newly diagnosed RA

A

Methotrexate
Short term glucocorticoid
Another DMARD

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4
Q

When is DMARD mono therapy used in RA

A

Pregnancy
Co morbidities

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5
Q

How should DMARD therapy be changed in recent onset RA where control is satisfactory

A

Decr dose

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6
Q

How do DMARDs effect radiographic progression, number of swollen joints, and fatigue severity

A

Improve radiographic progression and number of swollen joints
No effect on fatigue

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7
Q

What is the anchor drug for RA

A

Methotrexate

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8
Q

What is given to women before staring methotrexate

A

Pregnancy test

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9
Q

How is methotrexate administered for RA

A

Oral
SC or IM can be used if oral ineffective

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10
Q

How does methotrexate dose change over RA treatment

A

Start on high dose and decrease

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11
Q

Which enzymes do methotrexate inhibit to prevent DNA and RNA production

A

Dihydrofolate reductase
Thymidylate synthetase

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12
Q

What assessments do patients on methotrexate need every 1-3 months

A

Full blood count
Liver function tests

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13
Q

Methotrexate MOA

A

inhibiting dihydrofolate reductase + thymidylate synthetase -> decr RNA + DNA synthesis
JNK activation -> incr ROS -> Induce apoptosis and cell cycle arrest
Inhibit IL1 and NF-kB production

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14
Q

Salfasalazine

A

Sulphur based antibiotic combining sulfapyridine and 5-amino salicylic acid

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15
Q

Does sulfasalazine act locally or systematically

A

Sulfapyridine absorbed systematically
5-ASA has local anti inflam action

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16
Q

Sulfasalazine MOA

A

Not well understood
Concentrates in CT and serous fluid
Suppresses superoxide radical and cytokine production

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17
Q

What other condition is sulfasalazine mainly used for

A

Ulcerative colitis

18
Q

Hydroxychloroquine main use

A

Antimalarial

19
Q

Hydroxychloroquine MOA in RA

A

Increases pH in lysozymes decreasing protein modifications
Blocks TLR 9 decreasing dendritic cell activation

20
Q

Leflunomide MOA

A

Inhibits pyramiding biosynthesis by inhibiting dihydroorotate dehydrogenase

21
Q

D penecillin MOA in RA

A

copper chelator
Decr immune response and IL1 generation
Prevents fibrosis

22
Q

D pencillamine main side effect

A

Kidney damage

23
Q

Why are gold salts not often used for RA treat,ent

A

Side effects

24
Q

Traditional DMARDs

A

Methotrexate
Sulfasalazine
Hydroxychloroquine
Leflunomide
D pencillamine
Gold salts

25
Cells/molecules inhibited by Biological DMARDs
TNFa IL1, 6, 17, 23 B cells T cells IL6 JAK
26
TNFa blocker MOA
Remove TNFa from system before it reaches TNFa receptor
27
Etanercept
TNFa blocker Fusion protein of human TNF receptor 2 and human IgG1
28
Infliximab
TNFa blocker Monoclonal antibody against TNFa
29
Adalimumab
Human monoclonal antibody for TNFa
30
Which molecule is targeted by anakinra canakinumab and rilonacept
IL1 Anakinra - IL1 receptor antagonist Canakinumab - IL1 monoclonal antibody Riloncept - binds to IL1
31
Rituximab
Monoclonal antibody against CD20 on B cells
32
How does rituximab destroy normal and malignant B cells
Complement dependent cytotoxicity Antibody dependent cellular cytotoxicity Recognition by macrophages Activates apoptosis
33
What cells do abatacept and balatacept target and what process do they effect
T cells Disrupt cell signalling through CD28
34
Which drug is rituximab, and tocilizumab given in combination with
Methotrexate
35
Tocilizumab
Humanised monoclonal antibody against membrane and soluble IL6 receptor
36
What drug type are tofacitinib, baricitinib, and upadacitinib
JAK inhibitor
37
What is JAK
Janus kinase
38
How are biological DMARDs generated
Genetic engineering
39
What IL does secukinumab and ustekinumab target
Secukinumab - IL17 Ustekinumab - IL23
40
Which condition are IL17 and IL23 mainly used for
Psoriasis
41
Difference between neutralising and non neutralising anti drug antibodies
Neutralising directly interferes with biological drugs ability to work Non neutralising forms immune complexes around injection site reducing drug conc and pharmacokinetics
42
What molecule made by the body decreases the effectiveness of biological DMARDs
Anti drug antibodies

LOCO2 (26 decks)

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