DMARDs

Question 1

What are the Non-biological DMARDs

Answer 1

MTX
Leflunomide
Hydroxychloroquine
Sulfasalazine
Cyclosporine
Azathioprine
Cyclophosphamide
Gold sodium thiomalate
Auranofin

Question 2

What are the Biological DMARDs

Answer 2

Adalimumab
Infliximab
Etanercept
Anakinra

Question 3

What are used, but not real DMARDs

Answer 3

Glucocorticoids

Question 4

What is the only purpose of NSAID administration in RA

Answer 4

Sx relief

Question 5

What is the purpose of DMARD administration

Answer 5

Control Sx and delay disease progression

Question 6

How long does it take for DMARDs to kick in

Answer 6

6 weeks to 6 months

Some bio in 2wks

Question 7

What is the DOC for RA

Answer 7

MTX

Question 8

What does MTX do

Answer 8

Decrease purine synthesis

Question 9

How do you reduce MTX toxicity

Answer 9

Add Leucovorin or folate

Question 10

What does Leflunomide do

Answer 10

Arrest cells in G1

Decrease pyrimidine synthesis

Question 11

Used for UC Tx

Answer 11

Sulfasalazine

Question 12

What do you give with Hydroxychloroquine

Answer 12

MTX

Sulfasalazine

Question 13

How does Hydroxychloroquine work

Answer 13

Little gnomes in the blood

Question 14

What must be done before Hydroxychloroquine administration

Answer 14

Opthalmologic exam

Question 15

What are the Hydroxychloroquine AE

Answer 15

Hemolysis with G6PD deficiency

Retinal damage

Question 16

What does MTX do

Answer 16

Inhibit AICAR transformylase
No IMP formation
Adenosine accumulation

Question 17

What does a high amount of adenosine lead to

Answer 17

Decreased NF-kappaB

Question 18

What are the MTX AE

Answer 18

Nausea
Ulcers
Hepatotoxicity
Pseudolymphomatous Rxn

Question 19

When is MTX contraindicated

Answer 19

Pregnancy

Question 20

What is MTX important in inhibiting in cancer

Answer 20

DHF reductase

Question 21

How does Leflunomide act

Answer 21

Inhibits Dihydroorotate dehydrogenase
Decreases UMP
Inhibits autoimmune B, T cell prolif

Question 22

What happens if you mix Leflunomide with MTX

Answer 22

Severe hepatotoxicity

Question 23

What are the Leflunomide AE

Answer 23

Frequent diarrhea
Alopecia, rash
Myelosuppression
Increased aminotransferase activity

Question 24

When is Leflunomide contraindicated

Answer 24

Pregnancy

Question 25

What is the active form of Sulfasalazine

Answer 25

Sulfapyridine

Question 26

What happens to Sulfasalazine in the colon

Answer 26

Metabolized to Sulfapyridine and 5-ASA

Question 27

What are the Sulfasalazine AE

Answer 27

``` Nausea Anorexia Rash Hepatitis Leukopenia SLE ```

Question 28

What can happens with Sulfasalazine in G6PD deficiency

Answer 28

Hemolysis

Question 29

Is Sulfasalazine safe in pregnancy

Answer 29

Yes

Question 30

What does Cyclosporine do

Answer 30

Inhibits Ag-induced signal transduction in T-cells

Question 31

How does Cyclosporine work

Answer 31

Complex with Cyclophillin Prevents NFAT dephos by calcineurin Decreased IL-2

Question 32

Main AE of Cyclosporine

Answer 32

Nephrotoxicity Hirsutism Gum hyperplasia

Question 33

What is a purine antimetabolite

Answer 33

Azathioprine

Question 34

When is Azathioprine administered as a DMARD

Answer 34

Refractory RA

Question 35

How does Azathioprine work

Answer 35

Converted to 6-MP Inhibition of de novo purine synth Suppression of B and T cells

Question 36

When should you reduce the Azathioprine dose

Answer 36

Pt taking Allopurinol | Inhibition of xanthine oxidase

Question 37

What are the Azathioprine AE

Answer 37

BM suppression GI disturbance Infection/Malignancy

Question 38

When do you give Cyclophosphamide

Answer 38

Severe RA

Question 39

How does Cyclophosphamide work

Answer 39

Alkyklating agent crosslinks DNA | No cell replication

Question 40

What is the main AE of Cyclophosphamide

Answer 40

Hemorrhagic Cystitis

Question 41

How do you treat the main AE of Cyclophosphamide

Answer 41

Mesna

Question 42

What are the other Cyclophosphamide AE

Answer 42

BM suppression, Infertility Infection/Malignancy Fanconi's Anemia

Question 43

What are the Macrophage poisons

Answer 43

Gold sodium thiomalate | Auranofin

Question 44

How is GST administered

Answer 44

IM

Question 45

How is Auranofin administered

Answer 45

PO

Question 46

What do GST and Auranofin do

Answer 46

Suppress phagocytosis and lysosomal activity

Question 47

What is the fully human IgG1 anti-TNF Ab

Answer 47

Adalimumab

Question 48

What is the chimeric anti-TNF Ab

Answer 48

Infliximab

Question 49

What is the recombinant anti-TNF Ab

Answer 49

Etanercept

Question 50

How do anti-TNF Abs work

Answer 50

Bind TNFalpha and prevent receptor interaction | Downregulation of T-cell and macrophage function

Question 51

What should be done before anti-TNF Ab Tx

Answer 51

Screening for latent TB

Question 52

What is the main AE of anti-TNF Ab

Answer 52

Serious infection

Question 53

What is the Il-1 receptor antagonist

Answer 53

Anakinra

Question 54

When are Glucocorticoids given in RA

Answer 54

Short term Sx relief until positive DMARD effect is seen

Question 55

What do Glucocorticoids do

Answer 55

Inhibit PLA2 and COX-2

Question 56

What are the AE with chronic Glucocorticoid use

Answer 56

``` Osteoporosis Weight gain Ulcers HTN Hyperglycemia ```

Question 57

What do you never give as combinatino therapy

Answer 57

Multiple biological DMARDs