DMARDs

Question 1

TNF alpha is produced by _______ and stimulates production of_________

Answer 1

macrophages

prostaglandin

Question 2

what are NSAIDs used for in chronic inflammatory disease?

Answer 2

tx of sx

Question 3

DMARDs have what effect on chronic inflammatory diseases?

Answer 3

modify course of disease

Question 4

do DMARDs have analgesic properties?

Answer 4

no

Question 5

describe the onset of effects for DMARDs

Answer 5

generally weeks to months

Question 6

Which DMARD?

suppress cellular immunity

causes bone marrow damage and enterocolitis

Answer 6

Gold Salts

Question 7

This is a chelating DMARD that is effective in RA and Wilson’s disease

Answer 7

penicillamine

Question 8

The below are the toxicities of…

• high incidence of reaction
• thrombocytopenia, leukopenia, agranulocytosis, aplastic anemia
• lupus, pemphigus, goodpastures
• nephrotic syndrome

Answer 8

penicillamine

Question 9

This drug has antihistamine, anticholinesterase and antiprotease properties.

It stabilizes the lysosomes and reacts with nucleic acids/proteins

Answer 9

hydroxychloroquine

Question 10

This drug:

• inhibits prostaglandin synthesis
• inhibits mucopolysaccharaide synthesis
• inhibits chemotaxic responses and phagocytosis

Answer 10

hydroxychloroquine

Question 11

The below are toxicities to which drug?

• pruritis
• hemolysis in G6PD
• ototoxicity, retinopathy, peripheral neuropathy (cinchonism)

Answer 11

hydroxychloroquine

Question 12

This is an IBD drug now used to treat RA.

it is better tolerated and as effective as older therapies…

Answer 12

sulfasalazine

Question 13

how long must you monitor for hepatitis and marrow suppression when starting sulfasalazine?

Answer 13

2-3 weeks q 1st 3 months

Question 14

TNF Alpha inhibitors are often combined with…

Answer 14

MTX

Question 15

Which TNF Alpha inhibitor?

Chimeric

composed of human constant region

murine variable region

IgG1k mAb

Answer 15

infliximab

Question 16

4 C/I for TNF alphas?

Answer 16

pregnancy, breast feeding, children, infx

Question 17

route of admin for infliximab?

Answer 17

IV

Question 18

infliximab is approved for…(2)

Answer 18

Chron Disease and RA

Question 19

Which TNF Alpha inhibitor?

IgG1

100% human derived

monotherapy for RA

Answer 19

adalimumab

Question 20

adalimumab is administered ________ and has a half-life of…

Answer 20

SC

8-10 days

Question 21

the below are S/Es for…

rash
flu sxs
fatigue
HA
pruritis
N/V

Answer 21

TNF-A inhibitors

esp. adalimumab

Question 22

2 “me too” drugs of adalimumab…

Answer 22

certrolizumab

golimumab

Question 23

Which TNF Alpha inhibitor?

dimeric fusion protein via recombinant DNA

acts as false TNF receptor

Answer 23

etenercept

Question 24

The below are contraindications of…

bone marrow suppression
breast feeding
children
DM
Infx
Sepsis
Vaccination
Varicella

Answer 24

etanercept

Question 25

2 inhibitors of B/T cells

Answer 25

rituxumab abatacept

Question 26

Which T/B cell inhibitor? chimeric mAb IgG that binds to CD20 on B-Cells

Answer 26

Rituximab

Question 27

CD-20 is expressed on > 90% of B-Cells in _______

Answer 27

Non-Hodgkin Lymphoma

Question 28

Which T/B cell inhibitor? fully human recombinant fusion protein T-cell activation blocker Competes w/ CD-28

Answer 28

Abatacept

Question 29

This drug disrupts key mechanisms of inflammation and joint destruction in RA may also affect defenses against infx and malignancy via T cell inhibition

Answer 29

abatacept

Question 30

Inhibitor of nucleic acid synthesis...

Answer 30

leflunomide

Question 31

Which drug? inhibits DHODH, enzyme that catalyzes de novo pyramidine synth

Answer 31

leflunomide

Question 32

Which drug? inhibits the induction of COX-2

Answer 32

leflunomide

Question 33

route of leflunomide

Answer 33

PO

Question 34

3 C/Is for leflunomide

Answer 34

pregnancy breast feeding hepatic/renal failure

Question 35

Which drug? inhibits lymphocyte purine synth by reversible inhibition of IMPDH

Answer 35

mycophenolate mofetil

Question 36

C/Is for mycophenolate mofetil... (5)

Answer 36

``` Active GI disease Diarrhea Pregnancy Breast Feeding Infx ```

Question 37

IL-1 receptor antagonist...

Answer 37

anakinra

Question 38

mAb against IL-6 receptor. compete w. IL-6 to bind similar acts to other immunosuppressants

Answer 38

tocilizumab

Question 39

When should JAK inhibitors be considered?

Answer 39

severe RA w. intolerance to MTX

Question 40

Tofacitinib is what class?

Answer 40

JAK inhibitor

Question 41

tofacitinib can precipitate... (2)

Answer 41

malignancy & serious infx

Question 42

Which JAK inhibitor? Primarily inhibits JAK1 and JAK3

Answer 42

Tofacitinib

Question 43

Which JAK inhibitor? Primarily inhibits JAK1 and JAK2

Answer 43

Baricitinib

Question 44

This JAK inhibitor may be used as monotherapy or in combo w. MTX or other non-biologic DMARDs

Answer 44

baricitinib