DMARDs + gout

Question 1

What is the fastest-acting nonbiologic DMARD?

Answer 1

Methotrexate (3–6 weeks onset)

Question 2

How is methotrexate administered?

Answer 2

Once weekly, orally or intramuscularly

Question 3

What are the major adverse effects of methotrexate?

Answer 3

Hepatic fibrosis, bone marrow suppression, GI ulcers, pneumonitis, Pregnancy Category X

Question 4

What is the action of sulfasalazine?

Answer 4

Anti-inflammatory and immunomodulatory; slows joint deterioration

Question 5

What are AEs of sulfasalazine?

Answer 5

GI upset (N/V/D, anorexia, pain), rash

Question 6

Name additional nonbiologic DMARDs.

Answer 6

Leflunomide, hydroxychloroquine, minocycline, penicillamine, azathioprine, cyclosporine, prosorba column

Question 7

How are biologic DMARDs usually administered?

Answer 7

Often combined with methotrexate

Question 8

What risks are associated with biologic DMARDs?

Answer 8

Serious infections, possible cancer risk

Question 9

What do TNF inhibitors do?

Answer 9

Block tumor necrosis factor to reduce inflammation

Question 10

Name some TNF inhibitors.

Answer 10

Etanercept (Enbrel), Adalimumab (Humira), Certolizumab (Cimzia), Golimumab (Simponi), Infliximab (Remicade)

Question 11

What are the AEs of TNF inhibitors?

Answer 11

Infection, allergic reactions, heart failure, liver injury, hematologic issues

Question 12

What does Rituximab (Rituxan) target?

Answer 12

B lymphocytes

Question 13

What are AEs of Rituximab?

Answer 13

Infusion reactions, Hep B reactivation, progressive multifocal leukoencephalopathy

Question 14

What does Abatacept (Orencia) inhibit?

Answer 14

T-cell activation

Question 15

What are AEs of Abatacept?

Answer 15

Headache, URI, nasopharyngitis, nausea, infection

Question 16

What does Tocilizumab target?

Answer 16

IL-6 receptor

Question 17

What are AEs of Tocilizumab?

Answer 17

Infection, GI perforation, liver injury, neutropenia, thrombocytopenia

Question 18

What does Anakinra (Kineret) block?

Answer 18

IL-1 receptor

Question 19

AE of Anakinra?

Answer 19

Infection

Question 20

What causes gout?

Answer 20

Uric acid crystal accumulation in joints from overproduction or impaired excretion

Question 21

What are treatment options for acute gout?

Answer 21

NSAIDs, glucocorticoids, colchicine

Question 22

What serum uric acid level indicates treatment for hyperuricemia?

Answer 22

> 7 mg/dL

Question 23

What drugs lower serum uric acid?

Answer 23

Allopurinol, Febuxostat, Probenecid, Pegloticase

Question 24

What joint is most commonly affected by gout?

Answer 24

Big toe (first metatarsophalangeal joint)

Question 25

What does colchicine treat?

Answer 25

Acute gouty arthritis (most effective within 24 hours of symptom onset)

Question 26

Does colchicine have analgesic effects?

Answer 26

No – pain relief is due to anti-inflammatory effect

Question 27

What is colchicine’s mechanism of action?

Answer 27

Inhibits neutrophil migration and microtubule synthesis

Question 28

What are common AEs of colchicine?

Answer 28

N/V/D

Question 29

What are serious AEs of colchicine?

Answer 29

Myelosuppression, myopathy

Question 30

What should nurses monitor with colchicine use?

Answer 30

Serum uric acid, creatinine, colchicine toxicity (e.g., rhabdomyolysis), liver function, I&Os, urination patterns

Question 31

Is colchicine still a first-line therapy?

Answer 31

No – reserved for those unresponsive to other therapies