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Flashcards in Drugs for RA Deck (19):
1

What is RA?

Causes significant systemic effects
--shorten life and reduce mobility and quality of life
Autoimmune disease driven primarily by activated T cells
--give rise to cytokines like IL-1 and TNF

2

What are the three classes of drugs used for treatment of RA?

NSAIDs (symptomatic relief and inflammation reduction)
Glucocorticoids (relieve joint symptoms and control systemic manifestations)
DMARDs (longer onset of action)
(Neither NSAIDs nor glucocorticoids prevent disease progression or joint destruction)
(DMARDs reduce or prevent joint damage and delay or stop progression of disease)

3

What are the DMARDs prescribed for RA?

Methotrexate: first DMARD prescribed
Biologic DMARDs: TNF alpha inhibitors are for more moderate to severe disease

4

Methotrexate is the first choice to treat RA however what are other Non-biologic DMARDs?

Leflunomide:
--as effective as methotrexate -- pt can be given combo therapy with methotrexate if they do not respond to methotrexate as a monotherapy

5

What is the 3rd non-biologic DMARDs?

Hydroxychloroquine:
---moderately effective for mild RA
--least toxicity
--least effective as monotherapy (used with methotrexate and sulfasalazine)
3-6 months to see effectiveness

6

What is the 4th non-biologic DMARDs?

Sulfasalazine:
Effective for RA
2-3 months to become apparent

7

What is the 5th non-biologic DMARDs?

Cyclosporine
--can be helpful in RA but nephrotoxicity and many interactions with drugs and food is limited

8

What is the 6th non-biologic DMARD?

Azathioprine
--used for patients with refractory RA or systemic involvement (rheumatoid vasculitis)

9

What is the 7th non-biologic DMARD?

Cyclophosphamide
--limited to most severe cases of RA (systemic features)
--long term use increases risk of infection and malignancy
Effective against RA when given orally

10

Moving on to the Biologic DMARDs, these are your Anti-TNF alpha drugs. What are some general features of these drugs?

Adalimumab, Infliximab and Etancercept
Mediated by specific membrane bound TNF receptors
---TNF alpha is particularly important in the inflammatory process
Act much quicker
When used in combo with methotrexate there is synergistic effects

11

What are other options for drugs in RA?

Rituximab:
--given concurrently with methotrexate or another nonbiologic DMARD
Abatacept:
--patients who did not respond to nonbiologic DMARDs or anti-TNF agents
Anakinra
--moder to severe RA

12

Next set of drugs used for RA are glucocorticoids, what are some features?

Relieve joint symptoms and control systemic manifestations
There are many complications so usually these are used until the effects of DMARDs become apparent
Fast acting
Intra-articular injection of corticosteroid can often relieve an acutely inflamed rheumatoid join

13

What are some adverse effects of glucocorticoids?

Osteoporosis
Weight gain
Fluid retention
Cataracts
Poor wound healing
Gastric Ulcers
GI bleeding
Hyperglycemia
HTN
Adrenal Suppression
Increased risk of infection

14

NSAIDS can also be used for RA, when is this appropriate?

Immediate analgesic and anti-inflammatory effects
Bridge drugs for relief of symptoms

15

In regards to RA what are the choice of drugs?

Non-biological DMARD and add an NSAID or corticosteroid to control symptoms
(DMARD = methotrexate)

16

In regards to RA, what is the drug of choice in patients with severe disease?

Combine Biologic DMARD with a non-biologic DMARD (methotrexate) for initial treatment
(Non biologic = TNF alpha inhibitors)

17

Finally just to touch on combination therapy, what are some features?

1. Combination DMARD therapy may be more effective than monotherapy
2. Combination therapy typically includes weekly methotrexate, to which other agents are added
3. Combination of different biological agents increases the risk of infection and is not recommened

18

Leflunomide in combination with methotrexate has what side effect?

Increases risk of hepatotoxicity
--patients need to be monitored closely

19

What combo therapies have been shown to be effective in RA patients?

Methotrexate + hydroxychloroquine
Methotrexate + sulfasalazine
Methotrexate + hydroxychloroquine + sulfasalazine
Methotrexate + cyclosporine
Methotrexate + leflunomide
Methotrexate + gold
Methotrexate + TNF inhibitor

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