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Pharmacology > Drugs in Rheumatoid Arthritis Treatment > Flashcards

Drugs in Rheumatoid Arthritis Treatment Flashcards

1
Q

What drugs are used to reduce acute pain in RA?

A

Analgesics (Acetaminophen, Capsacin, Opioids)

NSAIDS

Glucocorticoids (dexamethasone)

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2
Q

What drug classes prevent or control joint damage in RA?

A

DMARDs = Disease Modifying anti-Rheumatic Drugs

BRMs = Biological Response Modifiers

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3
Q

General MOA for DMARDs

A

Reduce or prevent joint damage

Inhibit the overactive immune system

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4
Q

In general, how long do DMARDs take to work?

A

Weeks-months

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5
Q

Hydroxychloroquine

Indication and type of drug

A

DMARD

Anti-malarial drug that is moderately effective for mild RA

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6
Q

Hydroxychloroquine

Rare side effect

A

Ocular toxicity that may result in permanent visual loss

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7
Q

What DMARDs may be used during pregnancy and lactation?

A

Hydroxychloroquine

Sulfasalazine

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8
Q

Hydroxychloroquine

How long does it take to work?

A

3-6 months

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9
Q

Sulfasalazine

Adverse Effect

A

Agranulocytosis within 2 weeks

Hepatotoxicity

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10
Q

Sulfasalazine

Indication

A

Decreases signs/symptoms of disease and slows joint destruction

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11
Q

Methotrexate

Indication

A

DOC for pts with active moderate/severe RA

Decreases appearance of new bone erosions

Improves LT clinical outcome

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12
Q

How long does Methotrexate take to work?

A

4-6 weeks

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13
Q

Methotrexate

MOA

A

Indirectly increases adenosine production, which leads to immunosuppression

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14
Q

Methotrexate

AEs (common and rare)

A

Common:
Dose-related hepatotoxicity (do NOT drink alcohol with methotrexate)

Rare:

  • Pulm toxicity
  • Bone marrow suppression
  • Increased risk lymphoma
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15
Q

Methotrexate

Elimination

A

Renally excreted

So adverse effects are more common in renal impaired patients

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16
Q

Methotrexate

Contraindications

A

Pregnancy/Breast Feeding

Pre-existing liver disease

Renal impairment

17
Q

Leflunomide

Indication

A

Used in pts with RA who can’t take or are nonresponsive to Methotrexate

18
Q

Leflunomide

MOA

A

Inhibits dihyroorotate dehydrogenase, which synthesizes uridine

Causes G1 cell cycle arrest, inhibiting T cell proliferation and production of autoantibodies by B cells

19
Q

Leflunomide

Contraindications

A

Pregnancy/Breast feeding

Preexisting liver disease (risk of hepatotoxicity)

20
Q

Describe how TNF-alpha plays a role in inflammation of RA

A

Joint inflammation

Cartilage breakdown

Bone erosion

21
Q

List the anti-TNF-alpha drugs

A

Etanercept
Infliximab
Adalimumab

22
Q

Anti-TNF-alpha drugs

MOA

A

Bind TNF-alpha and prevent it from binding its receptor, thus preventing inflammation

23
Q

Anti-TNF-alpha drugs
Administration
Clinical Use

A

Given subQ or IV weekly or biweekly

Used in monotherapy or in combo with methotrexate

24
Q

Anti-TNF-alpha drugs

AEs

A

Increased risk of opportunistic infection (fungal/bacterial)

Potential reactivation of latent TB and latent HBV

25
Q

Before starting Anti-TNF-alpha drugs, you should screen the patient for….

A

Latent TB infection

Latent HBV infection

26
Q

Abatacept
What is it?
Clinical Use

A

Recombinant fusion protein of CTLA4 and human IgG

Used in pts non-responsive to TNF-alpha inhibitors

27
Q

Abatacept

MOA

A

It’s CTLA4 domain inhibits T cell activation by blocking delivery of CD28 costimulatory signals

28
Q

Abatacept

AEs and Contraindications

A

Increased risk for serious infections

Should NOT be given in combo with a TNF-alpha blocker

29
Q

Rituximab

MOA

A

Binds CD20 on B cells and depletes B cells from blood

30
Q

Rituximab

How long does it last?

A

Effects not seen for 3 months, though the effects may last 6 months - 2 years after one infusion

31
Q

Rituximab

AEs

A

Increased infections

Risk of PML

32
Q

Anakinra

MOA

A

IL-1 receptor antagonist

Competitively inhibits pro-inflammatory effects of Il-1

33
Q

Anakinra

AEs

A

Neutropenia
Infection risk increases

Never given to patients with an acute/chronic infection

Bad when given with an anti-TNF-alpha drug

34
Q

Tocilizumab

MOA and Clinical Use

A

IL-6 receptor antagonist

Used in patients who are non-responsive to TNF inhibitors

May be used in combo with methotrexate

35
Q

Tocilizumab

AEs

A

Bone marrow suppression (lymphocytopenia, neutropenia, anemia)

Increased infection risk

Hepatotoxicity

36
Q

Tofacitinib

MOA

A

Small molecule inhibitor of JAK tyrosine kinases involved in immune cell cytokine signaling

Pharmacology (67 decks)

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