Drugs in Rheumatoid Arthritis Treatment Flashcards Preview

Pharmacology > Drugs in Rheumatoid Arthritis Treatment > Flashcards

Flashcards in Drugs in Rheumatoid Arthritis Treatment Deck (36):
1

What drugs are used to reduce acute pain in RA?

Analgesics (Acetaminophen, Capsacin, Opioids)

NSAIDS

Glucocorticoids (dexamethasone)

2

What drug classes prevent or control joint damage in RA?

DMARDs = Disease Modifying anti-Rheumatic Drugs

BRMs = Biological Response Modifiers

3

General MOA for DMARDs

Reduce or prevent joint damage

Inhibit the overactive immune system

4

In general, how long do DMARDs take to work?

Weeks-months

5

Hydroxychloroquine
Indication and type of drug

DMARD

Anti-malarial drug that is moderately effective for mild RA

6

Hydroxychloroquine
Rare side effect

Ocular toxicity that may result in permanent visual loss

7

What DMARDs may be used during pregnancy and lactation?

Hydroxychloroquine

Sulfasalazine

8

Hydroxychloroquine
How long does it take to work?

3-6 months

9

Sulfasalazine
Adverse Effect

Agranulocytosis within 2 weeks

Hepatotoxicity

10

Sulfasalazine
Indication

Decreases signs/symptoms of disease and slows joint destruction

11

Methotrexate
Indication

DOC for pts with active moderate/severe RA

Decreases appearance of new bone erosions

Improves LT clinical outcome

12

How long does Methotrexate take to work?

4-6 weeks

13

Methotrexate
MOA

Indirectly increases adenosine production, which leads to immunosuppression

14

Methotrexate
AEs (common and rare)

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

Rare:
-Pulm toxicity
-Bone marrow suppression
-Increased risk lymphoma

15

Methotrexate
Elimination

Renally excreted

(So adverse effects are more common in renal impaired patients)

16

Methotrexate
Contraindications

Pregnancy/Breast Feeding

Pre-existing liver disease

Renal impairment

17

Leflunomide
Indication

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

18

Leflunomide
MOA

Inhibits dihyroorotate dehydrogenase, which synthesizes uridine

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

19

Leflunomide
Contraindications

Pregnancy/Breast feeding

Preexisting liver disease (risk of hepatotoxicity)

20

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

Joint inflammation

Cartilage breakdown

Bone erosion

21

List the anti-TNF-alpha drugs

Etanercept
Infliximab
Adalimumab

22

Anti-TNF-alpha drugs
MOA

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

23

Anti-TNF-alpha drugs
Administration
Clinical Use

Given subQ or IV weekly or biweekly

Used in monotherapy or in combo with methotrexate

24

Anti-TNF-alpha drugs
AEs

Increased risk of opportunistic infection (fungal/bacterial)

Potential reactivation of latent TB and latent HBV

25

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

Latent TB infection

Latent HBV infection

26

Abatacept
What is it?
Clinical Use

Recombinant fusion protein of CTLA4 and human IgG

Used in pts non-responsive to TNF-alpha inhibitors

27

Abatacept
MOA

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

28

Abatacept
AEs and Contraindications

Increased risk for serious infections

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

29

Rituximab
MOA

Binds CD20 on B cells and depletes B cells from blood

30

Rituximab
How long does it last?

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

31

Rituximab
AEs

Increased infections
Risk of PML

32

Anakinra
MOA

IL-1 receptor antagonist

Competitively inhibits pro-inflammatory effects of Il-1

33

Anakinra
AEs

Neutropenia
Infection risk increases

Never given to patients with an acute/chronic infection

Bad when given with an anti-TNF-alpha drug

34

Tocilizumab
MOA and Clinical Use

IL-6 receptor antagonist

Used in patients who are non-responsive to TNF inhibitors

May be used in combo with methotrexate

35

Tocilizumab
AEs

Bone marrow suppression (lymphocytopenia, neutropenia, anemia)

Increased infection risk

Hepatotoxicity

36

Tofacitinib
MOA

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

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