Flashcards in Drugs in Rheumatoid Arthritis Treatment Deck (36):
What drugs are used to reduce acute pain in RA?
Analgesics (Acetaminophen, Capsacin, Opioids)
What drug classes prevent or control joint damage in RA?
DMARDs = Disease Modifying anti-Rheumatic Drugs
BRMs = Biological Response Modifiers
General MOA for DMARDs
Reduce or prevent joint damage
Inhibit the overactive immune system
In general, how long do DMARDs take to work?
Indication and type of drug
Anti-malarial drug that is moderately effective for mild RA
Rare side effect
Ocular toxicity that may result in permanent visual loss
What DMARDs may be used during pregnancy and lactation?
How long does it take to work?
Agranulocytosis within 2 weeks
Decreases signs/symptoms of disease and slows joint destruction
DOC for pts with active moderate/severe RA
Decreases appearance of new bone erosions
Improves LT clinical outcome
How long does Methotrexate take to work?
Indirectly increases adenosine production, which leads to immunosuppression
AEs (common and rare)
Dose-related hepatotoxicity (do NOT drink alcohol with methotrexate)
-Bone marrow suppression
-Increased risk lymphoma
(So adverse effects are more common in renal impaired patients)
Pre-existing liver disease
Used in pts with RA who can't take or are nonresponsive to Methotrexate
Inhibits dihyroorotate dehydrogenase, which synthesizes uridine
Causes G1 cell cycle arrest, inhibiting T cell proliferation and production of autoantibodies by B cells
Preexisting liver disease (risk of hepatotoxicity)
Describe how TNF-alpha plays a role in inflammation of RA
List the anti-TNF-alpha drugs
Bind TNF-alpha and prevent it from binding its receptor, thus preventing inflammation
Given subQ or IV weekly or biweekly
Used in monotherapy or in combo with methotrexate
Increased risk of opportunistic infection (fungal/bacterial)
Potential reactivation of latent TB and latent HBV
Before starting Anti-TNF-alpha drugs, you should screen the patient for....
Latent TB infection
Latent HBV infection
What is it?
Recombinant fusion protein of CTLA4 and human IgG
Used in pts non-responsive to TNF-alpha inhibitors
It's CTLA4 domain inhibits T cell activation by blocking delivery of CD28 costimulatory signals
AEs and Contraindications
Increased risk for serious infections
Should NOT be given in combo with a TNF-alpha blocker
Binds CD20 on B cells and depletes B cells from blood
How long does it last?
Effects not seen for 3 months, though the effects may last 6 months - 2 years after one infusion
Risk of PML
IL-1 receptor antagonist
Competitively inhibits pro-inflammatory effects of Il-1
Infection risk increases
Never given to patients with an acute/chronic infection
Bad when given with an anti-TNF-alpha drug
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
Bone marrow suppression (lymphocytopenia, neutropenia, anemia)
Increased infection risk