module 4 anti-rheumatic drugs

Question 1

drugs for osteoarthritis

Answer 1

analgesia
- APAP
- NSAIDS
- COX-2 inhibitors 
inflammation if present
- NSAIDS
- COX-2 inhibitors
- intra-articular corticosteroids

Question 2

rheumatoid arthritis drugs

Answer 2

ASA at inflammatory doses: rarely used d/t AE
symptomatic therapy
- NSAID
- corticosteroids- systemic, intra-articular
Prevent or slow progression
- DMARDs

Question 3

corticosteroid use

Answer 3

anti-inflammatory
life-threatening complication of RA: 
- vasculitis 
bridge time to onset of DMARD
pulse therapy for acute flare ups 
intra-articular therapy for acute inflammation

Question 4

Corticosteroid AE

Answer 4

hyperglycemia
cataracts
glaucoma
aseptic necrosis of weight bearing joints
osteoporosis
cushing syndrome
adrenal suppression 
Na and H2O retention
CNS side effects

Question 5

corticosteroids with mineralcorticoid activity

Answer 5

cortisone
hydrocortisone
prednisone
prednisolone

Question 6

mineralcorticoid activity

Answer 6

promotes Na/H2O retention

Question 7

Disease modifying antirheumatic drugs (DMARDs)

Answer 7

standard of care
ideally used when Dx of RA is established
prevent or slow progression of joint destruction
- relatively toxic, potent, very expensive

Question 8

conventional DMARD drugs

Answer 8

hydroxychloroquine
methotrexate
azathioprine
gold
penicillamine
sulfasalazine
leflunomide
minocycline
cyclophosphamide

Question 9

biologic DMARDs

Answer 9

etanercept
infliximab
adalimumab
certolizumab
golimumab
tocilizumab
rituximab
abatacept
anakinra

Question 10

DMARD monitoring

Answer 10

may take 3-6mo for response
response is often incomplete
- continue NSAID
Monitor ROM, ADL

Question 11

DMARD seldom used and their AE

Answer 11

gold, penicillamine

• high toxicity
• myelosuppression
• proteinuria
• stomatitis
• rash
• altered taste
• visual changes

Question 12

Azathioprine (PO)

Answer 12

also for crohn’s disease
prodrug for mercaptopurine
immunosuppressant
reserved for aggressive disease or serious complications

Question 13

azathioprine AE

Answer 13

myelosuppression
hepatotoxicity
rash
infection

Question 14

hydroxychloroquine (PO)

Answer 14

primarily for mild RA

also an antimalarial drug

Question 15

hydroxychloroquine AE

Answer 15

some GI upset

retinopathy: rare
- eye exam every 6-12 months

Question 16

sulfasalazine (PO)

Answer 16

mild to moderate RA
also for crohn’s and UC
becomes: sulfapyridine and 5-aminosalicylic acid in intestine

Question 17

sulfasalazine AE

Answer 17

GI upset
rash
bodily fluids can turn yellow-orange
can bind to iron and dec. absorption

Question 18

sulfasalazine precaution

Answer 18

pt on antibiotic; intestinal flora may be destroyed, reducing conversion to active form.

Question 19

leflunomide (PO) MOA

Answer 19

inhibitor of pyrimidine synthesis

-> altered lymphocyte activation and dec. inflammatory response

Question 20

leflunomide AE

Answer 20

hepatotoxicity
reversible alopecia
GI distress
Preg: X 
-- cholestyramine can quickly lower drug levels in pts who wish to become pregnant

Question 21

Methotrexate (PO, IM, subQ) MOA

Answer 21

folate antagonist -> purine biosynthesis inhibition, cytokine production inhibition, adenosine production stimulation -> anti-inflammatory effect

Question 22

methotrexate AE

Answer 22

GI upset
megaloblastic anemia
- pt should receive folic acid replacement
hepatotoxicity

Question 23

Biologic DMARD advantage

Answer 23

no routine laboratory monitoring

Question 24

biologic DMARD disadvangates

Answer 24

risk of infections and malignancy
- temp. suspend tx if occur
very expensive
Parenteral: injection site reactions common

Question 25

Biologic DMARDs: TNF-a blocker drugs

Answer 25

``` etanercept infliximab adalimumab certolizumab pegol golimumab - may use in combo with DMARD ```

Question 26

biologic DMARD MOA

Answer 26

downregulate or antagonize TNF-a, a key cytokine in RA

Question 27

biologic DMARD AE

Answer 27

infections - fungal infections - active TB, and reactivation of latent TB - bacterial infection - viral infection - opportunistic infections lymphoma and other malignancies in children and teens

Question 28

Rituximab (biologic DMARD)

Answer 28

depletes B-cells which have been shown to be responsible for inflammation in RA - use when pt fails traditional DMARD and anti-TNF agents

Question 29

rituximab AE

Answer 29

fatal infusion reactions severe mucocutaneous reactions PML

Question 30

Abatacept (biologic DMARD)

Answer 30

inhibits T cell activation | - use when pt fails traditional DMARD and anti-TNF

Question 31

anakinra (biological DMARD)

Answer 31

antagonized IL-1 receptors, a proinflammatory cytokine - use when pt fails traditional DMARD and anti-TNF - can use in combo with DMARD but not other anti-TNF

Question 32

tocilizumab (biologic DMARD)

Answer 32

inhibits IL-6 | use when patient fail anti-TNF drugs

Question 33

tocilizumab AE

Answer 33

serious risk of infections - invasive fungal infection - active TB, and reactivation of latent TB - bacterial infection - viral infection - opportunistic infections

Question 34

methotrexate benefits

Answer 34

cheap well tolerated take effect within one month - most commonly used DMARD