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15. Rheumatoid Arthritis > Patho > Flashcards

Patho Flashcards

1
Q

NSAIDs

- Indication

A
  • DO NOT prevent or slow joint destruction

- Provide some sx relief, not appropriate for monotherapy & should only be used in conjunction w/ DMARDs

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2
Q

Corticosteroids

- Indication

A
  • Potent anti-inflammatory agents that can slow down the progression of joint damage in RA
  • Due to its SEs when use in long term
    => Reserved for brief periods of active disease

Bridge therapy use until DMARDS take effect
- Low dose Prednisone 5-10mg

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3
Q

Rayos

  • Formula
  • Administration
A

Prednisone Delayed-Release

  • F: 1, 2, 5 mg tab
  • Take w/ FOOD = incr absorption
  • The shell breaks open= releases ~ 4H after adm

=> RayOs => O => take w/ FOOD

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4
Q

Ridaura

  • Form
  • Dose
  • SEs
  • Monitor
A

Auranofin = gold salt

  • Form: PO
  • Dose: 3mg BID or 6mg QD PO
  • SEs: Itchy rash, mouth ulcers, diarrhea, flushing, vasodilation

Monitoring

  • CBC Q3M
  • UA Q3M for PO
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5
Q

Myochrysine

  • Indication
  • Route of adm
  • SEs
  • Monitoring
A

Gold sodium thiomalate = gold salt

  • Indication: RA
  • Dose: IM
SEs IM
- Pruritic rash 20%, Stomatitis
- Proteinuria
- BMS/Leucopenia, thrombocytopenia, anemia
- Nitroid rxn, flushing (vasodilation)
- HypoTN => tachycardia
  => gOld => O => hypOtn

Monitoring

  • CBC Q3M
  • UA Q3M for PO
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6
Q

Rheumatrex
Trexall

  • Form
  • Indications
A

Methotrexate

  • Form: PO

Indications:

  • Ectopic pregnancy
  • Psoriasis
  • Chemotherapy
  • RA
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7
Q

Arava

A

Leflunomide

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8
Q

Imuran

A

Azathioprine

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9
Q

Cuprimine

A

D- Penicillamine

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10
Q

Plaquenil

A

Hydroxychloroquine

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11
Q

Azulfidine
Azulfidine EN-tabs
Sulfazine
Sulfazine EC

  • Indication
A

Sulfasalazine

  • UC
  • RA
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12
Q

Xeljanz

A

Tofacitinib

Toe fa SYE tin nib

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13
Q

Kineret

  • Indication
A

Anakinra

  • Indication: RA, Neonatal-onset multisystem inflammatory disease (NOMID)
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14
Q

Enbrel

A

Etanercept

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15
Q

Remicade

A

Infliximab

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16
Q

Humira

A

Adalimumab

A da LIM YOO mab

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17
Q

Simponi

A

Golimumab

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18
Q

Cimzia

A

Certolizumab

Cer to LIZ u mab

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19
Q

Orencia

A

Abatacept

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20
Q

Rituximab

A

Rituxan

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21
Q

Actemra

A

Tocilizumab

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22
Q

Golimumab

  • Form:
A

Simponi-SC

Simponi Aria - IV

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23
Q

Methotrexate

  • MOA
    => what it’s is
    => Work on which phase
  • Indications
A

MOA

  • Antimetabolite chemotherapy (cell cycle specific)
  • S-phase toxin (DNA synthesis phase)
  • Folic acid structural analog
  • Completely inhibits dihydrofolate (DHF) reductase
  • Inhibits de novo pyrimidine synthesis

Indications

  • Cancer Chemo
  • Ectopic pregnancy (terminate pregnancy)
  • Psoriasis
  • RA
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24
Q

Methotrexate

  • Dosing for RA
    => Initial
    => Max
    => Rec take supplement
A

Rheumatrex, Otrexup, Trexall

Dosing
- Initial: 7.5mg PO single dose
- 2.5mg PO Q12H x 3 doses given as a course QW
- Max: 20mg/W
- Supplement: 1mg/d Folate
  => 1mg is Rx. 0.4 and 0.8 mg is OTC
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25
Methotrexate - SEs - Monitor
SEs - Oral ulcer & stomatitis - GI = N/diarrhea => most common - Hepatotoxicity - Renal - Pulmonary fibrosis (CXR) - Hypersensitivity pneumonitis: dry cough, fever, dyspenia. If so, stop MTX, exclude infection and start corticosteroids - Myelo-supression/thombo-cytopenia: minimal compare to imuran, cytoxin, sandiummune Monitor => obtain baseline - CBC (WBC & plt Q4W) - CXR - LFT (Q3-4M) - Renal fxn
26
Methotrexate - Absolute CI - Relative CI
Absolute CI - Preg Cat X and lactating W - Renal insuffiency SrCr > 1.5 - Pleural effusion - Active stomatitis - Diarrhea or any infection - Immuno-deficiency Relative CI - Alcohol use or liver disease - Age > 70 => as pt age, renal decre
27
Methotrexate - Antidote
- Leucovorin
28
Leflunomide - MOA - Dose - ADEs - Monitor => How long?
Arava MOA - Inhibits dihydroorotate dehydrogenase - Inhibitor of T-cell activation and proliferation Dose - LD: 100 mg PO QD x 3d - MD: 10-20mg PO QD ADEs - Nausea - Alopecia - Increase LFT (CI in imp liver fxn) Monitor: - LFT: ALT/ALT QM x 6M. Then Q8W thereafter (2Months) - CBC
29
Leflunomide - Arava - Wash out period => T1/2 => Antitode
- T1/2 life: 2wks Wash out period for: - Switch to a different DMARD - Hepatotoxiciy - Wish to have children Antitode => Cholestyramine 8grams TID for 11 days
30
Leflunomide - Arava C/I
- Impair liver fxn | - Pregnancy Cat X
31
Azathioprine - Imuran - MOA - Indication - Dosing - CI => Preg Cat - DDI
- MOA: Purine analog => antimetabolite converts to 6MP - I: RA, renal transplatation - D: 100-150 mg PO QD / 1-2.5 mg/kg/d - CI: Pregnancy Cat D and lactation - DDI: allopurinal (Aloprim, Zyloprim)
32
Azathioprine - Imuran - ADEs * Cause severe which ADEs? => check CBC how often
SEs - Myelosuppression: thrombocytopenia, anemia, leukopenia - Skin rash - Hepatotoxicity - Flu-like sx, fever - GI sx - severe N/V
33
D-Penicillamine - Cuprimine - MOA - Indication - Dose => take with what? - CI
- MOA: Lowers IgM Rheumatoid factor by unknown MOA Indication - RA: 3rd line DMARD agent) - Wilson's disease (Incr copper): promote excretion of excess copper Dose - Start low, increase slowly - Take on EMPTY STOMACH - MD:750-1000 mg PO QD CI: penicillin allergy
34
D-Penicillamine - Cuprimine - ADEs
``` SEs - GI: Nausea - Dysgeusia: taste change & metallic taste - Rash/hypersensitivity, Stomatitis - Myelosuppression - Autoimmune disease => must d/c if have myasthenia gravis & lupus - Proteinurea; renal toxicity ```
35
HydrOxychloroquine - Plaquenil - Indication - Dose/Administration
Indication - Early RA - Malaria Dose - 200-400 mg PO QD with FOOD or milk
36
Sulfasalazine - Azulfidine - MOA - Indication - Dosing for RA => Given when?
- MOA: inhibit of folate synthesis Indication - UC: Ulcerative colitis - RA (Azulfidine EN only) Dosing for RA - 500 mg EC DR QD-BID after meals - Increase to 1g PO BID Dosing for Colitis - 500-1000 mg PO QID
37
Sulfasalazine - Azulfidine - SEs - Monitoring - CI
ADEs - Rash/HA/GI upset - Myelosuppression: check CBC - Orange-yellow discoloration - Fertility impairment Monitoring - CBC, LFT, hypersensitivity rxn CI - Sulfonamide or salicylate sensitivity
38
Tofacitinib - Xeljanz - MOA - Indication => Do not combine with - Dosing route => Renal/hepatic imp - SEs => D/c lymphocyte decr: => Check ? B/4 use: - DDI
- MOA: Janus kinase inhibitor Indications - RA pt decr response to or intolerate to MTX - Do not combine w/ ABX or immunosuppressants Dosing - 5mg PO BID - Decr to 5mg PO QD in mod/severe renal/hepatic imp or receiving inhibitor 3A4 or 2C9 SEs - Infection - D/c if lymphocyte count less than 500 - check TB prior to use DDI - 3A4 and 2C9 substrate
39
AnakINra - KineRET - MOA - Indication - Route - Storage - SEs => Do not use in: - Monitor => RET: Lanh => fridge => in = Interleukin
- MOA: interleukin-1 receptor antagonist - I: RA, Neonatal-onset multisystem inflammatory disease (NOMID) - D: 100 mg SC QD - S: refridgerate and protect from light ``` ADEs - Infectious: neutropenia - Pulmonary infections (COPD) - HA => DO NOT use in active infection or w/ TNF blockers etancercept, infiximab, adalimumab, abatacept - Injection site rash ``` Monitor - CBC for neutrophil count
40
Etanercept - Enbrel - MOA - Indication - Route and Frequency - ADEs - ALLs
- MOA: TNF receptor blocker => rapid onset & very effective => Good synergic effect w/ MTX Indications - RA => combine w/ MTX of DMARDs - Psoristic arthritis - Plaque psoriasis Dosing - 50 mg SQ QW in thigh, abdomen, upper arm ADEs - Potential risk of infection ALL - Needle contains latex
41
Etanercept - Enbrel 3 rec SC injection sites
- Front of middle thigh - Abdomen - Outer area of upper back arms
42
``` Infliximab - Remicade - MOA - Indication - Dose => route - Storage - CI ``` => I => given IV
- MOA: Anti-TNF alpha monoclonal antibody Indications - Crohn's D - Ulcerative Colitis - Plaque psoriasis - Psoriatic arthritis - Refractory RA: added to MTX or other agents Dose for RA - Initial 3mg/kg IV at 0 wk, 2 wks, 6 wks - MD: 3mg/kg Q8W (6x every year) S: Refrigerate CI: - TB (check PPD), histoplasmosis, coccidiomycosis - Avoid live vaccines
43
Infliximab - Remicade - ADEs
ADEs - *Serious Life threatening infection - Fever - *May Worsen HF - *Increase risk of malignancy - HA - Dyspnea - Nausea - Abdominal pain - Optic neuropathy
44
Adalimumab - Humira - MOA - Indication - dosing => W/ MTX => w/o MTX - Storage
- MOA: Monoclonal antibody - TNF blocker Indications - RA: alone or w/ MTX - Psoriatic arthritis in adults - Ankylosing spondylitis (AS) in adults (spine is straight & inflamed) - Crohn's D in adult Dosing - 40 mg SC QOW if on MTX OR - 40 mg SC QW if not on MTX Storage - Refrigerate and protect from light
45
Adalimumab - Humira - ADEs - Warning => Dont combine w/: => May worsen - Monitoring - Notes
SEs - Infection: TB, virus, fungi, bacteria - BMS: aplastic anemia, thrombocytopenia, leukopenia - Cancer - HF - Lupus like syndrome Warnings - Dont combine w/ Anakinra => serious infection - May worsen HF Monitor - CBC Notes - Avoid live vaccines => true for all TNF blockers
46
Adalimumab - Humira Rec site to SC
- Front of thighs | - Abdomen (2 inches away from belly button)
47
Golimumab - Simponi SC and Simponi Aria IV - Indications - MOA - BBW - Route and Frequency - ADEs
Indication - RA: combine w/ MTX - Psoriatic arthritis - Ankylosing spondylitis : arthritis of spine MOA - Target and neutralizes TNF-alpha BBW - BBW risk of TB invasive fungal infection (histo, cocci) Dose - 50 mg SC once a month (self injected) - Simponia Aria: 2mg/kg IV over 30 min at weeks 0, 4 and then Q8W SEs - URI, sore throat, nasal congestion
48
Certolizumab - Cimzia - Indications - MOA - CI: same as others - Route and frequency - SEs
Indications - RA - Crohn's D MOA - TNF inhibitor CI - Same as other TNF inhibitors Dose: - 400 mg SC at wk 0, 4 followed by 200 mg QOW or 400 mg Q4W SEs - Serious infections - Malignancies - HF
49
Abatacept - Orencia - MOA - Indications - Route - SEs - avoid 3A => infusion over 30 min
MOA - Inhibits production of tumor necrosis factor, interleukin-2 and interferon-gamma Indications - RA: for who don't response to TNF blockers or DMARDs Dosing - 30 min IV infusion SEs - CoPD watch for exacerbation - Pulmonary infection - Malignancies => avoid live vaccine
50
Rituximab - Rituxan - MOA - Indication - Dosing => Premedicate - Storage - CI
MOA - Monoclonal antibody directly against CD20 on B cells Indications - Refractory RA - Non-Hodgkins Lymphoma - Microscopic polyangiitis (MPA$ Dosings - RA: 1g IV Q2W x 2 doses => Premedicate w/ methylprednisolone 100 mg IV Storage: - refrigerate away from light and moisture CI - Live virus vaccines - Allergy to murine proteins
51
Rituximab - Rituxan - SEs - Monitor
``` SEs - Severe infusion rxn: infuse w/in 30-120min => use methylprednisolone 100 mg IV 30 min prior to infusion - Tumor lysis syndrome: leading to ARF - HTN - Hepatitis B reactivation - Nephrotoxicity - URI ``` Monitoring - PPD: before initiating - CBC
52
``` Tocilizumab - Actemra => IV Q4W (once a month) - MOA - Indication - Doses => Dilute with: - Warning => Dont combine with: => Do not start if: ```
MOA - Interleukin-6 (IL-6) receptor inhibitor - Indication: RA pts w/ inadequate response to 1 or more TNF blockers Doses - Single vials IV => dilute to 100mL 0.9% NaCl - 4mg/kg - 8mg/kg Q4W. - Max: 800 mg/H IV infusion Warnings - Serious infections: don't combi w/ biological DMARDS - Anaphylaxis or serious hypersensitivity rxns - Live vaccines NOT to be given w/ actemra - Do not start if: => ANC Plt ALT/AST > 1.5 x ULN
53
Five TNF blockers are:
- Adalimumab (Humira) 40mg SC QOW - Etanercept (Enbrel) 50 mg SQ QW - Infliximab (Remicate) IV infusion Q8W - Simponi (Golimumab) SC once a month - Cimzia (Certolizumab) SQ once or twice a month
54
T cell activator inhibitor
- Abatacept (Orencia): IV infusion once a month
55
CD20 monoclonal antibody
Rituxan (Rituximab) TWO 1000 mg IV infusion separate by two weeks
56
When use TNF blockers, always rec => Caution => CI
- PPD test for TB before start therapy Caution - TNF blocker can worse HF - Avoid live vaccines - Avoid Interleukin -1 receptor blockers: CI - TB - Histoplasmosis - Coccidiomycosis
57
For all DMARDS | - Check wat
Check CBC for all
58
Monitoring - Gold - Methotrexate - Leflunomide - Arava - Azathioprine - Imuran - D-Penicillamine - Cuprimine - Hydroxychloroquine - Plaquenil - Sulfsalazine - Azulfidine - Anakinara - Kineret - Adalimumab - Humira - Rituximab - Rituxan
Gold - CBC Q3M - UA Q3M for PO Methotrexate - CBC: WBC & Plt check Q4W - CXR - LFT: check Q3-4M - Renal fxn Leflunomide - Arava - LFTs: QM x 6M. Thereafter Q2M Azathioprine - Imuran - CBC & Plt Q1-2W w/ changes of dose & ten Q1-3M thereafter D-Penicillamine - Cuprimine - CBC Hydroxychloroquine - Plaquenil - Plaque in eye => Eye exam Q6-12M Sulfsalazine - Azulfidine - CBC: Check Q2-4W x 3M then Q3M - LFT - Hypersensitivity rxn Anakinara - Kineret - CBC for neutrophil count Adalimumab - Humira - CBC Rituximab - Rituxan - PPD - CBC
59
Which medications should worry about latex allergy
- Etanercept - Enbrel | - Needle cover contains latex
60
Need Refrigerate
- Etanercept - Enbrel - Infliximab - Remicade - Adalimumab - Humira - Rituximab - Rituxan
61
Protect from light
- Adalimumab - Humira | - Rituximab - Rituxan => and moisture
62
Cause Lupus like syndrome
- Adalimumab - Humira
63
Worsen HF
- Inflixmab - Remicade - Adalimumab - Humira - Certolizumab - Cimzia
64
Which has ankylosing spondytitis indication
- Adalimumab - Humira | - Golumumab - Simponi
65
BBW for risk of TB invasive fungal infections
- Golumumab - Simponi
66
Use for Refractory RA
- Infliximab - Remicade - Rituximab - Rituxan => Abatacept - Orencia => for who don't respond to TNF blockers or other DMARDs => Tocilizumab - Actemra => for pt w/ inadequate response to 1 or more TNF blockers
67
CI in murine proteins allergy
- Rituximab - Rituxan
68
Anaphylaxis Rx
- Tocilizumab - Actemra
69
Rasuvo - Indication - Form
MTX - I: RA and severe psoriasis - Form: preservative free SQ weekly
70
Otrexup - Form
MTX - Form: auto injection

15. Rheumatoid Arthritis (1 decks)

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