Pharm Flashcards
(38 cards)
Which two DMARDs are contraindicated in pregnancy?
MTX and Leflunomide
Use of which DMARD would require a pt to have regular ophthalmologic exams?
Hydroxychloroquine
A reduced capacity to form MHC-peptide protein complexes with subsequent immune down regulation is the mechanism of action of this DMARD:
Hydroxychloroquine- raises pH of intracellular vacuoles where these MHC-peptide complexes occur. The rise in pH is not conducive to MHC-peptide bonding.
Unexplained coughing or shortness of breath is a side effect most likely to be reported by pts taking: MTX Hydroxychloroquine Leflunomide Sulfasalazine
MTX - listen for “cellophane-like crackles posteriorly at the bases of the lungs on inspiration/expiration. MTX can also cause inflammation & fibrosis, but so can RA.
Which monoclonal antibodies (and one fusion protein) block the actions of TNF-a?
Adalimumab Certolizumab Golimumab Infliximab Etanercept
Which Mab blocks CTLA-4 - B7 interaction?
Abatacept
Which Mab inhibits the action of IL-6?
And IL-1?
Tocilizumab (IL-6)
Anakinra (IL-1)
Which Mab inhibits action of CD20?
Rituximab
What biologic DMARD inhibits PDE4?
Apremilast
A pt receiving biological tx for RA who experiences a rapid decline in B cell numbers would most likely be taking:
Rituximab
A physician treating a pt for RA with a biological agent should be vigilant for signs of:
Blood dyscrasias & malignancy
During tx with a biological agent for RA, a pt should be advised to avoid:
Vaccines - their immune system is not strong enough to elicit the appropriate Ab response.
Also stop smoking because it decreases the efficacy of the DMARDs. Also, smoking is gross.
When used during pregnancy, which of the following would most likely produce fetal adversity? Anakinra Etanercept Rituximab Tocilizumab
Rituximab- crosses placenta and can diminish fetal B cell population
Which Mab is contraindicated in pts with existing CV issues?
infliximab
Celecoxib was developed as a COX 2 inhibitor to replace indomethacin (COX neutral), which was shown to have this adverse effect: (Celecoxib does NOT do this)
increases bleeding time, increased CV risk
What is special about the NSAID Piroxicam when used in combination for tx of RA?
long half-life, convenient dosing schedule
Reduction in the risk of GI erosion and bleeds is afforded by combining a traditional NSAID with:
proton pump inhibitor
Prostacyclin analog
H2 receptor blocker
Ringing in the ears is a clear sign of ______ toxicity.
Salicylate
Describe lethal salicylate toxicity.
High enough concentrations can cross the BBB, stimulate the respiratory center, resulting in respiratory alkalosis. But toxic buildup of salicylic acid within cells, disrupting intermediary metabolism, will cause metabolic acidosis. Then you get cerebral edema resulting in multi-organ failure.
Which NSAID is most likely to cause hepatotoxicity at normal clinical doses?
Sulindac- 5-fold greater risk
Describe how NSAID therapy could negatively impact the kidneys.
They block the production of prostacyclin, which is involved in microregulation of kidney perfusion in times of stress.
Appropriate lab tests for pts on NSAID therapy for RA include all of the following except: LFTs CBCs Serum BUN/Cr Vision
Vision
Pts should be screened for which of the following prior to initiating tx with glucocorticoids? Ankle edema Elevated BUN Arrythmias Anemia
Osteoporosis
Ankle edema
Glaucoma risk
pre-tx fasting blood (Glu?) levels
How does colchicine treat/prevent acute gouty flare-ups?
Describe the negative side effects.
With its anti-microtubule function, colchicine inhibits neutrophil motility and thus prevents/attenuates the inflammatory response to the buildup of gout crystals.
colchicine only useful in gouty arthritis
Side FX:
GI disturbances (acute)
Blood dyscrasias (chronic)
Proximal weakness and elevated serum CPK (neuropathic)
