Pharma 3

Question 1

What It is a CD80/86 inhibitor & function in RA treatment?

Answer 1

Abatacept (Fusion ptn) that prevents T cell co-stimulation.

Question 2

What role does Janus kinase (JAK) inhibitor, play in RA treatment with egs?

Answer 2

Tofacitinib modulating immune cell function.

Question 3

What is rheumatoid arthritis (RA)?

Answer 3

An autoimmune, chronic, progressive inflammatory disease characterized by symmetric small joint inflammation, swelling, deformity, and systemic manifestations.

Question 4

What are the clinical manifestations of rheumatoid arthritis?

Answer 4

Articular and extra-articular manifestations.

Question 5

What are the articular manifestations of rheumatoid arthritis?

Answer 5

Affects mainly small joints of the hands and feet, involves usually symmetric joint involvement, and symptoms include painful joints and prolonged morning joint stiffness.

Question 6

What are the signs of articular manifestations in rheumatoid arthritis?

Answer 6

Warm, tender, swollen, red joints with limited mobility.

Question 7

What are the extra-articular manifestations of rheumatoid arthritis?

Answer 7

Can include systemic organs such as pleural effusion, conjunctivitis, anemia, and vasculitis.

Question 8

What are the serological diagnostics for rheumatoid arthritis?

Answer 8

Abnormal antibodies ‘rheumatoid factor’ in 80% of RA patients, elevated CRP & ESR, and positive anti-CCP antibodies.

Question 9

What does a joint X-ray reveal in rheumatoid arthritis?

Answer 9

Shows joint swelling and erosions.

Question 10

What is the aim of drug treatment for rheumatoid arthritis?

Answer 10

To reduce pain, stiffness, improve joint mobility, and prevent chronic deformity by stopping inflammation.

Question 11

What are the symptomatic treatments for rheumatoid arthritis?

Answer 11

NSAIDs and corticosteroids.

Question 12

What are NSAIDs used for in rheumatoid arthritis?

Answer 12

Analgesic/anti-inflammatory drugs for relief of pain.

Question 13

Why are NSAIDs relatively ineffective when used alone in rheumatoid arthritis?

Answer 13

They do not prevent joint damage.

Question 14

What is the role of corticosteroids in rheumatoid arthritis treatment?

Answer 14

They are anti-inflammatory/immunosuppressive and may serve as ‘bridge therapy’.

Question 15

What do DMARDs aim to achieve in rheumatoid arthritis treatment?

Answer 15

Prevent disease progression and joint destruction.

Question 16

When should DMARDs be started in rheumatoid arthritis patients?

Answer 16

As early as possible, ideally within 3 months of symptom onset.

Question 17

What factors determine the drug therapy for rheumatoid arthritis?

Answer 17

One or more DMARDs are used depending on disease severity.

Question 18

Is it common to continue NSAIDs/corticosteroids with DMARDs in rheumatoid arthritis?

Answer 18

Yes, it is usual to continue them with DMARDs to manage symptoms.

Question 19

What is the purpose of using NSAIDs and corticosteroids together in rheumatoid arthritis treatment?

Answer 19

To provide symptomatic relief until the therapeutic effect of DMARDs is observed>bridge theraphy

Question 20

What does the Leflunomide do?

Answer 20

Inhibition of DHODH dihydroorotate dehydrogenase leads to reduced pyrimidine base synthesis and inhibits the proliferation and activation of T cells and B cells.

Question 21

What are biological DMARDs?

Answer 21

They are antibodies and antibody fusion proteins that inhibit the action of cytokines by blocking their binding to receptors.

Question 22

How are biological DMARDs administered?

Answer 22

They can be administered subcutaneously (S.C) or intravenously (IV).

Question 23

How do the effects of biological DMARDs compare to methotrexate?

Answer 23

These drugs have a stronger effect than methotrexate.

Question 24

What is the effect of combining methotrexate with a biological agent in RA treatment?

Answer 24

It is more effective than methotrexate alone.

Question 25

What types of antibodies are TNF α inhibitors?

Answer 25

They include chimeric antibodies (like Infliximab), human antibodies (like Adalimumab), and fusion proteins (like Etanercept).

Question 26

What is the mechanism of action of TNF α inhibitors?

Answer 26

They bind with cytokines or cytokine receptors and prevent their interaction.

Question 27

What are the main side effects of TNF α inhibitors?

Answer 27

Injection/infusion-related reactions, infections (TB, fungal, sepsis, hepatitis B reactivation), and increased risk of lymphoma and other cancers.

Question 28

What are the contraindications for TNF α inhibitors?

Answer 28

Acute and chronic infections, recent malignancies, live virus vaccination, demyelinating disorders, and Class III or IV heart failure.

Question 29

What is the il1 blocker and MAO?

Answer 29

Anakinra It is a competitive IL-1 receptor antagonist.

Question 30

What is a CD20 inhibitor with MOA

Answer 30

It Rituximab (Chimeric antibody) that leads to B cell depletion.

Question 31

What are the side effects (S/E) of Hydroxychloroquine?

Answer 31

Side effects of Hydroxychloroquine include gastrointestinal symptoms like diarrhea, corneal deposits and retinopathy (the most serious, potentially leading to irreversible retinal damage), skin discoloration, rash, and hemolysis in G6PD deficiency.

Question 32

What is the mechanism of action (MOA) of Cyclosporine?

Answer 32

Cyclosporine binds to cyclophilin, inhibiting calcineurin, which in turn inhibits the activation of NFAT (nuclear factor of active T cells), resulting in decreased biosynthesis of IL-2 and inhibition of T cell proliferation.

Question 33

What are the side effects (S/E) of Cyclosporine?

Answer 33

The side effects include nephrotoxicity, hypertension, hyperkalemia, hirsutism, and gingival hyperplasia.

Question 34

What is the main metabolite of Sulphasalazine and its significance?

Answer 34

Sulphasalazine is a prodrug that is cleaved by gut bacteria into 5-aminosalicylic acid and sulphapyridine, with sulphapyridine being the principal antirheumatic agent.

Question 35

What are the rare but serious side effects of Sulphasalazine?

Answer 35

Rare serious side effects of Sulphasalazine include corneal deposits leading to retinopathy, which may cause permanent blindness, skin discoloration, rash, and hemolysis, particularly in G6PD deficiency. Gastrointestinal side effects include diarrhea, nausea, and vomiting.

Question 36

What is the role of folinic acid (leucovorin) in Methotrexate treatment?

Answer 36

Folinic acid (leucovorin) is administered to reverse the toxic effects of Methotrexate.

Question 37

What should be monitored during Methotrexate therapy?

Answer 37

Liver functions should be monitored due to the common risk of hepatotoxicity.

Question 38

What is the use of leflunamide

Answer 38

Alternative to methotrexate for first-line management of RA

Question 39

What is the S/E of leflunamide?

Answer 39

GIT: nausea & diarrhea • Hepatotoxicity • Reversible alopecia • Rash

Question 40

What is the mechanism of action (MOA) of Methotrexate?

Answer 40

Methotrexate is an anti-neoplastic and immuno-suppressant drug that acts as a folic acid antagonist, inhibiting dihydrofolate reductase enzyme, decreasing the activation of folate to tetrahydrofolate, leading to reduced synthesis of purine and pyrimidine bases of DNA and RNA, and inhibits activation and proliferation of T cells and macrophages.

Question 41

What are the uses of Methotrexate in rheumatoid arthritis (RA)?

Answer 41

Methotrexate is the 1st line DMARD used in over 60% of RA cases, given once weekly orally or IM. Its toxic effects can be reversed by administering folinic acid (leucovorin).

Question 42

What are the side effects (S/E) of Methotrexate?

Answer 42

Side effects include gastrointestinal issues like nausea and mucosal ulceration, myelosuppression (especially leucopenia, increasing infections), hepatotoxicity, pneumonia-like syndrome, and it is contraindicated in pregnancy.

Question 43

What is the mechanism of action (MOA) of Hydroxychloroquine?

Answer 43

Hydroxychloroquine's mechanism of action is not fully understood but may involve inhibition of phagocytic functions and stabilization of lysosomal membranes.

Question 44

What blocks the IL-6 receptor in RA treatment?

Answer 44

Tocilizumab (Humanized antibody of IL-6 receptor) that blocks the IL-6 receptor.