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Pharm II MHM - FINAL > RA > Flashcards

Flashcards in RA Deck (48)
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1

Risk factors of RA

-Viral infection
-Birthweight greater than 10 lbs
-HLA DR4 allele
-Decaf coffee consumption

2

Factors that decrease risk of RA

-High Vit D intake
-OCPs
-Tea consumption

3

Systemic inflammation that occurs with RA

-Blood vessels
-Eyes
-Nerves
-Heart
-Skin

4

Misc effects of RA

-Decreased QOL
-Increased med costs
-Decreased employability

5

RA vs. OA

-Symmetrical (bilateral)
-Younger pts

6

Early vs. established RA classifications

Less than 6 months (early)
Over 6 months (established)

7

Low vs. moderate vs. high rheumatoid activity

Less than 6 joints (low)
6-20 joints (moderate)
Over 20 joints (high)

8

Poor prognosis factors of RA

-Persistent synovitis
-Early erosive disease
-Rheumatoid nodules
-HLA-DR4 alleles
-Fam hx
-High ESR and CRP

9

When should DMARDs be given in RA?

Within first 3 months of onset

10

Types of DMARDs

-Non biologic
-Biologic

11

When are nonbiologic DMARDs used in RA?

-Early disease w/low activity w/o poor prognosis (monotherapy)
-Early diseae w/HIGH activity w/o poor prognosis
-Established disease, low activity, w/o poor prognosis

12

MC used nonbiologic DMARD in RA?

MTX

13

MTX MOA in RA

-1st line
-Inhibits DNA synth, repair, cellular replication
-May affect immune function
-Unclear how exactly it works in RA

14

Key features of RA (dosing, onset, ADEs)

-Weekly dosing
-Onset in 3-6 wks
-Avoid ETOH and PPIs
-Can cause stomatitis, nausea, diarrhea, alopecia
-Preg Cat X

15

What can be taken to decrease the side effects of MTX?

Folic acid

16

What is Leflunomide (Arava)? MOA?

-Immunomodulatory pro-drug
-Usually 2nd line to MTX
-Inhibits pyrimidine synthesis (anti-proliferative and anti-inflammatory effects)

17

Leflunomide ADEs

-Diarrhea, alopecia, rash, HA
-Hepatotoxicity, PN, wt gain
-Maintain hydration
-Monitor BP
-Preg Cat X

18

When is Hydroxycholoroquine (Plaquenil) used in RA and MOA?

-Mild to mod w/o poor prognosis and for women of CBP
-Inhibits locomotion of neutrophils and chemotaxis of eosinophils
-Impairs complement-dependent antigen-antibody reactions

19

Features of hydroxycholoroquine (Plaquenil)

-Longer onset of action (8-12 wks)
-Eye exam every 3 months
-Rash, diarrhea, abdominal
-Blue/black skin discoloration
-Deafness, tinnitus

20

Sulfasalazine use in RA

-Can be monotherapy (MTX usually better choice)
-Inhibits PG synthesis

21

ADEs of sulfasalazine

-HA, nausea, dyspepsia
-Blue skin, sun sensitivity, jaundice
-Preg Cat B

22

How is minocycline used in RA?

-Unlabeled use
-Antimicrobial, immunomodulatory
-Potent inhibitor of metalloproteinates (which are active in RA joint destruction)

23

ADEs of minocycline

-Rash, HA, diarrhea
-Anorexia, tooth discoloration
-Avoid in pregnancy

24

Use of tofacitinib in RA

-2nd line to MTX
-JAK inhibitor (reduces inflammation)
-Should NOT be combined with a biologic

25

ADEs of tofacitinb

-TB
-Lowers blood counts
-Increases cholesterol and liver enzymes
-HA, diarrhea, infection, hepatic injury

26

Types of biologics used in RA

-Anti TNF biologics
-Non TNF biologics

27

When are biologics used in RA?

High disease activity w/poor prognosis

28

General warnings of biologics

Serious infections (including TB)
Malignancy

29

What is etanercept and its MOA?

-Self injection biologic for RA
-Binds w/circulating TNF inhibiting it
-No development of neutralizing antibodies

30

ADEs and other features of etanercept

-Self injected
-Keep refrigerated
-Local reactions, HA, rash, respiratory infections, etc.
-Preg Cat B