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Flashcards in RA/Gout not covered in sketchy Deck (40):
1

Major side effects of hydroxychloroquine?

Rare occular toxicity

2

Which biologic inhibits JAK kinase, blocking immune cytokine signaling?

Tofactinib

(Tofac blocks JAK)

3

Which biologic has this MoA: CTLA-4-IgG fusion protein. Binds CD80/86. Blocks T cell co-stimulation via CD28.

Abatacept

(Abba hates Mr. T)

4

Besides increasing risk of infection, what side effects can abatacept cause?

None, just increased risk of infection.

Abba is pure

5

Which biologic is an IL-6R monoclonal AB?

Tocilizumab

(Tociliz blocks IL-siz)

6

Which DMARD can be used as an alternate to MTX for treating mod-severe RA?

Leflunomide

7

Name the 4 Traditional DMARDs (disease-modifying anti-rheumatic drugs).

Hydroxychloroquine
Sulfasalazine
Methotrexate
Leflunomide

8

Besides increasing risk of infection, what side effects can rituximab cause?

PML (progressive multifocal leukoencephalopathy- reactivation of JC virus)

9

Which biologics are contraindicated in pregnancy?

None

10

What is the key feature of all DMARDs?

Slow-acting (take 1-3 months)

11

Major side effects of leflunomide?

Hepatotoxicity (esp. w/MTX); HTN (esp. NSAIDs); Diarrhea, nausea (~15%)

12

What is the MoA for Leflunomide?

Inhibitor of dihydroorotate DH (uridine synthesis) -> G1 cell cycle arrest. ( -> Inhibits B & T cell proliferation)

Le flu? Ur a Dean. (hypochondriac)

13

What is the DOC for mod-severe RA?

Methotrexate

14

Which of the biologics and DMARDs can cause increased risk of hepatotoxicty?

DMARDs: Methotrexate, leflunomide, sulfasalazine
Biologics: tocilizumab, tofactinib

15

Which DMARDs can be used to treat mild RA?

Hydroxychloroquine
Sulfasalazine

16

Besides increasing risk of infection, what side effects can tocilizumab and tofactinib cause?

Hepatotoxicity, hypercholesterolemia, BM suppression.
Increased risk of malignancy (esp. immuno)

(the 2 T biologics have the same side effects)

17

Which biologic is an IL-1R antagonist?

Anakinra

(Anna Kareninina is #1 book)

18

Major side effects of methotrexate?

Hepatotoxicity (common; abstain from etoh)
Rare: pulmonary toxicity; BM suppression; risk of lymphoma.

19

What is the indication for all of the biologics?

Active RA

20

What is the general MoA for Methotrexate?

Increases adenosine leading to immunosuppression. (MOA in RA different from use in cancer).

21

What drugs can provide symptomatic relief for RA, without treating the actual cause? (3)

- Analgesics (anetaminophen, capsacin, opioids)
- NSAIDS (ibuprofen, naproxin)
- Glucocorticoids (dexamethasone)

22

Which biologic binds to CD-20 on B cells?

Rituximab

23

What drugs should you avoid combining biologics w/?

Other biologics

24

Name 3 biologic response modifiers (biologics) that inhibit TNF-alpha.

Adlimumab, entanercept, infliximab

a, e, i (first 3 vowels)

25

What is the MoA for Sulfasalazine?

Pro Drug: Sulfayradine/5-aminosalicylic acid. Metabolized to active component (sulfapyridine) by colonic bacteria.
MOA unknown; Inhibits T & B cells probably via NF-kB.

26

Besides increasing risk of infection, what side effects can anakinra cause?

BM suppression (neutropenia via IL-1).
Increased risk malignancy.

(Anna Karenina has neutropenia due to her stress)

27

Which DMARDs are safe in pregnancy?
Which are not?

Safe: Hydroxychloroquine, Sulfasalazine
Unsafe: Methotrexate, Leflunomide

28

Which DMARD would be safest for a pt w/liver dz?

-Hydroxychloroquine would be safest
Not safe: Methotrexate and leflunomide, sulfasalazine.

29

Which DMARDs/biologics are contraindicated in renal disease?

Methotrexate

30

For which biologic do you not need to screen for TB and HPV?

Anakinra
(according to his table)

31

Major side effects of sulfasalazine?

Hepatotoxicity; agranulocytosis (rare)

32

Which biologics increase risk of infection?

All
(all probably cause increased risk malignancy as well)

33

What is the MoA for Hydroxychloroquine?

Inhibits:
a) TLR signaling
b) Antigen presentation

34

Which DMARDs/biologics would you use to treat mild RA sx?
Mod?
Severe?

Mild: hydroxychloroquine or sulfasalazine (or combo of them)
Mod: MTX (alt: leflunomide)
Severe: MTX + a biologic

35

Which 2 DMARDs are often combined together?

Hydroxychloroquine and sulfasalazine

36

Which of the biologics and DMARDs are contraindicated in pregnancy?

DMARDs: Methotrexate, leflunomide
Biologics: none

37

Besides increasing risk of infection, what side effects can entanercept, adlimumab, and infliximab cause?

Rare: Exacerbates CHF. Increase risk demyelinating disease.
Increased risk malignancy.

38

Which anti-RA drugs cause an increased risk of malignancy?

DMARDs: MTX
Biologics: all except abatacept, rituximab

39

Which DMARD can cause agranulocytosis?

Sulfasalazine

40

Which of the DMARDs and biologics cause bone marrow suppression?

DMARDs: MTX
Biologics: Anakinra, tocilizumab, tofactinib