Rheumatic Drugs

Question 1

Hydroxycloroquine(HCQ)

Answer 1

Non biologic DMARD
anti-inflammatory
tissue bound - liver removal 45 day 1/2life
3-6 month response time
ocular tox, N/V, abdominal, nightmares
OK in pregnancy

Question 2

Leflunomide

Answer 2

Non biologic DMARD
converted to active in intestine/plasma
inhibits T-cell proliferation and B-cell AB production
Diarrhea
Not in pregnancy

Question 3

Methotrexate

Answer 3

Non biologic DMARD
inhibitor of dihydrofolate reductase inhibits DNA synth
folic acid or leucovorin supplementation
Conc incrased by HCQ
4-6 week response time
fast response time
GI toxicity, stomatitis
hepatotox, pulmonary tox, myelosuppression
not with pregnancy

Question 4

Sulfasalazine

Answer 4

Non biologic DMARD
1-3 month response time
more toxic than HCQ 30% discontinue use

Question 5

Azathioprine

Answer 5

Non biologic DMARD - rarely used
anti inflammatory
prevent rejection of transplant organs
increased lymphoma risk
not in pregnancy

Question 6

Cyclosporine

Answer 6

Non biologic DMARD - rarely used
peptide antibiotic inhibits Tcell activation
nephrotox, many interactions

Question 7

Gold Salts

Answer 7

Non biologic DMARD - rarely used
can induce complete remission
severe enterocolitis, anaplastic anemia, inters pneumonia
not in pregnancy

Question 8

Minocycline

Answer 8

Non biologic DMARD - rarely used
tetracycline AB - mild RA only
drug induced lupus
not in kids or pregnancy

Question 9

Adalimumab

Answer 9

Biologic DMARD - TNFa blocking agents SUbQ

1/2 life: 10-20 days

Question 10

Certolizumab

Answer 10

Biologic DMARD - TNFa blocking agents SubQ

1/2 life: 14 days

Question 11

Etanercept

Answer 11

Biologic DMARD - TNFa blocking agents SubQ

1/2 life: 4.5 days

Question 12

Golimumab

Answer 12

Biologic DMARD - TNFa blocking agents SubQ

1/2 life: 14 days

Question 13

Infliximab

Answer 13

Biologic DMARD - TNFa blocking agents IV

1/2 life: 8-10 days

Question 14

Abatacept

Answer 14

Biologic DMARD - T cell Fc-fusion IV/SubQ
prevents t-cell activation
1/2 life: 13-16 days
relief of symptoms some after 1-2 doses - 6 months

Question 15

Rituximab

Answer 15

Biologic DMARD - anti CD 20 mAb  IV
1/2 life: 20 day
response: 6 weeks lasts 9 months
RA use with MTX
AE: infusion reactions, infection risk

Question 16

Tocilizumab

Answer 16

Biologic DMARD - anti IL-6 mAb IV/SubQ
1/2 life: 11-13 days
response - some early most in weeks 6-12
GI perf, infections, anaphylaxis

Question 17

Celocoxib

Answer 17

Anti-inflammatory - NSAID

Question 18

Ibuprofen

Answer 18

Anti-inflammatory - NSAID

Question 19

Naproxen

Answer 19

Anti-inflammatory - NSAID

Question 20

Prednisone

Answer 20

Anti-inflammatory - corticosteroid

oral

Question 21

Methylprednisolone

Answer 21

Anti-inflammatory - corticosteroid

oral, depot IM, IV, intra articular

Question 22

Triamcinolone

Answer 22

Anti-inflammatory - corticosteroid

intra-articular

Question 23

NSAIDS

Answer 23

Acute gout

Question 24

Colchicine

Answer 24

Acute gout

Question 25

Corticosteroids

Answer 25

Acute gout

Question 26

Allopurinol

Answer 26

Recurrent gout prevention | xanthine oxidase inhibitor - never stop it

Question 27

Febuxostat

Answer 27

Recurrent gout prevention | xantine oxidase inhibitor

Question 28

Pegloticase

Answer 28

Recurrent gout prevention

Question 29

Probenecid

Answer 29

Recurrent gout prevention

Question 30

Standard pharmacologic treatment for RA

Answer 30

DMARD + NSAID + corticosteroid to control symptoms

Question 31

Recommended DMARDS for initial treatment

Answer 31

Methotrexate or leflunomide | Hydroxychloroquine or sulfasalazine - safer in mild disease

Question 32

If inadequate response to biologic DMARDs:

Answer 32

1 non biologic added - usually TNFa inhibitor

Question 33

Common first choice of TNFa inhibitor

Answer 33

Etanercept - rapid onset of action and short half life or infliximab switching to etanercept/adalimumab if needed

Question 34

Actions of TNFa

Answer 34

pro inflammatory cytokine fever, apoptotic cell death, inflammation inhibit tumorigenesis and viral replication

Question 35

AE of TNFa blockers

Answer 35

injection site reactions(SubQ) - fever, urticaria, cytopenias - monitor CBCs Serious Infections! - bacterial sepsis and TB(screen) increase risk of viral/fungal/opportunistic pathogens malignancies? (RA has increase lymphoma risk) Heart failure - not with CHF class 3/4 and <50% EF demyelinating(infliximab) Safe up to 30 weeks in pregnancy

Question 36

NSAIDs

Answer 36

MOA: reduce prostaglandin synthesis aspirin irreversibly inhibits cox 1 and cox 2 others reverse found in synovial fluid after repeated dosing PAIN management - don't alter course

Question 37

NSAIDS - AE

Answer 37

gastric irritants - use PPI nephrotox, hepatotox, CV events not in third trimester

Question 38

Choice of NSAIDS

Answer 38

``` All equal tolmetin - not for gout asprin less effective for ankylosising spondylitis ketorolac - gi and renal effects salsalate and ibuprofen - least toxic ```