Rheumatoid arthritis Flashcards Preview

Pharmacology > Rheumatoid arthritis > Flashcards

Flashcards in Rheumatoid arthritis Deck (31):
1

RA presentation

fatigue, weakness, warm, red swollen joints, joint pain, low fever, stiffness, muscle ache

2

RA manifestations

nodules, vasculitis, pulmonary (fibrosis, PE),, ocular, cardiac (arrhythmias, pericarditis), lymphadenopathy, renal disease, anemia

3

Non-pharm treatment

education, rest, wt reduction, PT/OT, heat/ice

4

NSAIDs

Reduce pain, swelling, stiffness, do not alter course of disease, use in combo with DMARDs, give higher anti-inflammatory doses

5

DMARDs

Methotrexate, hydroxychloroquine (Plaquenil), Sulfasalazine (Azulfidine), Azathioprine (Imuran), Leflunomide (Arava)

6

DMARD PEARLs

timing is important, possibility to reduce damage, delay onset (months)

7

Methotrexate MOA

inhibits dihydrofolate reductase which inhibits neutrophil adhesion and chemotaxis, once weekly dosing

8

Methotrexate ADRs

hematologic (bone marrow suppression), N/V/D, stomatitis, mucositis, cirrhosis, hepatitis, increased LFTs, pneumonitis, fibrosis, ract, urticaria, alopecia

9

Methotrexate contraindications

Teratogenic, even if male, liver disease, immunodeficient pts, baseline blood dyscrasias, renal disease

10

Methotrexate PEARLs

considered to have best outcome, not expensive, hepatic metabolism, renal excretion

11

Hydroxychloroquine MOA

modification of inflammatory cytokine infiltration in to joint, PO, onset 2-4 months

12

Hydroxychloroquine ADRs

no myelosuppression, hepatic or renal (Advantage!), NVD, monitor for ocular toxicity

13

Sulfasalazine (Azulfidine) MOA

interleukin-1 inhibitor, prodrug, PO, 1-2 month onset

14

Sulfasalazine (Azulfidine) ADRs

NVD, hematologic leukopenia, thrombocytopenia, better tolerate than MTX

15

Azantioprine (Imuran)

Purine analogue that interferes w/ RNA/DNA synthesis and inhibits chemotaxis, PO, 2-3 month onset, short T1/2

16

Gold

Inhibits phagocytosis, given PO or injection, onset 4-6 months, not used much, last line, NVD, cramping and more!

17

Cyclosporine (Neoral, Sandimmune)

inhibits cytokine production to stop inflammation, usually for organ transplant pts, lot ADRs and DI, high pt sensitivity

18

Cyclophophamide (Cytoxan)

inhibits cell growth, very toxic, use limited, hemmorrhagic cystitis, GI upset, alopecia

19

Corticosteroids

used for anti-inflammatory and immunosuppressive, not monotherapy, short term until DMARDs kick in

20

What is considered most efficacious

Biologics

21

Biologics common

Etanercept (Enbrel), Infliximab (Remicade), Rituximab (rituxan), Adalimumab (Humira)

22

Biologics not as common

Golimumab (Simponi), certolizumab pergol (Cimzia), Tocilizumab (Actemra), Anakinra (Kineret), Tofacitinib (Xeljanz), Abatacept (Orencia)

23

Biologics clinical uses

Ankylosing spondylitis, Crohn's, plaque psoriasis, RA, ulcerative colitis

24

Risks with biologics

increased risk of infection (TB, fungal), pancytopenia, be careful w/ live vaccines, demyelinating disorders (MS, ALS), bone marrow suppression, HF, lymphoma, CA

25

Etanercept (Enbrel)

first one, TNF inhibitor, subcut injection once weekly, no monitoring

26

Infliximab (Remicade

TNF inhibitor, IV only as outpt, not be monotherapy,

27

Adalimumab (Humira)

TNF inhibitor, subcut every 2 weeks, self injectiable, decreases CRP, ESR, IL-6 and inflammatory mediators

28

Rituximab (Rituxan)

chimeric, monoclonal ab, binds to antigen CD20 located on pre-B and mature B cells, antigen is expressed on 90% of B cell non-hodgkin's lymphomas, used in chemo

29

Golimumab (Simponi)

TNF inhibitor, once monthly in combo with MTX

30

Anakinra (Kineret)

IL inhibitor, sub cu Daily, no combo w/ TNF inhibitors

31

Abatacept (Orencia)

T-cell immunoglobulin, IV once monthly, subcut weekly, useful for pts that fail TNF inhbitors