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Rheumatoid Arthritis Day 2 Flashcards

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1
Q

When do you initiate DMARDs?

A

within 3 months of diagnosis and the benifitis may take weeks to months to see benefit

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2
Q

What do DMARDs do?

A

reduce disease activity and preserve/ improve function

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3
Q

What are the 4 DMARDs?

A

hydrochloroquine, sulfasalazine, methotrexate, leflunomide

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4
Q

hydrochloroquine MOA?

A

inhibits APC action and T cell signaling. It also reduces IL- 1,2,6 and TNF- alpha

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5
Q

hydrochloroquine Dosing?

A

200-300 mg BID initial then 200 mg a day or BID

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6
Q

hydrochloroquine onset?

A

6 weeks to 6 months

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7
Q

hydrochloroquine adverse effects?

A

macular damage, rash, diarrhea

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8
Q

hydrochloroquine monitoring?

A

yearly eye exam, Amsler every 2 weeks at home

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9
Q

when do you use caution with hydrochloroquine?

A

significant visual impairment and hepatic and renal impairment

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10
Q

hydrochloroquine place in therapy?

A

elder, milder progresstion, improves symptoms and function but no radiographical data

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11
Q

Sulfasalazine MOA?

A

modualtes mediators of inflammatory response and inhibits TNF- alpha

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12
Q

Sulfasalazine dose?

A

500 mg to start then increase to 1000 mg BID

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13
Q

Sulfasalazine onset?

A

1-2 months

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14
Q

Sulfasalazine adverse effects?

A

myelosupression and rash

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15
Q

Sulfasalazine monitoring?

A

CBC every 1-2 months and LFTs

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16
Q

when is Sulfasalazine contraindicated?

A

sulfa allergy, kidney/hepatic impairment, glucose-6 phosphosphate dehydrogenase deficiency

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17
Q

Methotrexate MOA?

A

it is unknown in RA but it inhibits the cytokine production and purine biosynthesis

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18
Q

Methotrexate dosing?

A

7.5 mg a week and pulse dosing is 2.5 mg BID for only 3 days a week. Take with 1 mg folic acid a day

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19
Q

Methotrexate onset?

A

2 weeks to 2 months

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20
Q

Methotrexate adverse effects?

A

hepatic fibrosis, cirrhosis, stomatitis, reddening of skin, N/V/D, renal failure, leucopenia and thrombocytopenia

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21
Q

Methotrexate monitoring?

A

LFTs, CBC, SCr, Hep B&C, for baseline and during CBC and LFT every 1-2 months

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22
Q

when is Methotrexate contraindicated?

A

Pregnancy Category X, Chronic Liver Disease, immunosupression, and pre-existing blood dyscrasias

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23
Q

Leflunomide MOA?

A

inhibits pyrimidine synthesis. it prevents proliferation of lymphocytes

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24
Q

Leflunomide dosing?

A

loading is 100 mg/day for 3 days then 20 mg/day

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25
Leflunomide onset?
1-3 months
26
Leflunomide adverse effects?
elevated LFTs, N/V/D, adominal pain, alopecia
27
Leflunomide monitoring?
LFTs and CBC at baseline then monthy til stable then every 2 months
28
What are the contraindications of Leflunomide?
Pregnancy Category X and pre-existing liver disease
29
What do the Biologic agents do?
leads to significant reduction in the development in the progression and development of joint erosion. It is for moderate to severe RA. It is best with MTX then alone
30
What drugs bind to Tumor Necrosis Factor and blocks its interaction with cell surface receptors?
Entanercept, Infiximab, Adalimumab, Golimumab, Certolizumab, Tofactitinib
31
What is the dosing of Entanercept?
50 mg SUBQ weekly or 25 mg twice weekly
32
What is the dosing of Infiximab?
3-10 mg/kg IV q4-8 wks
33
What is the dosing of Adalimumab?
40 mg SUBQ q2weeks
34
What is the dosing of Golimumab?
50 mg SUBQ qmonthly or 2mg/kg IV q8weeks
35
What is the dosing of Certolizumab?
200mg SUBQ every other week
36
What is the dosing of Tofactitinib?
5mg PO BID
37
What is the onset of Tumor Necrosis Factor Antagonists?
2-3 weeks
38
What are the adverse effects of Tumor Necrosis Factor Antagonists?
infection (TB, Hep B and C), malignancy (lymphoma), injection/infusion sire reaction, Demyeliminating syndromes (exacerbation of multiple sclerosis), HF
39
What is the MOA of Anakinra?
blocks the effects of IL-1 thereby decreasing inflammation, aids in cartilage protection and decreases bone reabsorption
40
What is the onset of Anakinra?
days- months
41
What is the dose of Anakinra?
100 mg SUBQ daily
42
What are the adverse effects of Anakinra?
infection site reaction and infection
43
What do you monitor with Anakinra?
Baseline TB skin test, CBC base line the monthly for 3 months then every 3 months, signs of infections continuously
44
what are the contraindications of Anakinra?
uncontrolled CHF
45
What is the MOA of Abatacept?
inhibits T cell activation by blocking interaction between APCs and T- cells
46
What is the dosing of Abatacept?
less than 60 kg- 500 mg IV q4wk 60-100- 750 mg IV q4wk 100 kg 1000 mg IV q4wk 125 mg SUBQ weekly
47
What is the onset of Abatacept?
1-3 months
48
What is the adverse effects of Abatacept?
nausea, headache, infection, infusion reaction
49
what do you monitor with Abatacept?
signs of infection
50
What is the MOA of Rituximab?
monoclonal antibody against B- lymphocytes
51
What is the dosing of Rituximab?
1000 mg IV days 1 and 15 and repeat every 16- 24 weeks
52
When is Rituximab used?
last line
53
What is the onset of Rituximab?
rapid and sustained up to 6 months
54
What is the adverse effects of Rituximab?
Nausea, fatigue, cytopenias
55
What do you monitor for Rituximab?
CBC
56
What is the MOA of Tocilizumab?
blocks IL-6 binding leading to a decrease in cytokine and acute phase reactant production
57
What is the dosing of Tocilizumab?
4 mg/kg IV q4weeks
58
What is the onset of Tocilizumab?
2 weeks - 1 month
59
What is the adverse effects of Tocilizumab?
infection, injection site reaction
60
What do you monitor in Tocilizumab?
AST/ALT, CBC with plt
61
What therapies do you use in moderate to high disease activity?
Dual DMARD and Triple DMARD
62
What are the Dual DMARD options?
Methotrexate+hydrochloroquine Methotrexate + Lefunomide Methotrexate + Sulfasalazine
63
What is the triple DMARD therapy option?
Methotrexate + Sulfasalzine + Hydrochloroquine
64
What immunizations do you administer in RA patients?
administer prior vaccines prior to immunosuppressive treatment when possible. Live vaccines should not be given in patients on biologic DMARDs. Inactivated vaccines are safe

Muscoskeletal (9 decks)

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