Rheumatoid Arthritis Drugs

Question 1

Treatments for Mild Rheumatoid Arthritis

Answer 1

NSAIDs

Plaquenil

Sulfasalazine

Minocycline

Methotrexate

Question 2

Treatment for moderately severe Rheumatoid Arthritis

Answer 2

Agents used in Mild Rheumatoid Arthritis

Methotrexate

Anti-TNF-a agents

Anti-IL-1 agents

Leflunomide

Azathioprine

Gold

Cyclosporine

(All single or in combination)

Question 3

Treatment for Severe or Refractory Rheumatoid Arthritis

Answer 3

Combination DMARDS

oral steroids

cytotoxan

Question 4

MOA of NSAIDs

Answer 4

inhibits COX, thus preventing synthesis of prostaglandins

Question 5

Side effects of NSAIDS

Answer 5

GI upset

peptic ulcers

kidney damage

diversion of arachidonic acid to leukotrienes

Question 6

MOA of glucocorticoids

Answer 6

• Inhibits Phospholipase A2 to inhibit the synthesis of prostaglandins and leukotrienes
• Inhibits NF-kB to downregulate transcription and proliferation of lymphocytes

Question 7

Side effects of glucocorticoids

Answer 7

Hyperglycemia

weight gain

HTN

corticosteroid-induced myopathy

immunosuppression

Question 8

MOA of Methotrexate

Answer 8

inhibits DHF reductase, which prevents DNA synthesis

• No synthesis = No proliferation
• No proliferation= decreased cytokines
• Decreased cytokines= decreased the immune response

Question 9

Methotrexate rescue

Answer 9

Leucovorin

Question 10

Methotrexate side effects

Answer 10

Leukopenia

Anemia

stomatitis

GI ulcers

Alopecia

Question 11

MOA of Sulfasalazine

Answer 11

inhibits prostaglandin synthesis and prevents migration of inflammatory cells

Question 12

Side effects of Sulfasalazine

Answer 12

Hemolytic anemia in G6PD

Methemoglobinemia

Sulfa allergy

Question 13

MOA of Leflunomide

Answer 13

inhibits dihydropterate dehydrogenase to prevent DNA replication

Question 14

Side effects of Leflunomide

Answer 14

Teratogenic

Rash

Alopecia

Increased LFTs

Diarrhea

Question 15

What DMARD can be used as an alternative or in combination with Methotrexate?

What happens

Answer 15

Leflunomide

increased hepatotoxicity when used with Methotrexate

Question 16

MOA of Hydroxychloroquine

Answer 16

inhibits production of rheumatoid factor and acute phase reactants

Stabilizes lysosomal membranes

inhibits collagenase

Question 17

Side Effects of Hydroxychloroquine

Answer 17

Muscle Disorder

Abnormal vision

Hypoglycemia

Agranulocytosis

Torsades de pointes

Hemolytic anemia in G6PD

Angioedema

Thrombocytopenia

Question 18

Which DMARD is safe to use during pregnancy

Answer 18

Hydroxychloroquine

Question 19

MOA of Azathioprine

Answer 19

Guanine analog that inhibits DNA synthesis, thus decreasing lymphocyte function, Ig production and IL-2 secretion

Question 21

Side effects of Azathioprine

Answer 21

Bone marrow suppression

GI disturbance

Hepatotoxicity

increased rik of infection

Question 22

MOA of Cyclosporine

Answer 22

Inhibits Calcineurin to decrease IL-2 production

• inhibits macrophage/ T cell interaction and T cell responsiveness

Question 23

Cyclosporine Side Effects

Answer 23

Myelosuppression

Gingival Hyperplasia

Nephrotoxic

HLD

Hirsutism

• High doses could be cardiotoxic

Question 24

MOA of cyclophosphamide

Answer 24

Nitrogen mustard prodrug that alkylates DNA via cross-linking, which prevents replication

• Suppresses lymphocyte function

Question 25

Side effects of Cyclophosphamide

Answer 25

hemorrhagic cystitis myelosuppression pulmonary fibrosis Alopecia N/V

Question 26

Cyclophosphamide rescue

Answer 26

MESNA

Question 27

MOA of Mycophenolate Mofetil

Answer 27

inhibits IMP dehydrogenase, inhibiting DNA/ RNA synthesis * inhibits E-selectin, P-selectin, and intracellular adhesion * interferes with leukocyte adhesion to endothelial cells

Question 28

Side Effects of Mycophenolate Mofetil

Answer 28

hepatotoxic nephrotoxic Gi disturbance leukopenia thrombocytopenia

Question 29

Abatacept * Classification * MOA * Side Effects

Answer 29

Class: Biologic DMARD MOA: fusion protein composed of the Fc region of the immunoglobulin IgG1 fused to the extracellular domain of CTLA-4, this inhibiting T cell activation Side Effects: URI, Infusion-related hypersensitivity

Question 30

Anakinra * Class * MOA * Side Effects

Answer 30

Class: Biologic DMARD MOA: Recombinant IL-1Ra that binds to and blocks IL-1 Side Effects: serious infections

Question 31

Rituximab Class MAO Side Effects

Answer 31

Class: Biologic DMARD MOA: anti-CD-20 analog that causes cell lysis Side Effects: chills, fever, HA, nausea, myelosuppression, infusion-related rash

Question 32

Tocilizumab Class MOA Side effects

Answer 32

Class: Biologic DMARD MOA: Anti IL-6 recombinant cytokine Side Effects: serious infection **Be sure to screen for TB**

Question 33

Adalimumab Class MOA Side Effects

Answer 33

Class: Biologic DMARD: TNF-a inhibitor Class: IgG1 ant-monoclonal antibody that prevents interactionwithp55 and p75 cell receptors Side Effects: Myelosuppression Infection * **Be sure to screen for TB**

Question 34

Etanercept Class MOA Side Effects

Answer 34

Class Biological DMARD- TNF-a inhibitor MOA: Recombinant fusion protein consisting of 2 soluble TNF p75 receptor moieties linked to the Fc portion of IGg Side Effects: Myelosuppression and Risk of infection **Be sure to screen for TB**

Question 35

Infliximab Class MOA Side Effects

Answer 35

Class: Biologic DMARD- TNF-a inhibitor MOA: chimeric IgG1 monoclonal antibody that binds with high affinity to soluble and membrane-bound TNF Side Effects: Myelosuppression and infection **Be sure to screen for TB**