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Pharmacology II > Rheumatoid Arthritis (exam 1) > Flashcards

Rheumatoid Arthritis (exam 1) Flashcards

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1
Q

rheumatoid arthritis

A

chronic inflammation of the synovial tissue

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2
Q

pannus

A

invades the cartilage and bone surface
produces erosion of bone and cartilage

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3
Q

who is more likely to have arthritis?

A

women

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4
Q

RA symtoms can be associated with many diseases including

A

fibromyalgia
SLE
gouty arthritis
psoriatic arthritis

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5
Q

osteoarthritis pathology

A

thinned cartilage leads to bone ends rubbing together

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6
Q

rheumatoid arthritis pathology

A

bone erosion and swollen inflamed synovial membrane

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7
Q

in 75% of cases, T cell antigen motif ______________ signaling pathway involved in T cell ______________

A

Q(K/R)RA IL2

activation and proliferation

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8
Q

inflammation of RA leads to

A

severe pain
palpable synovial swelling
morning stiffness
loss of function in joints

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9
Q

RA occurs in a _________________ and typically involves the ______________

A

symmetrical pattern

wrists, MCP and PIP joints

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10
Q

MCP

A

metacarpophalangeal joints

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11
Q

PIP

A

proximal interphalangeal joints

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12
Q

what can cause RA?

A

infectious agents
environmental triggers
genetic risk factors

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13
Q

rheumatoid factor

A

autoantibody associated with RA
antibody against the Fc portion of IgG

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14
Q

RF and IgG form ____________ that contribute to the disease process

A

immune complexes

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15
Q

rheumatoid factors are antibodies with

A

various isotopes and affinities

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16
Q

most commonly mentioned RF

A

is an IgM

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17
Q

loss of tolerance to the proteins that have a citrulline residue likely produce autoantibodies like

A

anti-cyclic citrullinated protein/peptide antibody (ACPA) and RF

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18
Q

synovitis stage of RA

A

synovial membrane inflamed and thickened
bones and cartilage gradually eroded

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19
Q

pannus stage of RA

A

extensive cartilage loss
exposed and pitted bones

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20
Q

fibrous anklosis stage of RA

A

joint invaded by fibrous connective tissue

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21
Q

bony anklosis stage of RA

A

bones fused

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22
Q

RF is ____________ in the first 6 months and ____________ with established disease

A

45% positive

85% positive

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23
Q

PIP swelling in RA

A

swelling is confined to the area of the joint capsule
synovial thickening feels like a firm sponge

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24
Q

Rheumatoid arthritis is not

Study These Flashcards
A

restricted to the joints in the wrists

can be anywhere in the body!

25
genetic factors that can cause RA
HLA-DRB1 STAT4 PADI4 DR1
26
production of inflammatory cytokines leads to
decreased production of hyaluronan inflammation increases MMP production, increases cartilage damage plasma cell antibodies form immune complexes
27
joint damage recruits _____________________ which causes _____________ of the synovial membrane. This leads to ______________
neutrophils, T cells and B cells hyperplasia and angiogenesis palpable lumps in the joints (boggy joints)
28
pannus invades and _______________ which leads to __________ and continued usage on the joints can ______________
enzymatically destroys joint tissue decreased joint mobility Mal-align, sublux or collapse joints
29
diagnostic factor of RA
RF anti-cyclic citrullinated peptide
30
treatment for RA
NSAIDS TNF-a inhibitors steroids/corticosteroids DMARDs immunosuppressants
31
within the first three months, treatment is
MTX (or other DMARD), NSAID and prednisone
32
when there is poor response for initial treatment of RA,
try other combination triple drug (DMARD and biologic), low dose prednisone long term and consider second line DMARD
33
NSAIDs effects for RA
relieve pain reduce inflammation
34
types of NSAIDs for RA
ibuprofen (Advil, Motrin) naproxen (aleve)
35
side effects of NSAIDs
tinnitus stomach irritation heart problems liver/kidney damage
36
TNF-a inhibitors effects for RA
reduce pain, morning stiffness and tender or swollen joints
37
examples of TNF-a inhibitors for RA
Etanercept (Enbrel) infliximab (Remicade) adalimumab (HUMIRA) Golimumab (simponi) certolizumab (cimzia)
38
side effects of TNF-a inhibitors
risk of serious infections congestive heart failure cancer
39
steroids/corticosteroids effects for RA
reduce inflammation and pain slow joint damage
40
side effects of steroids/corticosteroids
thinning of bones, cataracts, weight gain, and diabetes
41
DMARDs effects for RA
slow the progression of RA save joints/tissues from permanent damage
42
side effects of DMARDs
liver damage bone marrow suppression severe lung infections
43
DMARDs examples for RA
methotrexate (Trexall) leflunomide (Arava) hydroxychloroquine (Plaquenil) sulfasalazine (Azulfidine) minocycline (Dynacin, Minocin)
44
immunosuppressants effects of RA side effects?
tackle immune system increase susceptibility to infection
45
examples of immunosuppressants for RA
azathioprine (Imuran, Azasan) cyclosporine (Neoral, sandimmune, Gengraf) cyclophosphamide (cytoxan)
46
which TNF-a inhibitors are human monoclonal antibodies?
adalimumab certolizumab
47
which TNF-a inhibitors are chimeric monoclonal antibodies?
infliximab
48
methotrexate MOA
interferes with DNA synthesis, repair and cellular replication inhibits dihydrofolate reductase
49
MTX inhibits _____________ uptake which shows
DNA precursor spleen cell hypo responsiveness and suppresses IL-2 production
50
what happens when dihydrofolate reductase is inhibited?
dihydrofolates cannot be converted to tetrahydrofolates which are needed for synthesis of purine nucleotides and thymidylate
51
what type of metabolism does MTX go through?
hepatic and intracellular metabolism to polyglutamated forms
52
polyglutamates act as
inhibitors to dihydrofolate reductase and thymidylate synthetase
53
how is MTX excreted?
renally 80-90% unchanged in urine
54
what is given to reduce toxicity of high dose regimens/delayed excretion of MTX?
leucovorin calcium (leucovorin rescue)
55
what is the half life of MTX? at high doses?
3-10 hours 8-15 hours
56
ADRs of MTX
bone marrow suppression aplastic anemia GI toxicity
57
after prolonged use, MTX can cause
hepatotoxicity, fibrosis, cirrhosis and pulmonary toxicity
58
MTX can be detected in _________ which can be an issue with babies
human breast milk

Pharmacology II (18 decks)

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