Rheumatology Flashcards Preview

Pharmacology II > Rheumatology > Flashcards

Flashcards in Rheumatology Deck (31):
1

If you wish to use NSAID in a patient with osteoarthritis what can be done to guard against GI problems?

1. Add misoprostol
2. Add PPI or H2 blocker
3. Switch to Cox-2

2

Most common symptom in osteoarthritis?

-pain

-pain relief is the primary objective

3

What do NSAIDs and ASA affect?

cyclooxygenase

4

1st line treatment for osteoarthritis

Acetaminophen 4g/day

5

2nd line treatment for osteoarthritis

topical or oral NSAID

6

What are the uses/benefits of using Choline and magnesium trisalicylate?

strategy to reduce GI toxicity

7

Topical NSAID of choice in patient over 75

Ketoprofen

8

If patient is over 75 years old, what is the first line agent for hand osteoarthritis?

Oral NSAIDs, Topical NSAIDs

or

topical capsaicin +/- tramadol

9

If patient is over 75 with hand arthritis what is the 2nd line treatment

Combination: topical NSAID with tramadol

10

Goal of RA treatment

Achieve remission or low disease activity

11

When should disease modifying antirheumatic drugs be started in RA?

within the first 3 months of diagnosis

12

What function do NSAIDs and corticosteroids have on RA disease?

adjunctive therapy for symptom relief.

13

What can be done if one DMARD is not adequate?

1. combination of DMARDS (ex. methotrexate and plaquenil)

2. DMARD + biologic

14

Non biologic DMARDs

-methotrexate*
-leflunomide
-hydroxychloroquine
-sulfasalazine
-minocycline
-Tofacitinib (kinase inhibitor)

15

Anti-TNF drugs

-Entanercept (Enbrel)
-infliximab (Remicade)
-adalimumab (Humira)
-certolizumab (Cimzia)
-golimumab (Simponi)

16

Non-TNF drugs

-abatacept
-tocilizumab (IL-6)
-Rituximab (peripheral B cell depletion)
-Anakinra (IL-1)

17

If triple drug therapy is needed, what does the ACR recommend?

Methotrexate + hydroxychloroquine + sulfasalazine

18

Early vs. established RA

early is <6 months

established is >6 months

19

Methotrexate: Toxicities

Hematologic - thrombocytopenia (CBC)

Pulmonary fibrosis (Xray)

Hepatic - elevated AST, ALT

Stomatitis*

20

Leflunomide

MOA: decreases lymphocyte proliferation

Contraindicated: pregnancy, liver disease

Toxicities: bone marrow toxicity

21

Hydroxychloroquine

-NOT myelosuppressive (like leflunomide)

-Hepatic and renal toxicities
-Ocular** (visual changes decrease in night or peripheral vision)

22

Sulfasalazine

-Prodrug cleaved in colon (2 active metabolites after passing through the liver)

ADEs:
-Elevated ALT, AST
-May turn skin yellow-orange color* (no clinical significance)
-Binds iron supplements decreasing absorption of sulfazalazine****

23

Minocycline

-Tetracycline antibiotic derivative

-

24

Tofacitinib

-Use in moderate to severe disease in pt. who has failed methotrexate
-Tyrosine kinase inhibitor
-No live vaccines if taking this medication**

25

TNF-alpha biologics

infliximab, etanercept, adalimumab

contraindications: CHF
ADE: MS-like illness, exacerbate MS
increased risk of lymphoproliferative cancer

26

Which biologic depletes peripheral b cells

rituximab

27

Infliximab

-Chimeric antibody (human and mouse)
-Must be given with Methotrexate to prevent antibody formation

28

Adalimumab

-human IgG antibody to TNF

29

Anakinra (Kineret)

-IL-1
-MOA: affects T-cell proliferation and activation
-Don't give live vaccines

30

Tocilizumab

-IL-6
-avoid live vaccines

31

How often can corticosteroids be injected?

every 3 months

MAX of 2-3 a year in same joint