Flashcards in T4- Rheumatoid Arthritis Deck (40):
What does the synovial membrane do?
Synovial membrane normally surrounds joints (360) like a donut
What does the articular cartilage?
On ends of bones normally keeps motion smooth and painless (no friction or grinding)
In a healthy adult, there is almost ___ friction.
What happens in RA?
In RA, the immune cells are too active, and they release cytokines which cause inflammation
Overtime the synovial membrane overgrows into the cartilage and takes over the joint--you will hear grinding noises--bones will fuse together eventually
What is meant by ulnar drift/deviation?
Swelling/inflammation in the big knuckles of your hand causes bones to become displaced and to drift toward the ULNAR bone --ulnar drift; bones have slipped off each other
What are the 3 major medication groups given to RA patients?
-Disease modifying anti-rheumatic drugs (DMARDs)
Which two RA drugs give rapid relief?
Which RA drug is given daily?
Speed of onset: _____. Decrease inflammatory response.
NSAIDs. Does it slow down the disease progression? Does it prevent joint damage?
No, it does not slow disease progression
No it does not prevent joint damage
NSAIDs are more ___ than glucocorticoids.
Safer drug= less vigorous monitoring (safer than ___ & ____)
Glucocorticoids and DMARDs
Speed of onset: _____ (decrease inflammatory response)
Glucocorticoids ______ disease progression.
What is the issue with glucocorticoids?
TOXICITY with long-term use...good for an acute flare up ONLY
DMARDS speed of action= ____ (months to start working)
DMARDs _____ disease progression (and reduce joint destruction)
DMARDs: start taking this drug within ___ of RA diagnosis (aggressive treatment)
Can you stay on DMARDs long term without toxicity?
Identify at which stage of RA it's appropriate to start a client on an NSAID.
Immediately (along with DEMARD
*stay on NSAID until DMARD has had time to work, after which the NSAID can be withdrawn
What are the 3 DMARDs?
Methotrexate is a well known cancer drug, but often used for ____. It is the "___"
RA; drug of choice
What is the MOA of methotrexate?
1. Folic acid is essential to making DNA
2. DHFR enzyme changes folic acid into adenine and guanine, which is transferred into DNA
*without A & G, DNA can't be built
The MOA of the drug is blocking the DHFR enzyme
DNA helps make cells. With the blocking of the DHFR enzyme (that helps make DNA), then we worry about the decrease in ____ cells. Without these cells what happens?
WBC; without these cells inflammation is not suppressed, which is what is needed to help slow the progression of RA
How often do we take methotrexate?
Only ONCE A WEEk; not daily--this will help reduce side effects
There are 11 BBW associated with this drug!!!
What are the adverse effects of methotrexate?
-N/D= most common
-Decrease bone marrow
-Pneumonitis (inflammed lung)
What is the MOA of hydroxychloroquine?
What is hydroxychloroquine combined with?
Methotrexate (not as strong)
Do you take hydroxychloroquine with food?
Hydroxychloroquine causes a risk of _____
Educate a client regarding the need for eye exams while taking hydroxychloroquine and what S/S to report immediately?
Risk for retinal damage with this drug
Need to have an eye exam BEFORE taking to get baseline, and then every year after
Stop taking medication immediately if vision changes or vision loss occur
T/F: Hydroxychloroquine is less toxic and less effective than methotrexate?
What is the MOA of TNF blockers?
Bind to the TNF-alpha and block it
*TNF alpha is a cytokine involved with inflammation
What are the 3 TNF blockers?
*All work equally well
Explain why it is essential to check a client's immunization status before beginning RA drugs like tumor necrosis factor inhibitors.
TNF inhibitors suppress the immune system
-bodys normal fighting mechanism is not working
-can get infection, diseases, and even cancer much easier without body fighting it off
TNF is contraindicated for what patients?
-Active infections (TB and HBS infections)
TNF exercise caution in what patients (6)
-Taking immunpsuppressing drugs
What are adverse effects of TNF?
-Injection site reactions (irritation, weakness, itching, pain, swelling)
-Infections (pneumonia, flu, TB)
What are the rare adverse effects of TNF?
-severe allergic (stevens johnson) reactions
-HF (do not take TNF if you have HF!!)
-Cancer (immune system normally fights cancer, but TNF weakens the immune system)