T4- Rheumatoid Arthritis Flashcards Preview

Melissa's Pharm 2 > T4- Rheumatoid Arthritis > Flashcards

Flashcards in T4- Rheumatoid Arthritis Deck (40):
1

What does the synovial membrane do?

Synovial membrane normally surrounds joints (360) like a donut

2

What does the articular cartilage?

On ends of bones normally keeps motion smooth and painless (no friction or grinding)

3

In a healthy adult, there is almost ___ friction.

Zero

4

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

5

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

6

What are the 3 major medication groups given to RA patients?

-NSAIDS
-Glucocorticoids
-Disease modifying anti-rheumatic drugs (DMARDs)

7

Which two RA drugs give rapid relief?

NSAIDs
Glucocorticoids

8

Which RA drug is given daily?

DMARD

9

NSAIDs
Speed of onset: _____. Decrease inflammatory response.

Rapid relief

10

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

11

NSAIDs are more ___ than glucocorticoids.

Safer

12

NSAIDs
Safer drug= less vigorous monitoring (safer than ___ & ____)

Glucocorticoids and DMARDs

13

Glucocorticoids
Speed of onset: _____ (decrease inflammatory response)

Rapid relief!!

14

Glucocorticoids ______ disease progression.

Can slow

15

What is the issue with glucocorticoids?

TOXICITY with long-term use...good for an acute flare up ONLY

16

DMARDS speed of action= ____ (months to start working)

Slow

17

DMARDs _____ disease progression (and reduce joint destruction)

Slows

18

DMARDs: start taking this drug within ___ of RA diagnosis (aggressive treatment)

3 months

19

Can you stay on DMARDs long term without toxicity?

Yes!

20

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*stay on NSAID until DMARD has had time to work, after which the NSAID can be withdrawn

21

What are the 3 DMARDs?

Methotrexate
Hydroxychloroquine
TNF Blockers

22

Methotrexate is a well known cancer drug, but often used for ____. It is the "___"

RA; drug of choice

23

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

24

Methotrexate:
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

25

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!!!

26

What are the adverse effects of methotrexate?

-N/D= most common
-GI ulceration
-Decrease bone marrow
-Pneumonitis (inflammed lung)
-Hepatotoxicty
-Renal failure
-Infection (immunosuppression)
-Severe Rash

27

What is the MOA of hydroxychloroquine?

Unknown

28

What is hydroxychloroquine combined with?

Methotrexate (not as strong)

29

Do you take hydroxychloroquine with food?

Yes

30

Hydroxychloroquine causes a risk of _____

Retinal damage

31

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

32

T/F: Hydroxychloroquine is less toxic and less effective than methotrexate?

True

33

What is the MOA of TNF blockers?

Bind to the TNF-alpha and block it

*TNF alpha is a cytokine involved with inflammation

34

What are the 3 TNF blockers?

-Infliximab (IV/SQ)
-Adalimumab (SQ)
-Etanercept (SQ)

*All work equally well

35

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

36

TNF is contraindicated for what patients?

-Demyelinating disorders
-Severe HF
-Active infections (TB and HBS infections)

37

TNF exercise caution in what patients (6)

-HIV meds
-Taking immunpsuppressing drugs
-Diabetes
-Mild HF
-Liver dysfunction
-Latent TB

38

What are adverse effects of TNF?

-Injection site reactions (irritation, weakness, itching, pain, swelling)
-Infections (pneumonia, flu, TB)

39

What are the rare adverse effects of TNF?

-severe allergic (stevens johnson) reactions
-HF (do not take TNF if you have HF!!)
-Hepatotoxicty (JAUNDICE)
-Cancer (immune system normally fights cancer, but TNF weakens the immune system)

40

Explain why a client taking a TNF inhibitors should report being exposed to a communicable disease to their doctor.

There is an increased risk of infection while taking these drugs--pneumonia, TB, flu
*immune system is suppressed and the body can't fight