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Locomotor Y2 > Treatment options for Rhumatoid arthritis > Flashcards

Treatment options for Rhumatoid arthritis Flashcards

(52 cards)

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1
Q

Describe the

A

Joint involvement Score

1 large joint 0

2-10 large joints 1

1-3 small joints 2

4-10 small joints 3

>10 joints (at least 1 small joint) 5

Serology

Negative RF and negative ACPA 0

Low positive RF or low positive ACPA 2

High positive RF or high positive ACPA 3

Acute phase reactants

Normal CRP and normal ESR 0

Abnormal CRP or abnormal ESR 1

Duration of symptoms

<6 weeks 0

>6 weeks 1

> 6/10 for diagnosis

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2
Q

What is the order of RA treatment based on severity

A

Newly diagosed- Pain managment

NSAIDS,COX- 2 inhibitors, Narcotics (opioids)

First line treatment (Mild Ra)

Methotrexate + second line DMARD

Second line treatment (moderate RA)

Methotrexate + TNF alpha inhibitors

Second line teratment (sever RA)

Methotrexate and Rituxximab

For unmanageable RA

Surgival intervention

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3
Q

List 4 non-pharmacological treatments for RA

A
  • Physiotherapy
  • Occupational therapy
  • Podiatry
  • Therapy (for relaxation, stress managment and coping)
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4
Q

What is the Adjunct therapy used to treat RA that is not on the usual treatment schedual?

A

Oral corticosteroid pulse

Prednisone

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5
Q

When someone is newly diagnosed with RA, how would you treat them?

A

•Methotrexate and at least one other DMARD plus short term glucocorticoids

When control is obtained, reduce the dose to a level that still controls the disease

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6
Q

What is the treatment stratergy used when combination DMARD therapy is not appropriate?

A

•DMARD monotherapy

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7
Q

How is Methotrexate administerd and what is the starting dose?

A

•Orally once a week on the same day

–2.5mg tablets

–Start between 5-10mg a week

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8
Q

What is the alternative mode of administartion used when oral methotrexate doesnt work?

A

subcutaneous or intramuscular injection of methotrexate

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9
Q

How long does it take for the benifits of methotrexate to start working?

A

3-12 weeks

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10
Q

List 3 side effects of methotrexate

A

–Can cause liver problems- hepatotoxicity with fibrosis and cirrhosis

–Can affect blood count- cytopenia useually leukopenia and thrombocytopenia - due to bone marrow surpression

  • Stomatitis
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11
Q

What is the mode of action for methotrexate?

A
  • Folic acid antagonist
  • It limits DNA and RNA synthesis
  • Inhibits dihydrofolate reductase and thymidylate synthetase
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12
Q

How does methotrexate enter the body? What is it converted into when it enters the body?

A

Enters via acive transport using folate receptors/ carriers

It is converted into methotrexate glutamate

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13
Q

What is Sulfasalazine composed of?

A

–Combines sulfapyridine and salicylate with azo bond

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14
Q

How is Sulfasalazine normally administerd?

A

Orally-

Satrts with 500mg daily

–Gradually increased over 4 weeks

1g twice a day

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15
Q

How long does it take for the effects of Sulfasalazine to present?

A

12 weeks

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16
Q

How does Sulfasalazine enter the blood stream?

A

Not well absorbed across the gut. Metabolised by gut bacteria and these are better absorbed

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17
Q

What is the effect of Sulfasalazine on RA?

A

Mode of action is not well understood

Gets concentrated in connective tissue and serous fluids

relieves arthritic symptoms

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18
Q

Which other condition does Sulfasalazine treat?

A

ulcerative colitis

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19
Q

When Sulfasalazine is absorbed it is broken down into 2 things. Name then and state which of the two has the theraputic effect?

A

Sulfapyridine and 5-ASA = 5-aminosalicylic acid

5-ASA = 5-aminosalicylic acid- inhibits COX, IL-1 and TNF alpha

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20
Q

When Sulfasalazine enters the liver, what is it converted into?

A

NAT2 = N-actetyltransferase 2

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22
Q

What kind of drug is Sulfasalazine?

Study These Flashcards
A

An antibiotic

23
Q

What type of drug is Hydroxychloroquine?

Study These Flashcards
A

Anti-malarial drug

24
Q

How is Hydroxychloroquine administerd?

Study These Flashcards
A

•Oral with or after food

–Start

•400mg daily

–Reduced to 2-3 times a week

25
What is the mechanism of action for Hydroxychloroquine?
* Accumulates in lysosomes increasing the pH decreasing protein modifications * Blocks Toll-like receptor 9 which decreases activation of dendritic cells
26
The efficacy of Leflunomide is similar to another drug, name this drug
methotrexate
27
How much Leflunomide should be given a day?
For the first 3 days - a higher dose 100mg a day then 10-20mg a day
28
What is the mode of action for Leflunomide?
–Inhibits pyrimidine Synthesis by inhibiting dihydroorotate dehydrogenase (DHODH)
29
What is the emchanism of action for D-Pencillamine?
–Copper chelator –Thought to decrease immune response and IL1 generation –Preventing maturation of newly synthesised collagen prevents collagen cross linking (prevent fibrosis)
30
What are the side effects of D-Pencillamine? How is this potenial side effect monitored?
–Kidney damage – monitor for proteinuria
31
How are Gold Salts administerd?
Intra muscular injections given once a week
32
What is the avergae dosage for Gold salts?
50 mg
33
How long does it take for the effects of Gold salts to be seen?
4-6 months
34
What is the mode of action for Gold salts?
alter morphology and function of macrophages and inhibits monocyte chemotactic factors IL-8, 1beta Reduce histamine release Affects lysosomal activity
35
Biological DMARDS have 6 main fucntions, name them
–inhibition of TNFα –inhibition of interleukin 1 –Inhibit B cells –Block T-cell stimulation –Inhibition of interleukin 6 –Inhibition interleukin 17 and 23
36
Give 3 examples of a TNF alpha inhibitor?
•Etanercept Recombinant TNF receptor: Fc fusion protein •Infliximab –Monoclonal antibody against TNFα •Adalimumab –Human TNFα monoclonal antibody
37
What is the dosage and administration for Etanercept?
–50mg once per week subcutaneous injection
38
How long does it take for Etanercept to take effect?
–1-4 weeks for effect
39
How is Infliximab administerd? How long does it take to have an effect?
3mg/kg Infusions 2-3 hrs in duration 2-6 weeks apart –Days to weeks to have an effect
40
How is Adalimumab administered? How long does it take to have an effect?
–40mg subcutaneously every other week. –Effect seen 1-4 weeks
41
List and describe 3 drugs which inhibit interlukin 1
Anakinra- –Human recombinant IL-1 receptor antagonist Canakinumab - Human monoclonal antibody targets IL1β Rilonacept-
42
How is Anakinra administerd? What is the usual dosage? And how long does it take to have an effect?
–100mg per day subcutaneous –2-4 weeks to have an effect
43
Name and describe 1 drug which inhibits B cells
•Rituximab –Chimeric monoclonal antibody against CD20 primarily found on surface of B-cells
44
Name and describe 2 drugs which inhibits T cells
•Abatacept –Fusion protein IgG fused to extracellular domain of CTLA-4
45
How is Rituximab administerd? What is the usual dosage? How long does it take for the effects ot occure?
–A single course of 2 infusions of 1000mg given 2 weeks apart depletes B-cells for up to 6 months and possibly 1 year
46
What is the mechanism of action for Abatacept
–Prevents 2nd signal (co-stimulatory) from being delivered to T-cell
47
How is Abatacept adminaisterd? How long do the effects take to happen?
–Dosage dependent on body weight i.v. infusion over 30mins to 1hr once a month
48
What os one positive and one negtiave aspect of Abatacept compared to TNFα agents
Positive- Fewer adverse events Negative-
49
Name and describe 1 drug which inhibits interlukin 6. What is its mechanism of action?
•Tocilizumab –Humanized monoclonal antibody against membrane and soluble IL-6 receptor
50
How is Tocilizumab administered?
–i.v. 8mg/kg monthly
51
Name 1 drug which is an IL-23 inhibitor? What is this drug used to treat?
Ustekinumab used in psoriasis
52
What is a neutralising and Non-neutralising anti-drug antibody
Neutralising - Directly interferes with the biological drugs ability to work Non neutralising - May form immune complexes around injection site reducing drug concentration and pharmacokinetics Increased clearance

Locomotor Y2 (8 decks)

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