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Sem 2 CelS > Week 2 - Jane Rossi > Flashcards

Week 2 - Jane Rossi Flashcards

1
Q

What is hydrocortisone?

A

A glucocorticoid which inhibits genes that code for cytokines, interleukins and TNF-a. This limits T cell proliferation
Also suppresses humoral immunity, reducing Il-2 secreted by B-cells and IL-2 receptors

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2
Q

Why is hydrocortisone used in treatment of RA?

A

It’s anti-inflammatory and also may be disease modifying

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3
Q

What are possible short term side effects of hydrocortisone?

A

Mood changes - euphoria, aggression, dizziness, headache, weight gain, appetite, hyperglycemia, muscle wasting/weakness

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4
Q

What are possible long term side effects of hydrocortisone use?

A

HPA axis activity suppression, virilism, menstrual irregularities, peptic ulcer disease, cataracts, myopathy, osteoporosis, vertebral compression fractures.
CVD effects like hypertension and congestive heart failure
Difficulty for diabetics

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5
Q

Which drug is infliximab usually used with?

A

Methotrexate

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6
Q

What is the treatment schedule of infliximab?

A 
IV administered
first dose
1 two weeks later
1 6 weeks later
Maintenance injections every 8 weeks
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7
Q

How does infliximab work?

A

TNF-a binding antibody - prevents TNF-a from interacting with its receptors, lowering pro-inflammatory cytokine concentration

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8
Q

What are side effects of infliximab?

A 
Cough, rash, back pain, vomiting, abdominal pain and fever
Immunosuppression
Poor outcomes with latent TB
Lympomas
Heart failure
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9
Q

Which conditions prevent the use of infliximab?

A

Ankylosing spondylitis, Crohn’s disease, ulcerative colitis, psoriasis

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10
Q

How do selective NSAIDs differ from non-selective?

A

Selective only bind to COX-2, so only affect inflammatory processes

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11
Q

Which RA drugs do NSAIDs interfere with?

A

Glucocorticoids and methotrexate

– if you give low doses and monitor then it’s fine

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12
Q

What are some side effects of NSAIDs?

A

GIT bleeding, easy bruising, hypertension, hypersensitivity and CVD

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13
Q

Why is RA considered autoimmune?

A

Autoantibodies are present, which can precede clinical manifestation of RA by many years

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14
Q

What are the autoantibodies in RA?

A

Rheumatoid factor

Anti-citrullinated cyclic protein

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15
Q

In which patients can the 2010 rheumatoid arthritis checklist be used in?

A

Patients who have:
Evidence of currently active synovitis with at least one joint, except distal proximal joint involved.
Only use the criteria in patients whose synovitis isn’t better explained by something else i.e. psoriatic arthitis

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16
Q

What are some key strategies for talking to patients about a diagnosis or condition? (6)

A
  1. Check patient’s knowledge and attitude
  2. Communicate clearly and simply
  3. Give concrete and specific advice
  4. Explain the side effects and expected advice
  5. Repeat and stress the most important feedback
  6. Ask the to repeat everything back
17
Q

What are the antigens in RA?

A

Citrullinating protein

Fc portion of IgG

18
Q

What are results of antibodies binding to antigens?

A 
Opsonization - immune complexes form
Neutralisation
Cross-linking
Phagocytosis
Complement activation
Cytotoxic killing
Chemotaxis
Neovascularization
Increased permeability
19
Q

Which important cytokine is released by B-cells?

A

IL-6

20
Q

Which important cytokine is released by T-cells?

A

IL-1

21
Q

Which important cytokine is released by macrophages?

A

TNF-alpha

22
Q

Which cells release prostaglandins?

A

Nearly all of them

23
Q

Why is methotrexate so good in RA?

A

Folic acid antagonist, inhibits DNA synthesis and stops the rapidly dividing synoviocytes

24
Q

What does Etanercept do?

A

TNF-a antagonist - blocks the effect of TNF-a on chondrocytes and synoviocytes

25
Q

Which drugs are TNF-a antagonists?

A

Etanercept
Infliximab
Adalimumab

26
Q

What are some long term consequences of TNF-a antagonists?

A

Long term CV problems

Malignancies including lymphomas and leukemias

27
Q

What does Ritiximub do?

A

Blocks the CD-20 receptor on B-cells, which stops their proliferation. It’s a very nasty immunosuppressant

28
Q

What does Abatacept do?

A

Acts on antigen presenting cells - CD80 and CD86 receptors, preventing interaction with T cells

29
Q

What does Sulfasalazine do?

A

Is thought to decrease DNA by decreasing DNA transcription, but is largely unknown

30
Q

What do plaquenil/hydroxychloroquine do?

A

Increase pH in certain cellular processes, which decreases effectiveness of antigen processing

31
Q

Which drug is often used in place of methotrexate, in pregnant women or those trying to conceive?

A

Sulfasalazine

Sem 2 CelS (5 decks)

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