Week 7 Flashcards
Rheumatology Drugs (27 cards)
Which drugs are monoclonal antibodies to TNF-alpha?
Adalimumab (Humira)
Certolizumab (Cimzia)
Infliximab (Remicade)
Golimumab (Simponi)
What does Adalimumab,
Certolizumab, Infliximab, and
Golimumab treat?
Rheumatoid arthritis
Psoriasis/psoriatic arthritis
Ankylosing spondylitis
Inflammatory bowel disease
Adalimumab & Certolizumab – Subcutaneous injection
Infliximab – IV only
Golimumab – IV or subcutaneous injection
What are adverse effects of Adalimumab,
Certolizumab, Infliximab, and Golimumab?
Common: injection site reaction, infection, URI
Rare/serious: demyelinating disease, CHF, infections, drug induced Lupus, tuberculosis and hepatitis B reactivation
TEST FOR TUBERCULOSIS AND HEP B BEFORE USE
Avoid in patients that heart failure, multiple sclerosis
Which drug is a fusion protein that binds to patient’s TNF and blocks its interaction with cell surface receptors?
Etanercept (Enbrel)
What does Etanercept treat?
Rheumatoid arthritis
Psoriasis/psoriatic arthritis
Ankylosing spondylitis
Subcutaneous injection
What are some adverse effects of Etanercept?
Common: injection site reaction, infection, URI
Rare/serious: demyelinating disease, CHF, infections, drug induced Lupus, reactivation of tuberculosis and hepatitis B
TEST FOR TB AND HEP B BEFORE USE
Avoid in patients that heart failure, multiple sclerosis
Which non-biologic DMARD is not fully elucidated but is thought to work on Toll-like receptors?
Hydroxychloroquine
(Plaquenil)
What does Hydroxychloroquine treat?
Lupus
Sjogren’s
What are some adverse effects of Hydroxychloroquine?
Common: GI, rash
Rare/serious: RETINAL TOXICITY,
PROLONGED QT INTERVAL (ESPECIALLY WITH OTHER MEDS THAT PROLONG QT INTERVAL (I.E. AZITHROMYCIN))
Retinal toxicity risk is higher at higher doses and longer duration of therapy
RECOMMEND PATIENTS TO HAVE YEARLY EYE EXAM
Which non-biologic DMARD is a FOLATE ANTI-METABOLITE/FOLIC ACID ANALOG that competitively INHIBITS DIHYRDOFOLATE REDUCTASE which DECREASES dTMP leading to a DECREASE in DNA synthesis?
Methotrexate
What does Methotrexate treat?
Rheumatoid arthritis
Psoriasis
Psoriatic arthritis
SUPPLEMENT WITH FOLATE
Oral or SQ
What are some adverse effects of Methotrexate?
Common: aphthous stomatitis (mouth ulcers), GI (nausea, emesis), headache
Rare/serious: HEPATOTOXICITY, PULMONARY FIBROSIS, nephrotoxicity
Contraindicated in pregnancy, breastfeeding and chronic excessive alcohol use
Leucovorin treats methotrexate toxicity
Which non-biologic DMARD is not fully understood but is thought to modulate leukotrienes and inhibits neutrophil migration and lymphocyte response?
Sulfasalazine
What does Sulfasalazine treat?
Rheumatoid arthritis
What are some adverse effects of Sulfasalazine?
Common: GI, headache
Rare/serious: bone marrow suppression, SJS/TEN, hepatic necrosis
Contraindicated in sulfa allergy
Which non-biologic DMARD inhibits B and T cell proliferation?
Mycophenolate (Cellcept)
What does Mycophenolate treat?
Transplant
Lupus
Scleroderma, myositis especially in patients that have associated ILD
What are some adverse effects of Mycophenolate?
Common: nausea, diarrhea
Rare/serious: BONE MARROW SUPPRESSION
Contraindicated in pregnancy
Which non-biologic DMARD is an alkylating agent that prevents cell division (toxic to lymphocytes)?
Cyclophosphamide
What does Cyclophosphamide treat?
Lupus, scleroderma, myositis, vasculitis
Oncology
What are some adverse effects of Cyclophosphamide?
Common: BONE MARROW SUPPRESSION, DECREASE IN LYMPHOCYTES
Rare/serious: hemorrhagic cystitis, QT interval prolongation, concern for increased risk of malignancy in the future (leukemia, bladder cancer)
Contraindicated in pregnancy
Which drug inhibits pyrimidine synthesis for anti-inflammatory and anti-proliferative effects?
Leflunomide
What does Leflunomide treat?
Rheumatoid arthritis
What are some adverse effects of Leflunomide?
Common: GI (diarrhea) headache, alopecia, HTN
Rare/serious: hepatotoxicity (boxed warning), BONE MARROW SUPPRESSION
Contraindicated in pregnancy and severe hepatic impairment
