5) Rheumatoid Arthritis and Gout Flashcards by Aqeel Nabijohn

What is the class for Indomethacin (Indocin)

Non-selective NSAID

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What is the mechanism for Indomethacin (Indocin)

Eliminate pain; reduce inflammation (but does not slow disease progression)

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What are the therapeutics for Indomethacin (Indocin)

Rheumatoid arthritis; acute gouty arthritis

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What are the important side effects for Indomethacin (Indocin)

Gastric and duodenal ulcers

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What is the class for Naproxen (Aleve)

Non-selective NSAID

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What is the mechanism for Naproxen (Aleve)

Eliminate pain; reduce inflammation (but does not slow disease progression)

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What are the therapeutics for Naproxen (Aleve)

Rheumatoid arthritis; acute gouty arthritis

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What are the important side effects for Naproxen (Aleve)

Gastric and duodenal ulcers

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What is the class for COX-2 inhibitors

Selective NSAID

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What is the mechanism for COX-2 inhibitors

Eliminate pain; reduce inflammation (but does not slow disease progression)

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What are the therapeutics for COX-2 inhibitors

Superseding conventional NSAIDs for rheumatoid arthritis

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What are the important side effects for COX-2 inhibitors

50% fewer gastric and duodenal ulcers than traditional NSAIDs

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What is the class for Quinolones

DMARD (antimalarial)

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What is the mechanism for Quinolones

Reduces T-cell activation & chemotaxis

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What are the therapeutics for Quinolones

Rheumatoid arthritis, SLE

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What are the important side effects for Quinolones

Retinal damage (chloroquine)

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What are the miscellaneous for Quinolones

Used for patients who no longer respond to NSAIDS or can’t tolerate other DMARDs

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What is the class for Glucocorticoids
(Corticosteroids)

DMARD

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What is the mechanism for Glucocorticoids

Corticosteroids

Inhibits phospholipase A2 (inhibiting release of arachidonic acid and, thus, formation of prostaglandins)
Inhibits cytokine production (which prevents induction of COX-2)

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What are the therapeutics for Glucocorticoids

Corticosteroids

Rheumatoid arthritis; acute gouty arthritis (intraarticular injection for relief of acute monoarticular gout)

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What are the important side effects for Glucocorticoids

Corticosteroids

Cushingoid symptoms

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What are the miscellaneous for Glucocorticoids

Corticosteroids

Started initially (fast acting) before other drugs become effective
Can give orally or intra-articularly

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What is the class for Sulfasalazine (Azulfidine)

DMARD

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What is the mechanism for Sulfasalazine (Azulfidine)

Likely inhibition of IL-1 & TNF-alpha release

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What are the therapeutics for Sulfasalazine (Azulfidine)

Rheumatoid arthritis

What are the important side effects for Sulfasalazine (Azulfidine)

N/V, skin rashes, neutropenia (30% of patient discontinue drug)

What are the other side effects for Sulfasalazine (Azulfidine)

Headaches

What are the miscellaneous for Sulfasalazine (Azulfidine)

Acts more quickly than other drugs

What is the class for Methotrexate (Trexall)

DMARD | Immunosuppressive

What is the mechanism for Methotrexate (Trexall)

1. Inhibition of aminoimidazolecarboxamide (AICAR) transformylase and thymidylate synthetase, with secondary effects on PMN chemotaxis 2. Causes adenosine accumulation, which inhibits inflammation

What are the therapeutics for Methotrexate (Trexall)

Rheumatoid arthritis

What are the important side effects for Methotrexate (Trexall)

Nausea, stomatitis, hepatotoxicity (rare)

What are the miscellaneous for Methotrexate (Trexall)

Takes several weeks to start working; "gold standard" of therapy

What is the class for Leflunomide (Arava)

DMARD | Immunosuppressive

What is the mechanism for Leflunomide (Arava)

Inhibits dihydroorotate dehydrogenase (DHODH), which inhibits T-lymphocyte response to stimuli

What are the therapeutics for Leflunomide (Arava)

Rheumatoid arthritis

What are the important side effects for Leflunomide (Arava)

Diarrhea, hepatotoxity

What are the miscellaneous for Leflunomide (Arava)

Takes several weeks to start working; oral prodrug

What is the class for Etanercept (Enbrel)

Biologic Response Modifiers

What is the mechanism for Etanercept (Enbrel)

Blocks binding of TNF to TNF receptors

What are the therapeutics for Etanercept (Enbrel)

Rheumatoid arthritis

What are the miscellaneous for Etanercept (Enbrel)

Twice weekly subcutaneous injections

What is the class for Infliximab (Remicade)

Biologic Response Modifiers

What is the mechanism for Infliximab (Remicade)

Blocks binding of TNF to TNF receptors

What are the therapeutics for Infliximab (Remicade)

Rheumatoid arthritis

What are the important side effects for Infliximab (Remicade)

Antigenic response to murine monoclonal Ab

What is the class for Adalimumab (Humira)

Biologic Response Modifiers

What is the mechanism for Adalimumab (Humira)

Blocks binding of TNF to TNF receptors

What are the therapeutics for Adalimumab (Humira)

Rheumatoid arthritis

What are the miscellaneous for Adalimumab (Humira)

Fully human, so no antigenic response; twice monthly injections

What is the class for Golimumab

Biologic Response Modifiers

What is the mechanism for Golimumab

Blocks binding of TNF to TNF receptors

What are the therapeutics for Golimumab

Rheumatoid arthritis

What are the important side effects for Golimumab

Risk of serious infections

What is the class for Certolizumab

Biologic Response Modifiers

What is the mechanism for Certolizumab

Blocks binding of TNF to TNF receptors

What are the therapeutics for Certolizumab

Rheumatoid arthritis

What are the important side effects for Certolizumab

Risk of serious infections

What are the miscellaneous for Certolizumab

Conjugated to PEG for stabilization

What is the class for Anakinra (Kineret)

Biologic Response Modifiers

What is the mechanism for Anakinra (Kineret)

IL-1 Receptor Antagonist

What are the therapeutics for Anakinra (Kineret)

Rheumatoid arthritis

What are the miscellaneous for Anakinra (Kineret)

Short (6 hr) plasma half-life; daily treatment with high doses

What is the class for Tocilizumab (Actemra)

Biologic Response Modifiers

What is the mechanism for Tocilizumab (Actemra)

IL-6 Receptor Antagonist

What are the therapeutics for Tocilizumab (Actemra)

Rheumatoid arthritis

What is the class for Rituximab (Rituxan)

Biologic Response Modifiers

What is the mechanism for Rituximab (Rituxan)

Anti-CD20 mAb, reduces circulating B cells

What are the therapeutics for Rituximab (Rituxan)

Rheumatoid arthritis

What are the important side effects for Rituximab (Rituxan)

Infections; hypersensitivity reactions

What are the miscellaneous for Rituximab (Rituxan)

Used for RA refractory to TNF-alpha inhibitors

What is the class for Abatacept (Orencia)

Biologic Response Modifiers

What is the mechanism for Abatacept (Orencia)

Inhibits T-cell activation and induces T-cell apoptosis

What are the therapeutics for Abatacept (Orencia)

Rheumatoid arthritis

What are the important side effects for Abatacept (Orencia)

Headaches; infections

What are the miscellaneous for Abatacept (Orencia)

Used in patients for RA refractory to MTX or TNF-alpha inhibitors

What is the mechanism for Colchicine (Colcrys)

Prevents tubulin polymerization & leads to inibition of leukocyte migration, phagocytosis, and release of cytokines

What are the therapeutics for Colchicine (Colcrys)

Acute gouty arthritis

What are the important side effects for Colchicine (Colcrys)

Long-term use causes peripheral neuropathy & neutropenia

What are the other side effects for Colchicine (Colcrys)

Nausea, vomiting, abdominal pain, troublesome diarrhea

What are the miscellaneous for Colchicine (Colcrys)

Works in 12-24 hours!

What is the class for Probenecid (Benemid)

Uricosuric Agent

What is the mechanism for Probenecid (Benemid)

Compete with urate at the anionic transport site of the renal tubule and inhibit urate reabsorption

What are the therapeutics for Probenecid (Benemid)

Chronic tophaceous gout

What are the important side effects for Probenecid (Benemid)

Urate crystal mobilization and acute gouty arthritis

What are the other side effects for Probenecid (Benemid)

Gastrointestinal irritation

What are the miscellaneous for Probenecid (Benemid)

Secretion of some weak acids (e.g., penicillin) is reduced

What is the mechanism for Allopurinol (Zyloprim)

1. Reduces uric acid synthesis by inhibiting xanthine oxidase (competitive inhibition) --> alloxanthine 2. Alloxanthine is a non-competitive inhibitor of xanthine oxidase

What are the therapeutics for Allopurinol (Zyloprim)

Chronic tophaceous gout

What are the important side effects for Allopurinol (Zyloprim)

Acute attacks of gouty arthritis early in treatment due to mobilization of urate crystals

What is the mechanism for Febuxostat (Uloric)

Non-purine, non-competitive antagonist of xanthine oxidase

What are the therapeutics for Febuxostat (Uloric)

Chronic tophaceous gout

What are the important side effects for Febuxostat (Uloric)

Nausea, rash, arthralgias

What are the miscellaneous for Febuxostat (Uloric)

Expensive

What is the class for Pegloticase (Krystexxa)

Recombinant, stabilized uricase

What is the mechanism for Pegloticase (Krystexxa)

Converts uric acid to allantoin

What are the therapeutics for Pegloticase (Krystexxa)

Chronic tophaceous gout