Anti Inflammatory And Corticoids

Question 1

3 goals of RA therapy?

Answer 1

Stop inflammation, relieve symptoms, and prevent joint and organ damage

Question 2

7 non drug therapies for RA?

Answer 2

Rest, exercise, PT, OT, nutrition and diet, bone protection, lower CV risk.

Question 3

What is drug of choice for additional pain relief? What is the first drug of choice for RA and why?

Answer 3

Acetaminophen

NSAIDS because of anti inflammatory action and pain relief

Question 4

3 mechanism of actions for prednisone?

Answer 4

Through GR
GR complexing with NFKB and AP1
Lipocortin, an inhibitor of PLA2

Question 5

What is the clinical application for using prednisone?

Answer 5

Autoimmune diseases like RA
Relieve pain and inflammation while waiting for DMARD effects
Flare ups

Question 6

How is prednisone converted to its active form?

Answer 6

The liver converts prednisone, which is a pro drug, to prednisone

Question 7

What is the idea in mind when using prednisone for active RA?

Answer 7

Use it for a short time to quickly minimize disease activity while waiting for DMARDs to kick in. Not a great idea to use chronic, but if you are, use it with DMARDs and less than 5mg a day.

Question 8

How many joints are involved in mild RA and what is the initial treatment for it?

Answer 8

5 and under

DMARD monotherapy and consider giving glucos for flare ups

Question 9

How many joints involved in moderate RA, what are two big differences between mild and moderate as far as labs, what would be initial treatment for moderate?

Answer 9

Greater than 5
Rheumatoid factor and antibodies against CCP
Combination DMARDS with glucos for flare ups or
TNF inhibitor with glucos for flare ups, maybe MTX
Non TNF maybe MTX glucos for flare ups

Question 10

What is the mechanism of action of methotrexate, 3 things?

Answer 10

Becomes MTX PG which leads to blocking thymidine synthesis, blocks purine synthesis, and adenosine activating purinergic G protein receptors for ani inflammatory effect.

Question 11

What is unique to methotrexate effect and what is the most significant clinical application?

Answer 11

Quickest acting of DMARDs 3-6 weeks

First line drug of choice for RA

Question 12

2 most common adverse effects of Methotrexate and what 3 adverse effects with chronic administration?

Answer 12

Mucosal ulcers and nausea

Cytopenias (particularly WBC), cirrhosis, and pneumonia

Question 13

How is sulfasalazine metabolized and what is the clinical application for it?

Answer 13

It is metabolized to 5 ASA (active agent in IBD) and sulfapyridine (active agent in RA)
Early mild RA with methotrexate and/or hydroxy. This is the triple therapy.

Question 14

2 most common adverse effects of sulfasalazine?

Answer 14

GI and leukopenia

Question 15

MOA of leflunomide and its clinical application?

Answer 15

Inhibition of DHODH to block synthesis of rUMP that causes cell arrest in autoimmune lymphocytes (particular T cells).
Alternative nonbiological DMARD to methotrexate, so second choice drug.
Can be used in combination with DMARDs as well.

Question 16

5 most common adverse effects for leflunomide?

Answer 16

Diarrhea, respiratory infections, alopecia, rash and nausea

Question 17

What is the MOA and effect of hydroxychloroquine?

Answer 17

Increases pH in lysosomes of antigen presenting cells (auto antigens is key here) and limits association with peptides from MHC.

Question 18

3 clinical applications of hydroxy and what is the 1 adverse effect to know?

Answer 18

First choice for RA by itself or with methotrexate.
Lupus
Malaria

retinal damage

Question 19

Two DMARDs Ok for pregnancy?

Answer 19

Hydroxy and sulfa

Question 20

What is the general rules of biologic DMARDs?

Answer 20

Can combine with non biological DMARDs but never with another biologic DMARD.

Typically faster onset and high rate of response
More expensive and increased risk for severe adverse effects

Question 21

4 anti inflammatory cytokines to know?

Answer 21

6, 10, 23 and TGFbeta.

Question 22

MOA of TNF antagonists, 2 effects, clinical application, 2 adverse effects?

Answer 22

Neutralize TNF
Reduce RA symptoms and disease progression
Moderate to severe RA
Serious infections and severe allergic reactions

Question 23

MOA, clinical pplciaiton and administration of etanercept?

Answer 23

Protein that has 2 receptors for 2 TNF molecules
RA, psoriasis, and AS
Subq once or twice a week

Question 24

MOA of infliximab, clinical application and administration?

Answer 24

Monoclonal antibody to TNF
RA with methotrexate, IBD and other inflammatory conditions
IV every 6-8 weeks

Question 25

MOA of adalimumab, clinical application and administration?

Answer 25

Full human monoclonal antibody against TNF
RA, psoriasis, AS, and Crohns
Sub q every week or two.

Question 26

MOA of Rituximab, clinical application, 1 adverse effect to know?

Answer 26

Anti cd20
Moderate to severe RA in combo with methotrexate in pts who have not responded to TNF blockers
Infusion hypersensitivity reactions

Question 27

Once rituximab binds the B cell, what are the 3 ways it can destroy the B cell?

Answer 27

Complement, direct lysis via NK, and phagocytosis

Question 28

MOA of abatacept, clinical application, 1 adverse effect?

Answer 28

Block CD80/86 on B cell from activating T cells
Moderate to severe RA in patients who haven’t responded to DMARDs or TNF blockers
Serious infections

Question 29

MOA of tocilizumab, clinical application, 1 adverse effect?

Answer 29

Antibody against IL6
Moderate to severe RA when DMARDs and TNF blockers don’t work
Upper respiratory infections

Question 30

MOA of tofacitinib, clinical application, 2 adverse effects?

Answer 30

Jak3 blocker
Moderate to severe RA in patients who don’t response to methotrexate
Secondary malignancies and opportunistic infections

Question 31

MOA for anakinra, clinical application and 2 adverse effects?

Answer 31

IL1 receptor blocker
Moderate to severe RA
Infections and hypersensitivity reactions