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Pharmacology - Locomotor Module > Anti-Rheumatic Agents > Flashcards

Anti-Rheumatic Agents Flashcards

1
Q

__________ is generally prefered when doing monotherapy with traditional DMARDs (disease-modifying antirheumatic drugs)

A

Methotrexate

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2
Q

Methotrexate (MTX) is a folic acid antagonist that inhibits cytokine production and _________ (purine/pyrimidine) synthesis.

A

purine

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3
Q

Response to methotrexate (MTX) usually occurs within _________ weeks

A

3-6 weeks

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4
Q

If monotherapy with MTX gives an inadequate response, what should we do?

A

Combine MTX with other traditional DMARDs/TNF inhibitors/non-TNF biologic agents

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5
Q

How often should MTX be administered?

A

Once weekly

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6
Q

MTX is contraindicated in ____________

A

pregnancy

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7
Q

_____________ syndrome may occur with chronic administration of MTX

A

acute pneumonia-like syndrome

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8
Q

____________ (leukocytosis/leukopenia) may occur with chronic administration of MTX

A

leukopenia

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9
Q

Periodic liver function tests are recommended because chronic administration of MTX can cause __________ of the liver

A

cirrhosis

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10
Q

What are the GI-related adverse effects?

A

mucosal ulceration and nausea

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11
Q

Supplementation of __________ may improve tolerability of MTX and reduce GI and hepatic adverse effects.

A

Folic acid

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12
Q

Hydroxychloroquine (HCQ) is used for tx of early and mild RA. Its onset of effects is ____________

A

6 weeks to 6 months

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13
Q 
A 34-year-old woman with RA is planning for pregnancy. Which RA agents are absolutely contraindicated in pregnancy?
A. Abatacept and rituximab
B. Adalimumab and certolizumab
C. Infliximab and etanercept
D. Methotrexate and leflunomide
A

Methotrexate and leflunomide

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14
Q

Which traditional DMARD produces irreversible retinal damage?

A

Hydroxychloroquine

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15
Q

Where does hydroxychloroquine form deposits?

A

In the cornea

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16
Q

Hydroxychloroquine causes __________ (ocular toxicity/ototoxicity)

A

ocular toxicity

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17
Q

What are the adverse effects of MTX?

A 
Nausea
Mucosal ulcerations
Cytopenias
Cirrhosis
Acute pneumonia-like syndrome
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18
Q

Leflunomide is contraindicated in ____________

A

pregnancy

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19
Q

Leflunomide causes cell arrest of the autoimmune lymphocytes through its action on ___________

A

Dihydroorotate dehydrogenase (DHODH)

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20
Q

DHODH is an enzyme responsible for _________ (purine/pyrimidine) synthesis

A

pyrimidine

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21
Q

What does DHODH do?

A

It converts dihydroorotate to orotate (removes hydrogen and puts a double bond in the ring)

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22
Q

After biotransformation, leflunomide becomes a _________ (reversible/irreversible) inhibitor of DHODH

A

reversible

23
Q

When can leflunomide be used as monotherapy

A

Patients who have contraindications and intolerance to the use of MTX

{Remember, leflunomide is also contraindicated in pregnancy}

24
Q

Routine CBC and monitoring for signs of infection is important when giving ____________ (MTX/hydroxychloroquine)

A

MTX

25
Q

What are the adverse effects of hydroxychloroquine?

A 
Ocular toxicity
Corneal deposits
Irreversible retinal damage
CNS disturbances
GI upset
skin discoloration and eruptions
26
Q

___________ is not recommended in liver disease as it can be hepatotoxic

A

Leflunomide

27
Q

Hairless Ariel Wobbled Reluctantly. Mnemonic for adverse effects of leflunomide.

A

Headache
Allergic reactions
Weight loss
Rash

28
Q

Fat Astronauts Demeaned Hermione Naughtily. Mnemonic for adverse effects of leflunomide.

A 
Flu-like syndrome
Alopecia
Diarrhea
Hypokalemia
Nausea
29
Q

What things should we monitor if a patient is being given leflunomide?

A

CBC
Signs of infection
Liver enzymes (because of hepatotoxicity)
Electrolytes (because of hypokalemia)

30
Q

The onset of activity of sulfasalazine is ____________

A

1-3 months

31
Q

What are the adverse effects of sulfasalazine?

A

Nausea
Vomiting
Anorexia
Leukopenia

32
Q

The onset of action of traditional DMARDs is long so what should be done in the meantime?

A

Glucocorticoids should be given for symptomatic relief.

33
Q

How should glucocorticoids be given?

A

the lowest dose for the shortest duration to avoid adverse effects

34
Q 
Which agent for RA competes with CD28 to prevent full T-cell activation?
A. Sarilumab
B. Abatacept
C. Golimumab
D. Adalimumab
A

Abatacept is a costimulation modulator that competes with CD28 to prevent its binding on CD80/CD86 protein, resulting in reduced T-cell activation

35
Q

Golimumab and adalimumab are both ______

inhibitors

A

TNF-α inhibitors

36
Q

Sarilumab is ____ inhibitor

A

IL-6 inhibitor

37
Q 
Which statement correctly represents the mechanism of action of tofacitinib in the treatment of RA?
A. TNF-α inhibitor
B. Janus kinase inhibitor
C. IL-6 receptor blocker
D. Dihydrofolate reductase inhibitor
A

Janus kinase inhibitor

38
Q

Methotrexate inhibits _____________

A

dihydrofolate reductase

39
Q

Etanercept is an example of ________ inhibitor

A

TNF-α

40
Q

Tocilizumab is an example of ______ inhibitor

A

IL-6

41
Q

Rituximab is a monoclonal antibody against ________

A

CD20 antigen on B cells

42
Q

What are the names of TNF-α inhibitors?

A 
Adalimumab
Certolizumab
Etanercept
Golimumab
Infliximab
43
Q

What are the names of non-TNF biologic agents?

A

Abatacept
Rituximab
Tocilizumab
Sarilumab

44
Q

What is the function of TNF-α?

A

Stimulate synovial cells to proliferate and synthesize collagenase -> degrading cartilage
Stimulate bone resorption
Inhibiting proteoglycan synthesis

45
Q

Clinical response with TNF-α inhibitors can be seen within _______ of therapy

A

2 weeks

46
Q

When are TNF-α inhibitors used?

A

Used after a patient has an inadequate response to traditional DMARDs

47
Q

TNF-α should be used cautiously in those with __________ as it can worsen the condition.

A

heart failure

48
Q

A risk of _________ (type of cancer) has been observed with the use of TNF-α inhibitors

A

lymphoma

49
Q

Patients receiving biologic DMARDs (TNF-α inhibitors and non-TNF agents) are at risk of infections. Give examples of infections.

A

tuberculosis
fungal opportunistic infections
sepsis

50
Q

Non-TNF agents and ___________ should not be used in combination because of high risk of infections.

A

TNF-α inhibitors

51
Q

Reactivation of ___________ can occur with the use of biologic DMARDs

A

hepatitis B

52
Q

____________ should not be administered to patients taking biologic DMARDs

A

Live vaccinations

53
Q

Name some other uses of TNF-α inhibitors.

A

Ulcerative colitis
Crohn disease
Psoriasis
Ankylosing spondylitis

Pharmacology - Locomotor Module (5 decks)

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