Antirheumatic Drugs Flashcards
Analgesia for osetoarthritis includes:
APAP
NSAIDs
COX-2 inhibitors
IF inflammation is present in osteoarthritis what should be prescribed?
NSAIDs
COX-2 inhibitors
Intra-articular corticosteroids
What drug is not effective in RA?
APAP, no effect on inflammatory component
Non-acetylated salicylates also less effective than traditional NSAIDs
Why is ASA rarely used in RA?
AE of high doses needed to achieve anti-inflamm effects
Which drugs are used for symptomatic therapy of RA and which to prevent/slow disease progression?
Symptomatic- NSAIDs, corticosteroids(systemic, intra-articular)
Prevent/slow- DMARDs (disease modifying antirheumatic drugs)
How are corticosteroids used in RA?
- Life threatening complications of RA, like vasculitis
- Bridge time to onset of action of DMARDs
- Pulse for acute flare ups
- Intra-articular therapy for very acute inflammation
- *Do not use longterm d/t SE
Long term AE of corticosteroids:
Hyperglycemia Catatracts Glaucoma Aspetic necrosis of weight bearing joints Osteoporosis Cushing's syndrome Adrenal suppresion Sodium and water retention CNS side effects (high doses)
When dosing corticosteroids, the ______ does possible should be used.
Lowest
Patients will need to be tapered after being on corticosteroids for how long and why?
> 2wks
prevent withdrawal secondary to adrenal suppression
Coricosteroids include:
Cortisone Hydrocortisone Prednisone Prednisolone Methylprednisolone Triamcinolone Dexamethasone Betamethasone
Which corticosteroids should be avoided in patients with CHF and HTN and why?
(in order of most to lease mineralcorticoid activity)
Cortisone
Hydrocort
Prednisone
Prednisolone
These have higher mineralcorticoid activity and cause more sodium and water retention
When should DMARDs be started?
As soon as RA is diagnosed to prevent/slow progression of joint destruction and deformities
Conventional DMARDs include:
Hydroxychloroquine (Plaquenil, Quineprox) Methotrexate Azathioprine (Imuran, AZA) Gold Penicillamine Sulfasalazine Leflunomide Minocycline Cyclophosphamide
Biologic DMARDs include:
Etanercept (Enbrel) Infliximab (Remicade) Adalimumab (Humira) Certolizumab pegol (Cimzia) Golimumab (Simponi) Tocilizumab (Acetmra) Rituximab (Rituxan) Abatacept (Orencia) Anakinra (Kineret)
How long does it typically take DMARDs to elicit a response?
3-6months
use NSAIDs or corticosteroid to manage s/s, NSAIDs often continued even once DMARDs begin to work
What should be monitored to assess efficacy of DMARDs?
ROM
ADLs
Which DMARDs, which used to be the standard of care, are seldom used d/t their high incidence of toxicity?
Gold (oral or IV) and Penicillamine
S/s of toxicity of Gold or Penicillamine?
Myelosuppresion, proteinuria, stomatitis rash, altered taste perception (penicillamine), visual changes (gold)
Azathioprine, a conventional DMARD, is also used for ______ ______.
Crohns Disease (rarely used for RA)
Azathioprine is a prodrug for what and what does it do?
Mercaptopurine
Immunosuppressant
S/s of azathioprine toxicity are:
Mylosuppression, hepatotoxicity, rash, infection
reserved for aggressive disease or serious complications like vasculitis
Hydroxychloroquine (PO), a conventional DMARD, is also used as an ______ ______ .
Anti-malarial drug
Hydroxychloroquine is most commonly used for what type of RA and may take up to how long before a clinical effect is seen?
Used for mild RA
May take 6mos
Toxicity of Hydroxychloroquine includes what s/s:
Usually well tolerated, some GI upset
Retinopathy is rare but ophthalmology exams are recommended q6-12mos
