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PHRM 864: Therapeutics IV > Arthritis > Flashcards

Arthritis Flashcards

1
Q

What is the definiation of Rheumatoid Arthritis?

A
  • MOST COMMON systemic inflammatory disease characterized by Symmetrical Joint involvement.
  • CHRONIC
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2
Q

What is the pathophysiology of Rheumatoid Arthritis?

A
  • Chronic Autoimmune
  • Synovial Space in joints becomes inflammed –> leading to death
  • Forming Pannus: going to cause erosions that break the joint
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3
Q

What are some of the clinical presentions of Rheumatoid Arthritis?

A
  • Fatigue, Weakness, Loss of Appetite, Joint Pain, Lowgrade Fever
  • Stiffness & Muscle Ache –> Joint Swelling
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4
Q

In what way is Rheumatoid Arthritis diagnosed?

A
  • Needs a score of 6
  • Joint Involvement: 1 Medium-Large Joint to <10 Small Joints [0-5 points]
  • Serology: +/- for RF or ACPA [0-3 points]
  • Duration of Symptoms: </> 6 weeks [0-1 points]
  • Acute Phase Reactant: CRP or ESR [0-1 point]
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5
Q

What are the most common joints that are affected my Rheumatoid Arthritis?

A
  • Most Common: Hands, Wrists, Feet
  • Other sites: Elbow, Shouldersm Hips, Knees, Ankles
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6
Q

What are the Extra-Articular Manifestations in Rheumatoid Arthritis?

A
  • Rheumatoid Nodules
  • Vasculitis
  • Pulmonary
  • Ocular
  • Cardaic
  • Felty’s
  • Other
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7
Q

What is important to understand about what Rheumatoid Nodules are in Rheumatoid Arthritis?

A
  • On Pressure Points
  • Found within Hands, Wrists, Forearms
  • More common in Erosive disease
  • Asymptomatic? Dont need to treat
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8
Q

What is important to understand about Vasculitis in Rheumatoid Arthritis?

A
  • Inflammation of Small, Superficial Vessels
  • Could lead to necrosis
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9
Q

What is important to understand about Pulmonary in Rheumatoid Arthritis?

A
  • Could cause Pulmonary Embolisms, Pleural Effusions
  • RARE: Inflammation within the lungs or arteries
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10
Q

What is important to understand about Ocular in Rheumatoid Arthritis?

A
  • Inflammation in Sclera, Episclera, Cornea
  • Sjorgens Syndrome: Icthy, Dry Eyes [Keratoconjunctivitis] + Inflammation [RA]
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11
Q

What is important to understand about Cardaic in Rheumatiod Arthritis?

A
  • Increased risk of CV mortality
  • Pericarditis: Inflammed Cardiac Tissue
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12
Q

What is Felty’s within Rheumatoid Arthritis?

A
  • Splenomegaly
  • Neutropenia
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13
Q

What are some clincial features for Rheumatoid Arthritis?

A
  • Any Age, Systemic, Elevated ESR, Inflammation, Bilateral, am Stiffness > 1hour, -Osteophyte, +Pannus +RF, +Nodules,

SE: Malase, Fatigue, Musculoskeletal Pain, Fever

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14
Q

What are some clinical features for Osetoarthritis?

A
  • > 40 yo, ONLY joint, Normal ESR, Slight Inflammation, Uni or Bilateral Involvement, am Stiffness < 30mins, +Osteophyte, -Pannus, -RF,

SE: Deep, aching pain

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15
Q

What are the two adjunct therpies?

A
  • NSAIDS
  • Corticosteroids
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16
Q

How are NSAIDs used in Rheumatoid Arthritis?

A
  • Great at reducing pain, swelling, stiffness
  • Does NOT alter disease progression
  • Used WITH DMARDS
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17
Q

How are Corticosteroids used in Rheumatoid Arthritis?

A
  • Used for anti-inflammatory & immunosuppressive
  • NOT a monotherpay [same as NSAIDs]
  • Used in combo WITH DMARDs
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18
Q

What are the adverse effects fo corticosteroids?

WILL BE ON THE EXAM!!

A
  • Short Term: Hyperglycemia, Increased BP, Gastritis, Mood Swings
  • Long Term: Cataracts, Obesity, Osetoporsis, Growth Failure, Apestic Necrosis

Monitor: BP & BG

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19
Q

What is DMARDs and what do they help do?

A
  • Disease Modifying Anti-Rheumatic Drugs
  • Decreased/prevent joint damage DOES NOT reverse it
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20
Q

What are some of the Traditional DMARDS [Conventional Synthetic DMARDs] that are used in Rheumatoid Arthritis?

A
  • Methotrexate
  • Sulfasalazine
  • Hydroxychoroquine
  • Leflunomide
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21
Q

What is important to know about Methotrexate in Rheumatoid Arthritis?

MOA? Indication?

A
  • DMARD of choice
  • MOA: inhibit dihydrofolic acid reductase
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22
Q

What is the dosing of Methotrexate in Rheumatiod Arthritis?

WILL BE ON THE EXAM!!

`

A
  • 7.5 mg per WEEK PO or IV
  • May need to tirate up
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23
Q

What are some of the adverse effects of Methotrexate in Rheimatoid Arthritis?

A
  • Bone Marrow Suppression, N/V/D, Mucositis [should give folic acid]
  • Hepatic, Pulmonary, Skin issues
  • Teratogenic

CONTRAINDICATION: Pregnancy, Chronic Liver Disese, CrCl < 40

24
Q

What are some of monitoring for Methotrexate in Rheumatoid Arthritis?

A
  • CXR, CBC, SCr, LFTs, Albumin
25
Q

What is important to know about Leflunomide in Rheumatoid Arthritis?

MOA? Indication?

A
  • Prodrug
  • MOA: Inhibits cell cycle progression
  • Should have loading dose THEN maintenance dose
26
Q

What are some of the adverse effects of Leflunomide in Rheumatoid Arthritis?

A
  • Diarrhea, Rash, Alopecia, Increased LFTs, Teratogenicity
27
Q

What is some of the monitoring for Leflunomide in Rheumatoid Arthritis?

A
  • CBC, SCr, LFT
28
Q

What MOA for Sulfasalazine in Rheumatoid Arthritis?

A
  • MOA: Inhibits IL-1; prodrug that is cleased in the colon to Sulfpyradine and 5-ASA
29
Q

What are the adverse effects of Sulfasalazine in Rheumatoid Arthritis?

A
  • N/V/D, Anorexia, Rash, Hypersensitivity [SULFA Allergy]
30
Q

What is some of the monitoring for Sulfasalazine in Rheumatoid Arthritis?

A
  • CBC, SCr, LFT
31
Q

What is the MOA for Hydroxychoroquine in Rheumatoid Arthritis?

A
  • MOA: Modification to cytokine infiltration in joints
  • Possibly great to use in New Onset or Low Disease Therapy; so maybe start –> DONT switch to it
32
Q

What are some of the Advere Effects of Hydrochoroquine in Rheumatoid Arthritis?

A
  • NO myelosuppression
  • Retinal Toxicity
  • N/V/D [Take with food], Rash, Increased Skin Pigment
33
Q

What is the monitoring for Hydroxycholorquine in Rheumatoid Arthritis?

A
  • VISION EXAM

6-12 months

34
Q

What are the TNF Neutralizers that are used in Rheumatoid Arthritis?

A
  • Etanercept
  • Infliximab
  • Adailmumab
  • Golimumab
  • Certolizumab
35
Q

What are some of the general Warnings/Precautions for the TNFs in Rheumatoid Arthritis?

Same as IBD!

A
  • Increased infection risk
  • DO NOT use with other TNFs or Biologics
  • BLACK BOX: Demylination, CHF Exacerbation, NO live vaccines
36
Q

What are some of the general Adverse Effects for TNFs in Rheumatoid Arthritis?

A
  • Headache & Rash
  • Risk of Infection [Upper Respiratory]
  • CHF Exacerbation
  • Demylination
  • Malignancies
37
Q

What is important to know for Etanercept in Rheumatoid Arthritis?

MOA? Dosage Form?

A
  • MOA: Binds to and inhibits TNF; binds to the surface and causes inflammation
  • SUBQ once weekly
38
Q

What is important to know about Infliximab in Rheumatoid arthritis?

MOA? Dosage Form?

A
  • MOA: Inhibits TNF; Chimeric
  • IV
  • Usually taken with Methotrexate
39
Q

What is important to know about Adalimumab in Rheumatoid Arthritis?

MOA? Indication? Dosage form?

A
  • MOA: Inhibits TNF by blocking p55 and p75 in those that failed other TNFs
  • Used ALONE or COMBO
  • SUBQ every OTHER week
40
Q

What is important to know about Golimumab in Rheumatoid Arthritis?

MOA? Dosage Form? Monitoring?

A
  • MOA: Inhibits TNF For Mod-Severe RA; use with Methotrexate
  • SUBQ once monthy
  • CXR, LFTs
41
Q

What is important to know about Certolizumab in Rheumatoid Arthritis?

A
  • MOA: Inhibits TNF For Mod-Servere RA
  • Used ALONE or COMBO with non-BRM DMARDs?
  • SUBQ
42
Q

What is important to know about Anakinra in Rheumatoid Arthritis?

MOA? Dosage Form?

A
  • MOA: Blocks IL-1 receptors In Mod-Severe RA for those that failed one or more DMARD
  • ALONE or COMBO
  • SUBQ
43
Q

What are some of the Advere Effects for Anakinra in Rheumatoid Arthritis?

A
  • Headache, N/V/ Flu-like symptoms
  • Injection site reactions, Hypersensitivity, Increased Infections, Decreased Neutrophils
44
Q

What is the monitoring for Anakinra in Rheumatoid Arthritis?

A
  • Neutriophil Count
45
Q

What is important to know about Abatacept in Rheumatoid Arthritis?

MOA? Dosage Form? When?

A
  • MOA: Inhibits t-cell activation in Mod-Severe RA in those that failed one or more DMARDs
  • ALONE or COMBO [not with TNF or IL-1]
  • IV
46
Q

What are some of the warnings for Abatacept for Rheumatoid Arthritis?

A
  • DO NOT use with TNF or IL-1
  • Increased Infection Risk
  • NO Live Vaccines
  • Caution in COPD
47
Q

What are some of the Advere Effects of Abatacept in Rheumatoid Arthritis?

A
  • Headache, Nausea, Upper Respiratory Infection, Nasopharingitis
48
Q

What is important to know about Tocilizumab & Sarilumab in Rheumatoid Arthritis?

MOA? Dosage Form? When?

A
  • MOA: Bind and Inhibit IL-6 for Mod-Servere RA for those that failed one or more DMARDs
  • Use ALONE or COMBO with Methotrexate or other DMARDS
  • IV [Tocilizumab] & SUBQ[Sarilumab]
49
Q

What are some of the warnings and contraindications for Tocilizumab & Sarilumab in Rheumatoid Arthritis?

A
  • BLACK BOX: Infections
  • Contraindication:Liver Toxicity, Thrombocytopenia, Neutpenia
50
Q

What are some of the Adverse Effects of Tocilizumab & Sarilumab in Rheumatoid Arthritis?

A
  • Serious Infections, Liver Toxicity, Thrombocytopenia, Neutpenia, Lipid Abnormalities
51
Q

What are some of the Monitoring for Tocilizumab & Sarilumab in Rheumatoid Arthritis?

A
  • Neutrophil count, Platelet count, LFTs, Lipid Profile
52
Q

What is important to know about Rituximab in Rheumatoid Arthritis?

MOA? Dosage Form? When?

A
  • MOA: Binds to CD20 [B-cells] in Mod-Severe RA for those that failed TNF
  • COMBO with Methorexate
  • IV

Give Methylprednisolone 30 mins before infusion

53
Q

What are some of the monitoring for Rituximab in Rheumatoid Arthritis?

A
  • CBC, Creatinine, Vital Signs
54
Q

What is important to know about the JAK Kinase Inhibitors in Rheumatoid Arthritis?

MOA?

A
  • MOA: Inhibits Janus Kinase
  • Mod-Severe RA for those that failed TNF
  • ALONE or COMBO with Methotrexate or other DMARD
  • ORAL

NOT with BRM, Azathiprine, or Cyclosporine

55
Q

What are the JAK Inhibitors that are used in Rheumatoid Arthritis?

A
  • Totacitinib, Baricitinib, Upadacitinib
56
Q

What are some of the Warnings for the JAK inhibitors in Rheumatoid Arthritis?

A LOT!

A
  • P450 interactions
  • Risk of Infection & Malignancy
  • CV Issues
  • Thrombosis
  • NO Live Vaccines
57
Q

When shoud you NOT used JAK Inhibitors in Rheumatoid Arthritis?

A
  • Hgb < 8mg/dL
  • ANC < 1000 cells/mm^3
  • ALC < 500 cells/mm^3

PHRM 864: Therapeutics IV (28 decks)

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