Arthritis drugs Flashcards
Symptomatic treatment of osteoarthritis
NSAIDS and Acetaminophen
Corticosteroids
Opioids
Drugs for Rheumatoid arthritis
NSAIDS and Cox2's Analgesics Glucocorticoids Disease-modifyng anti-rheumatic drugs (DMARDs) Biologic response modifiers (BRMs)
DMARDs (prevent progression)
Hydrochloroquine
Sulfasalazine
Methotrexate
Leflunomide
Hydrochloroquine - MoA
unclear
HCQ - adverse effects
GI, skin, CNS
Blindness***
HCQ - indication
Mild RA
Sulfasalazine - MoA
gut bacteria reduce drug to sulfapyridine, then mechanism is unclear
Sulfasalazine - adverse
Hypersensitivity (rash, pneumonitis, hepatitis, agranulocytosis, aplastic anemia)**These always recur
Dose-related (GI, CNS, mild leukopenia)
Methotrexate - MoA
inhibits folate metabolism, then mechanism is unknown
“halts” disease progression
Methotrexate - adverse rxns
Stomatitis, alopecia, GI, CNS, macrocytosis (folate def)
Methotrexate - serious rxns
bone marrow suppression, hepatic fibrosis, liver failure, pulmonary fibrosis, lung failure
Leflunomide - MoA
converted to teriflunomide, then inhibits mitochondrial DHODH to block synthesis of rUMP
Leflunomide - adverse rxns
neuropathy diarrhea, nausea hypertension hepatitis, liver failure leukopenia
Biological Response Modifiers
Anti-cytokine therapies Anti-TNF Anti-IL-6 Costimulation blockade (t-cells) B Cell depletion
Anti-TNFa drugs
Etanercept Infliximab Adalimumab Golimumab Certolizumab
Etanercept - MoA
solubleTNFa receptor fusion protein
It’s a TNFa receptor attached to an IgG Fc domain
Infliximab - MoA
chimeric (mouse) anti-TNFa IgG antibody
Adalimumab, golimumab, certolizumab - MoA
human anti-TNFa
certo- is pegylated to increase half life
Tocilizumab - MoA
anti-IL-6 receptor antibody and binds both soluble and membrane bound receptors
Abatacept - MoA
co-stimulation blockage
CTLA-4 antigen attached to IgG Fc
Binds to CD80/86 (B7) on APC and produces anergic T-cells
Abatacept - contraindications
do not use with TNF inhibitors (complete immunosuppression)
Rituximab - MoA
Binds to and depletes all cells that are CD20+ (B-cells)
Biological response modifiers - adverse effects
Activation of latent infections (TB, histo, hepB) - anti-TNFa’s
Hepatotoxicity
Demyelinating disorders