Arthritis RA and OA (2)

Question 1

Name the 8 analgesic tx for OA

Answer 1

oral acetaminophen(APAP)/NSAIDs
topical capsaicin
glucosamine/chondroitin
corticosteroids (intraart inj)
viscosupp: Hyaluronic acid (intrart inj)
opioids
tramadol

Question 2

___________ not recommended in the tx of OA

Answer 2

Oral corticosteroids

Question 3

triamcinolone and methylprednisolone

Answer 3

intra-articular steroid injections for OA

Question 4

3 main recommended drug therapies for hand OA

Answer 4

topical capsaicin
Topical NSAIDs(better than oral bc kidney and GI issues)
Oral NSAIDs and COX 2 inhib

Question 5

_____________ and _____________ should NOT be used in hand OA

Answer 5

intrart inj(NEVER USE IN HAND)
opioid analgesics

Question 6

5 recommended drug therapies for Knee OA

Answer 6

acetaminophen
oral NSAIDs
Topical NSAIDs
Tramadol
Intrart corticosteroid injections

Question 7

______ and _______ should NOT be used in Knee OA

Answer 7

glucosamine/chondroitin

topical capsaicin

Question 8

_______ and ________ show no benefit in knee OA

Answer 8

Inraart inj of HA

opiate analgesics

Question 9

4 recommended drug therapies in hip OA

Answer 9

Acetaminophen
Oral NSAIDs
Tramadol
Intraart corticosteroid injection

Question 10

________ should NOT be used in hip OA

Answer 10

glucosamine chondroitin

Question 11

_______, ________, and ________ show no benefit in Hip OA

Answer 11

topical NSAIDs
Intrart HA injection
opioid analgesics

Question 12

_______ drug therapy should be started on new RA pts with in 3 months

Answer 12

DMARDs (misc group of drugs that reduce or prevent joint damage)

Question 13

Name the 4 nonbiologics DMARDs

Answer 13

Methotrexate
hydroxychloroquine
sulfasalazine
leflunomide
(all can be used as a monotherapy)

Question 14

most biologics affect antibodies and have “_____” in the name

Answer 14

mab

Question 15

when patients’ RA appears to be in remission what must you do

Answer 15

attempt to taper the DMARDs

Question 16

low RA dz activity should be treated with _______; high disease activity requires _______

Answer 16

low: monotherapy (most frequently methotrexate)
high: combination therapy (methotrexate with biologic)

Question 17

what is the very first recommended therapy for a new RA pt

Answer 17

NSAIDs

Question 18

_________ is the best first line option for an RA pt who cannot take NSAIDs

Answer 18

methotrexate

Question 19

____________ has weaker DMARD activity and was developed as an antimalarial

Answer 19

hydroxycholorquine

Question 20

hydroxycholorquine requires what monitoring?

Answer 20

Ophthalmic exam biannually for retinal toxicity (damage initially reversible)

may see a rash and skin pigmentation

(does NOT cause liver, kidney, or bone toxicities)

Question 21

hydroxycholorquine contraindicated in pts with… (3)

Answer 21

sig visual, hepatic or renal impairment

Question 22

Methotrexate requires what monitoring

Answer 22

liver, thrombo/leuko count (CBC), creatinine

Question 23

what should you also prescribe with Methotrexate

Answer 23

folic acid supplement (it is a folic acid antagonist)

Question 24

________ may be elevated with Methotrexate use, and low _________ may signal toxicity

Answer 24

liver enzymes (cirrhosis)
low serum albumin may signal liver toxicity

Question 25

leucovorin

Answer 25

antidote for Methotrexate toxicity (folic acid derivative)

Question 26

Sulfasalazine

Answer 26

prodrug tx for mild RA

Question 27

what monitoring needs to be done for Sulfasalazine

Answer 27

CBC weekly for 1st month and then every 1-2 months

Question 28

Leflunomide

Answer 28

reversible inhibitor of DNA and RNA synth in lymphocytes

Question 29

Leflunomide requires what monitoring

Answer 29

CBC and ALT(liver, bc renal and biliary secretion)

Question 30

Leflunomide contraindicated with pts who

Answer 30

have liver dz

are getting preg or want to get pregnant soon (need to wash drug out of syst 1st)

Question 31

Entanercept

Answer 31

competatively binds TNF molecules to inactivate

additive effect with MTX

Question 32

Infliximab and adalimumab

Answer 32

Anti-TNF-alpha monoclonal antibody

Addative effects with MTX

Question 33

Infliximab should be taken…

Answer 33

ONLY WITH MTX, cannot be a monotherapy

Question 34

Entanercept, Infliximab, and adalimumab all require what monitoring

Answer 34

Tb skin test initially b/c immunosuppressant

also beware Hx Hep B

May worsen heart faliure or ongoing infection

Question 35

Anakinra

Answer 35

for moderate to severe RA

works as an IL-1 receptor antagonist

Question 36

Anakinra should be taken…

Answer 36

anakinra s/b taken with MTX or can be used as a monotherapy

should be taken if TNF antagonists are ineffective only

Question 37

anakinra should NOT be taken

Answer 37

with TNF antagonists

Question 38

Abtacept

Answer 38

moderate to severe RA where no other tx can eb used

monotherapy or combo

Very expensive, inhibits T cell activation

Question 39

Rituximab

Answer 39

depletes B lymphocytes to dec antibody formation

should be used only after TNF deemed inadequate

used with MTX as IV influsion

Question 40

Tofactimab MOA, indications, and metabolism

Answer 40

inhibits Janus kinase - stops hematopoiesis (last resort med)

use as monotherapy or in combo with MTX or nonbiolog

metabolized by liver, P450

Question 41

Tofactimab caution

Answer 41

BLACK BOX WARNING: infections and malignancy risk

Question 42

5 tx for symptom relief in RA

Answer 42

NSAIDs(beware GI bleed)
Oral prednisone (NOT seen in OA)
Intraart injections of glucocorticoids
opioids
surgical tx

Question 43

corticosteroids in RA

Answer 43

antiinflam and immunosup
bridge to control sx until DMARDs take effect

low dose long term or high dose bursts b/c long term can lead to osteoporosis