Arthritis RA and OA (2) Flashcards
Name the 8 analgesic tx for OA
oral acetaminophen(APAP)/NSAIDs topical capsaicin glucosamine/chondroitin corticosteroids (intraart inj) viscosupp: Hyaluronic acid (intrart inj) opioids tramadol
___________ not recommended in the tx of OA
Oral corticosteroids
triamcinolone and methylprednisolone
intra-articular steroid injections for OA
3 main recommended drug therapies for hand OA
topical capsaicin
Topical NSAIDs(better than oral bc kidney and GI issues)
Oral NSAIDs and COX 2 inhib
_____________ and _____________ should NOT be used in hand OA
intrart inj(NEVER USE IN HAND) opioid analgesics
5 recommended drug therapies for Knee OA
acetaminophen oral NSAIDs Topical NSAIDs Tramadol Intrart corticosteroid injections
______ and _______ should NOT be used in Knee OA
glucosamine/chondroitin
topical capsaicin
_______ and ________ show no benefit in knee OA
Inraart inj of HA
opiate analgesics
4 recommended drug therapies in hip OA
Acetaminophen
Oral NSAIDs
Tramadol
Intraart corticosteroid injection
________ should NOT be used in hip OA
glucosamine chondroitin
_______, ________, and ________ show no benefit in Hip OA
topical NSAIDs
Intrart HA injection
opioid analgesics
_______ drug therapy should be started on new RA pts with in 3 months
DMARDs (misc group of drugs that reduce or prevent joint damage)
Name the 4 nonbiologics DMARDs
Methotrexate hydroxychloroquine sulfasalazine leflunomide (all can be used as a monotherapy)
most biologics affect antibodies and have “_____” in the name
mab
when patients’ RA appears to be in remission what must you do
attempt to taper the DMARDs
low RA dz activity should be treated with _______; high disease activity requires _______
low: monotherapy (most frequently methotrexate)
high: combination therapy (methotrexate with biologic)
what is the very first recommended therapy for a new RA pt
NSAIDs
_________ is the best first line option for an RA pt who cannot take NSAIDs
methotrexate
____________ has weaker DMARD activity and was developed as an antimalarial
hydroxycholorquine
hydroxycholorquine requires what monitoring?
Ophthalmic exam biannually for retinal toxicity (damage initially reversible)
may see a rash and skin pigmentation
(does NOT cause liver, kidney, or bone toxicities)
hydroxycholorquine contraindicated in pts with… (3)
sig visual, hepatic or renal impairment
Methotrexate requires what monitoring
liver, thrombo/leuko count (CBC), creatinine
what should you also prescribe with Methotrexate
folic acid supplement (it is a folic acid antagonist)
________ may be elevated with Methotrexate use, and low _________ may signal toxicity
liver enzymes (cirrhosis) low serum albumin may signal liver toxicity
leucovorin
antidote for Methotrexate toxicity (folic acid derivative)
Sulfasalazine
prodrug tx for mild RA
what monitoring needs to be done for Sulfasalazine
CBC weekly for 1st month and then every 1-2 months
Leflunomide
reversible inhibitor of DNA and RNA synth in lymphocytes
Leflunomide requires what monitoring
CBC and ALT(liver, bc renal and biliary secretion)
Leflunomide contraindicated with pts who
have liver dz
are getting preg or want to get pregnant soon (need to wash drug out of syst 1st)
Entanercept
competatively binds TNF molecules to inactivate
additive effect with MTX
Infliximab and adalimumab
Anti-TNF-alpha monoclonal antibody
Addative effects with MTX
Infliximab should be taken…
ONLY WITH MTX, cannot be a monotherapy
Entanercept, Infliximab, and adalimumab all require what monitoring
Tb skin test initially b/c immunosuppressant
also beware Hx Hep B
May worsen heart faliure or ongoing infection
Anakinra
for moderate to severe RA
works as an IL-1 receptor antagonist
Anakinra should be taken…
anakinra s/b taken with MTX or can be used as a monotherapy
should be taken if TNF antagonists are ineffective only
anakinra should NOT be taken
with TNF antagonists
Abtacept
moderate to severe RA where no other tx can eb used
monotherapy or combo
Very expensive, inhibits T cell activation
Rituximab
depletes B lymphocytes to dec antibody formation
should be used only after TNF deemed inadequate
used with MTX as IV influsion
Tofactimab MOA, indications, and metabolism
inhibits Janus kinase - stops hematopoiesis (last resort med)
use as monotherapy or in combo with MTX or nonbiolog
metabolized by liver, P450
Tofactimab caution
BLACK BOX WARNING: infections and malignancy risk
5 tx for symptom relief in RA
NSAIDs(beware GI bleed) Oral prednisone (NOT seen in OA) Intraart injections of glucocorticoids opioids surgical tx
corticosteroids in RA
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
