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1
Q

What is the goal within 3 months of a diagnosis of RA?

A

start the patient on a DMARD

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2
Q

what are the non biologic DMARDs?

A 
MTX - Rhematrex, Trexall, Otrexup
sulfasalazine-Azulfidine, Sulfazine  
minocycline-Minocin, Dynacin, Solodyn
hydroxychloroquine-Plaquinel
Leflunomide- Arava
Tofacitinib- Xeljanz (Not sure may be biologic)
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3
Q

What are the antiTNF alfa drugs for RA?

A

adalimumab certolizumab etanercept golimumab infliximab

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4
Q

what are the nonTNF agents for RA?

A

abatacept rituximab and tocilizumab

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5
Q

methotrexate brand

A

Rheumatrex; Trexall, Otrexup

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6
Q

Otrexup

A

SC weekly methotrexate injection

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7
Q

How long can it take to see benefit from MTX?

A

up to 12 weeks

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8
Q

What are the common SEs associated with MTX?

A

N/V increased LFTs stomatitis alopecia photoxensitivity

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9
Q

What should be done at baseline when using MTX?

A

Hep B and C testing

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10
Q

What are some BB warnings with MTX?

A 
hepatitis  
BMS  
mucositis
Dermatologic conditions 
renal
pneumonitis
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11
Q

What are SEs associated with Plaquenil?

A

N/D rashes pigmentation of skin and hair weakness vision changes

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12
Q

What SEs are associated with sulfasalazine?

A

HA anorexia dyspepsia N/V/D oligospermia rash folate deficiency

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13
Q

What RA drug can cause yellow/orange coloration of skin/urine?

A

sulfasalazine

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14
Q

leflunomide

A

Arava

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15
Q

What do you have to screen for prior to starting leflunomide?

A

Tb and pregnancy (category X)

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16
Q

tofacitinib

A

Xeljanz

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17
Q

What should you screen for prior to starting Xeljanz?

A

latent Tb should be treated prior to using

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18
Q

________ is a REMS drug which also has to be given once daily if given with a strong 3A4/2C19 inhibitors

A

Tofacitinib

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19
Q

renal excretion is decreased when MTX is given with what drugs

A

NSAIDS probenacid beta lactams aspirin

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20
Q

what combination should be avoided due to both concentrations increasing when coadministered?

A

MTX and cyclosporine

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21
Q

etanercept

A

Enbrel

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22
Q

Which RA drugs are only given in combo with MTX in RA?

A

infliximab and golimumab rituximab

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23
Q

adalimumab

A

Humira

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24
Q

golimumab

A

Simponi

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25
Q

Remicade

A

infliximab

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26
Q

Which drug has the possiblility of a delayed hypersensitivity reaction?

A

infliximab; 3 to 10days later (fever rash myalgia sore throat)

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27
Q

What are the BB warnings with the TNF drugs?

A

serious infections. lymphomas and other malignancies reactivation of latent Tb

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28
Q

What are the warnings with the TNF drugs?

A

can cause hep B reactivation, HF, hepatotoxicity, LLS

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29
Q

When dispensing TNF inhibitors you must give a _____

A

medguide

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30
Q

Which drugs carry the potential to cause progressive multifocal leukoencephalopathy?

A

rituximab(Rituxan) & natalizumab (Tysabri)

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31
Q

anakinra brand name &MOA

A

Kineret; IL1 antagonist

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32
Q

abatacept

A

Orencia

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33
Q

abatacept MOA

A

inhibits T cell activation by binding CD80 and 86

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34
Q

toclizumab

35
Q

toclizumab MOA

A

IL6 receptor antagonist

36
Q

How should biologics be stored?

A

refrigerated!

etanercept(Enbrel) may be kept at RT up to 14 days

37
Q

What drugs are commonly associated with drug induced Lupus?

A 
procainamide,  
propylthiouracil
methimazole
methyldopa
hydralazine,  
isoniazid,  
terbinafine
quinidine
antiTNF agents
38
Q

Which two antimalarial drugs are used in Lupus?

A

hydroxychloroquine & chloroquine for mild disease; may take up to 6 months to see effect

39
Q

What cytotoxic drugs are used in severe Lupus disease?

A

cyclophosphamide,
cyclosporine,
azathioprine,
mycophenolate,

40
Q

Sandimmune/Neoral

A

cyclosporine

41
Q

Cellcept

A

mycophenolate

42
Q

What is the drug that is an antibody that binds Blys protein reducing the activity of B cell mediated immunity?

A

belimumab/ BenLysta

43
Q

belimumab

44
Q

What are SEs associated with mycophenolate?

A

diarrhea GI upset vomiting hypotension tachycardia pain hyperglycemia hypomagnesemia hypocalcemia hypercholesterolemia tremor acne

45
Q

Which form of cyclosporine has been modified to incrase bioavailability?

A

Neoral; not interchangable with sandimmune

46
Q

What are common SEs with cyclosporine

A

HTN and nephropathy

47
Q

glatiramer

A

Copaxone daily SC

48
Q

What are the administration differences between the interferon betas for MS?

A

Avonex is IM weekly; Rebif is three times a week; betaseron/Extavia is every other day; All are SC except Avonex is IM

49
Q

What MS drug is given IV every 4w?

A

natalizumab (Tysabri)

50
Q

Which drug is only available through the TOUCH REMS program?

51
Q

Which drug for MS has a CI with HF, heart block, MI, unstable agnina etc.?

A

fingolimod (Gilenya) ; *can decrease HR

52
Q

gluten is a protein found in

A

wheat barley and rhye

53
Q

Where can the phone # to a drug information line of a MNF be found

A

RedBook drug facts and comparisons

54
Q

what eye drop can be used in Sjogrens if OTC drops are not working

A

cyclosporine (Restasis)

55
Q

What prescription products are available to treat dry mouth?

A

pilocarpine (Salagen) Cevimeline (Evoxac)

56
Q

What are the side effects of Gilenya (fingolimod)?

A

Influenza, back pain, cough, increased LFTs

57
Q

How long after Gilenya (fingolimod) should one wait to get MMR or zoster vaccines?

A

more than 2months

58
Q

What must be monitored hourly for 6 hours after the 1st dose of Gilenya (fingolimod)

A

HR, BP & signs of Bradycardia

59
Q

How often is a Hysabri (natalizumab) infusion given

A

every 4 weeks

60
Q

What are the side effects of natalizumab (Tysabri)?

A

depression, pain in extremities, abdominal discomfort, infection

61
Q

What are Inteferon betas used for

A

Relapsing MS

62
Q

List the interferon betas, their rout & frequency of administration & dosage forms

A

Inteferon beta-1a: Avonex IM once wkly powder, pre-filled syringe & pen
Inteferon beta-1a: Rebif & Rebif ebidose SC 3x week pre-filled syringes
Interferon beta-1b: Betaseron & Extavia SC EOD powder

63
Q

How long can Copaxone (glatiramer acetate) be kept at room temp

A

up to 1 month

64
Q

All MS medications are pregnancy C except

A

Copaxone (glatiramer acetate) pregnancy B

Aubagio (teriflunomide) pregnancy X

65
Q

What are the contraindications of Aubagio (terflunomide)

A

sever liver impairment, pregnancy, current leflunomide use

66
Q

What are the side effects of Aubagio (teriflunomide)

A

increased LFTs, alopecia, influenza, hypophosphatemia, paresthesia,
rare: renal impairment, hyperkalemia, peripheral neuropathy

67
Q

What is the manor side effect of dimethyl fumarate (Tecfiera) and how is it managed?

A

Flushing, treat with aspirin 30 minutes before

68
Q

What is the mechanism of action of Ampyra (dalfampridine

A

potassium channel blocker which may increase nerve signal conduction

69
Q

What is the contradiction for using Amyra (dalfampridine

A

history of seizures & CrCl < 50ml/min

70
Q

What are the side effects of Amyra (dalfampridine)

A

UTI, insomnia, dizziness, back pain

71
Q

how long does it take for Ampyra (dalfampridine) to take effect & what symptom does it improve?

A

up to 6 weeks & mainly improves walking

72
Q

What are additional symptoms of MS & how are they managed ?

A

Incontinence- anticholinergics–> worsen cognition
Constipation- laxatives
diarrhea-loparamide
muscle spasms- skeletal muscle relaxants or opioids
localized pain-botox
tremors-propranolol–> worsen cognition, depression, sexual function
depression- antidep., SNRI for neuropathic & depression–> worsen libido
fatigue-modafinil or stimulants
dizziness & vertigo-meclizine & scopolamine–> worsen cognition
cognitive function- donepazil or acetylcholinesterase inhibitors
Erectile dysfunction-PDE-inhibitors

79
Q

Azulfidine, sulfazine

A

Sulfasalazine

80
Q

Minocycline

A

Minocin, Dymacin, Solodyn

81
Q

JAK inhibitor used in moderate- severe RA, not to be used with biologics or potent immunosuppressants

A

Xeljanz-tofacitinib

82
Q

Which RA therapies can be used in liver disease

A 
Minocyclin-Minocin 
Sulfasalazine- sulfazine, azulfidine
Hydroxychloroquine - plaquenil
Rituximab-rituxan
Anakinra-kineret
Abatacept- orencia
83
Q

All biologics have a warning for

A

Increased infections
Activation of latent TB
NO live vaccines

84
Q

Leflunomide-Arava side effects a NDASI contraindications

A

Contraindicated: pregnancy-X
SE: Hepatotoxicity, URTI, hypertention, alopecia, blood dyscrasias

85
Q

What warnings make Xeljanz-tofacitinib unique

A

Opertunistic infections

GI perforations

86
Q

Orencia- abatacept is not a good option for RA in pts with what condition?

87
Q

What are the special warnings and side effects of Actemra- tocilizumab

A

May cause GI PERFORATION
DO NOT give if LFTs >1.5. ULN
increases LDL

88
Q

BBW of Rituxan- Rituximab

A 
Serious/ fatal infusion rxtn: monitor heart & vitals during & after infusion eps. 1st
Causes PML
Tumor lysis- this usually when for NHL
SJS/TENS
Angioedema (more SE)
89
Q

What specific monitoring must be done with plaquenil

Autoimmune (4 decks)

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