ch 59 highlights Flashcards
what tests need to happen prior to starting a biologic DMARD
TB
Hep B
CBC
what monitoring do you do periodically during treatment for biologic DMARD
Close monitor CBC (white count and platelets)
periodic Hep B
periodic TB
While on a biologic DMARD what are you prone to
mycoplasm
Vaccine use while taking a Biologic DMARD
No live vaccines
what are the conventional DMARDs
Methotrexate
Hydroxychloroquine (Plaquenil)
Leflunomide (Arava)
what supplement do you need to take with Methotrexate
folic acid
first line DMARD
Methotrexate
can you give Methotrexate in pregnancy
no
Methotrexate increases risk of
hepatotoxicity
vaccines for someone on methotrexate
no live vaccines
pt should be revaccinated within 3 months after therapy is discontinued. Ideally, needed vaccines should be administered prior to starting methotrexate
important note for Leflunomide (Arava)
Conventional DMARD
increased r/o liver damage
goals of RA treatment
relieve symptoms - pain, inflammation, stiffness
maintaining joint function and rom
minimizing systemic involvement
delay disease progression
non drug measures RA
physical therapy
exercise
surgery
massage, warm baths, apply heat to affected regions
classes of antiarthritic drugs
NSAIDS
Glucocorticoids
DMARDS
what class of RA drugs are for rapid relief
NSAIDS
glucocorticoids
drugs that reduce joint destruction and slow disease progression
DMARDS
localized pain
intraarticular injections of glucocorticoids
systemic pain
oral glucocorticoids
conventional DMARD that can be combined with methotrexate
Hydroxychloroquine (plaquenil)
1/2 life of Hydroxychloroquine (plaquenil)
40 days - 3-6 months to develop
what special monitoring do we need to have for Hydroxychloroquine (plaquenil)
eye dr every 6 mos to check for retinal damage
what are the Biologic DMARDS names
Etanercept (Enbrel)
- mab
- cept
what are the targeted DMARDS
Xeljanz
Xeljanz XR
Targeted DMARDS monitoring
HR for bradycardia
BP
ECG for prolonged PR interval
every 4-8 weeks and then every 3 months:\
lipid panel
AST
ALT
Why should you report infections for Abatacept
It may warrant d/c medication, educate families to report infection
what needs to happen if someone on Leflunomide (Arava) wants to get pregnant or father a child
1) D/c med
2) Take cholestyramine for 11 days
3) verify plasma drug levels less than 20
what needs to be tested periodically for methotrexate
renal and liver fx test
how often do you take methotrexate
once weekly
Need to know for Rituximab infusions
severe infusion related hypersensitivity rx
be prepared to administer epi, steroids, o2
tylenol and antihistamines given before infustion
monitor closely
