ch 59 highlights

Question 1

what tests need to happen prior to starting a biologic DMARD

Answer 1

TB
Hep B
CBC

Question 2

what monitoring do you do periodically during treatment for biologic DMARD

Answer 2

Close monitor CBC (white count and platelets)
periodic Hep B
periodic TB

Question 3

While on a biologic DMARD what are you prone to

Answer 3

mycoplasm

Question 4

Vaccine use while taking a Biologic DMARD

Answer 4

No live vaccines

Question 5

what are the conventional DMARDs

Answer 5

Methotrexate
Hydroxychloroquine (Plaquenil)
Leflunomide (Arava)

Question 6

what supplement do you need to take with Methotrexate

Answer 6

folic acid

Question 7

first line DMARD

Answer 7

Methotrexate

Question 8

can you give Methotrexate in pregnancy

Answer 8

no

Question 9

Methotrexate increases risk of

Answer 9

hepatotoxicity

Question 10

vaccines for someone on methotrexate

Answer 10

no live vaccines
pt should be revaccinated within 3 months after therapy is discontinued. Ideally, needed vaccines should be administered prior to starting methotrexate

Question 11

important note for Leflunomide (Arava)

Answer 11

Conventional DMARD

increased r/o liver damage

Question 12

goals of RA treatment

Answer 12

relieve symptoms - pain, inflammation, stiffness
maintaining joint function and rom
minimizing systemic involvement
delay disease progression

Question 13

non drug measures RA

Answer 13

physical therapy
exercise
surgery
massage, warm baths, apply heat to affected regions

Question 14

classes of antiarthritic drugs

Answer 14

NSAIDS
Glucocorticoids
DMARDS

Question 15

what class of RA drugs are for rapid relief

Answer 15

NSAIDS

glucocorticoids

Question 16

drugs that reduce joint destruction and slow disease progression

Answer 16

DMARDS

Question 17

localized pain

Answer 17

intraarticular injections of glucocorticoids

Question 18

systemic pain

Answer 18

oral glucocorticoids

Question 19

conventional DMARD that can be combined with methotrexate

Answer 19

Hydroxychloroquine (plaquenil)

Question 20

1/2 life of Hydroxychloroquine (plaquenil)

Answer 20

40 days - 3-6 months to develop

Question 21

what special monitoring do we need to have for Hydroxychloroquine (plaquenil)

Answer 21

eye dr every 6 mos to check for retinal damage

Question 22

what are the Biologic DMARDS names

Answer 22

Etanercept (Enbrel)

• mab
• cept

Question 23

what are the targeted DMARDS

Answer 23

Xeljanz

Xeljanz XR

Question 24

Targeted DMARDS monitoring

Answer 24

HR for bradycardia
BP
ECG for prolonged PR interval

every 4-8 weeks and then every 3 months:\
lipid panel
AST
ALT

Question 25

Why should you report infections for Abatacept

Answer 25

It may warrant d/c medication, educate families to report infection

Question 26

what needs to happen if someone on Leflunomide (Arava) wants to get pregnant or father a child

Answer 26

1) D/c med
2) Take cholestyramine for 11 days
3) verify plasma drug levels less than 20

Question 27

what needs to be tested periodically for methotrexate

Answer 27

renal and liver fx test

Question 28

how often do you take methotrexate

Answer 28

once weekly

Question 29

Need to know for Rituximab infusions

Answer 29

severe infusion related hypersensitivity rx
be prepared to administer epi, steroids, o2
tylenol and antihistamines given before infustion
monitor closely