Chapter 77 Drug Therapy for RA Flashcards
What is rheumatoid arthritis (RA) in a nut shell?
autoimmune inflammatory disorder of the joints of the UE and LEs leading to bone on bone friction with reduction of synovial fluid and cartilage
What is the brief overview of drug selection for RA?
- NSAIDs
- DMARDs (disease modifying antirheumatic drugs) w/n 3 mos of diagnosis (with adjunct of NSAIDs until DMARD has had time to act)
- Glucocorticoids can be added until DMARDs take effect as well IF symptoms are not controlled with NSAIDs
Why are NSAIDs the first choice medication for RA?
They are rapid pain relief medications that can actively help the patient. They are there to provide symptomatic relief not progression
Why would you use glucocorticoids for RA?
Used for short term for generalized symptoms while adjectively using DMARD if NSAIDs are ruled ineffective
What are non-biologic DMARDs? What is their use? Would you use a non biologic or a biologic? Hydroxychloroquine needs what?
SLOWS PROGRESSION OF RA
Non-biologic > biologic d/t creation/ease of access
Hydroxychloroquine - needs eye exam at onset of tx and q6 months afterwards.
Non-biologic DMARD - Methotrexate choice? Dosing? What a/e? What other supplement should be given when taking methotrexate?
1st choice
ONCE WEEKLY injection
Hepatic & renal fx tests, CBC, platelet lvls
FOLIC ACID helps with reduction of GI and hepatic toxicity
Biologic DMARDs - TNF Inhibitors do what?
Suppress immune fx, neutralizing TNF
Biologic DMARDs - TNF Inhibitors - Etanercept MOA? Use? A/e?
PROTOTYPE!
inactivates TNF for moderate to severe RA
Given via Sub-Q injection
MANY a/e effects - esoecially Liver injury!
Biologic DMARDs - TNF Inhibitors - Rituximab MOA?
Reduces the # of B-lymphocytes thus reducing RA symptoms
Biologic DMARDs - TNF Inhibitors - Abatacept MOA?
MOA - inhibits T-lymphocytes
NOT USED WITH A TNF ANTAGONISTS DUE TO RISK OF SEVERE INFX
May blunt live virus vaccines and potentially make the individual ill
Janus kinase (JAK) inhibitor - tofacitinib MOA? Therapy type?
FIRST ORAL BIOLOGIC
Monotherapy or w/ methotrexate or NONbiologic DMARDs
