csDMARDS

Question 1

What 3 things can be used to treat pain/inflammation with RA?

Answer 1

NSAIDS
Acetaminophen
Glucocorticoids

Question 2

What are the 4 Conventional Synthetic DMARDS?

Answer 2

Methotrexate
Hydroxychloroquine
Sulfasalazine
Leflunomide

Question 3

What are the 4 csDMARDS?

Answer 3

Methotrexate
Hydroxychloroquine
Sulfasalazine
Leflunomide

Question 4

NSAIDs are a drug of first choice +/- Acetaminophen for pain. What do they NOT alter?

Answer 4

Do NOT alter disease progression

Question 5

When are Glucocorticoids used?

Answer 5

Relieves pain/inflammation/flares while WAITING FOR DMARD EFFECTS

Question 6

When are Glucocorticoids used?

Answer 6

Relieves pain/inflammation/flares while WAITING FOR DMARD EFFECTS

Question 7

How long should Glucocorticoids be used?

Answer 7

Less than 3 months

– use lowest dose for shortest time possible

Question 8

Do NOT use Glucocorticoids with ____ for longer than 3 months

Answer 8

Do NOT used Glucocorticoids with csDMARDS for > 3 months

Question 9

What is the MOA for Glucocorticoids?

Answer 9

Glucocorticoid Receptor complexes with NF-KB and AP-1 which (+) lipocortin gene and inhibits PLA2

Question 10

What is an adverse effect of Glucocorticoid use?

Answer 10

Cushing’s Syndrome

Question 11

Should Glucocorticoids be used chronically?

Answer 11

NO

Question 12

What is the fastest acting DMARD?

Answer 12

Methotrexate – effects in 3-6 weeks

Question 13

How often is Methotrexate given?

Answer 13

1x/week

Question 14

Patients on low doses of Methotrexate should?

Answer 14

Take weekly Folate supplements

Question 15

What are possible adverse effects of high doses of Methotrexate (6)?

Answer 15

Bone marrow suppression
Hepatic fibrosis
GI ulceration
Pneumonitis
Decreased life expectancy
Fetal death/abnormalities

Question 16

What is the MOA for Hydroxychloroquine?

Answer 16

Lipophilic weak base that accumulates in lysosomes and increases pH
==> limits associated of APC peptides with MHC class 2 molecules

Question 17

What drug is a lipophilic weak base that accumulates in lysosomes to increase pH, and thus limits association of APC peptides with MHC class 2 molecules?

Answer 17

Hydroxychloroquine

Question 18

What is the onset time and half life of Hydroxychloroquine?

Answer 18

3-6 months

– half life = 23 days

Question 19

What csDMARD is SAFE with pregnancy?

Answer 19

Hydroxychloroquine

Question 20

What are 4 possible adverse effects of Hydroxychloroquine?

Answer 20

Retinal damage
Cardiac disease
Skin hyperpigmentation
Neuromyotoxicity/cytopenias

Question 21

Sulfasalazine is metabolized to ____

Answer 21

Sulfapyridine

Question 22

Can Sulfasalazine be used in pregnancy?

Answer 22

Seems OK – not much studies done

Question 23

What are possible side effects with Sulfasalazine (2)?

Answer 23

GI issues

Skin reactions due to it being a sulfa drug

Question 24

What is the MOA for Leflunomide?

Answer 24

(-) dihydroorotate dehydrogenase to block synthesis of rUMP and (-) T cell proliferation

Question 25

What drug (-) dihydroorotate dehydrogenase to block synthesis of rUMP and (-) T cell proliferation?

Answer 25

Leflunomide

Question 26

What is the half life of Leflunomide?

Answer 26

16.5 days

Question 27

What are 2 possible adverse effects of Leflunomide?

Answer 27

Hepatotoxic

Increased risk of infections

Question 28

With LOW disease activity, what is the order of drugs that you should pick?

Answer 28

1. Hydroxychloroquine
2. Sulfasalazine
3. Methotrexate
4. Leflunomide

Question 29

With MODERATE-HIGH disease activity, what csDMARD should you try first?

Answer 29

Methotrexate

Question 30

What csDMARDS can be used as “triple therapy”?

Answer 30

Methotrexate
Hydroxychloroquine
Sulfasalazine