csDMARDS Flashcards
What 3 things can be used to treat pain/inflammation with RA?
NSAIDS
Acetaminophen
Glucocorticoids
What are the 4 Conventional Synthetic DMARDS?
Methotrexate
Hydroxychloroquine
Sulfasalazine
Leflunomide
What are the 4 csDMARDS?
Methotrexate
Hydroxychloroquine
Sulfasalazine
Leflunomide
NSAIDs are a drug of first choice +/- Acetaminophen for pain. What do they NOT alter?
Do NOT alter disease progression
When are Glucocorticoids used?
Relieves pain/inflammation/flares while WAITING FOR DMARD EFFECTS
When are Glucocorticoids used?
Relieves pain/inflammation/flares while WAITING FOR DMARD EFFECTS
How long should Glucocorticoids be used?
Less than 3 months
– use lowest dose for shortest time possible
Do NOT use Glucocorticoids with ____ for longer than 3 months
Do NOT used Glucocorticoids with csDMARDS for > 3 months
What is the MOA for Glucocorticoids?
Glucocorticoid Receptor complexes with NF-KB and AP-1 which (+) lipocortin gene and inhibits PLA2
What is an adverse effect of Glucocorticoid use?
Cushing’s Syndrome
Should Glucocorticoids be used chronically?
NO
What is the fastest acting DMARD?
Methotrexate – effects in 3-6 weeks
How often is Methotrexate given?
1x/week
Patients on low doses of Methotrexate should?
Take weekly Folate supplements
What are possible adverse effects of high doses of Methotrexate (6)?
Bone marrow suppression Hepatic fibrosis GI ulceration Pneumonitis Decreased life expectancy Fetal death/abnormalities
What is the MOA for Hydroxychloroquine?
Lipophilic weak base that accumulates in lysosomes and increases pH ==> limits associated of APC peptides with MHC class 2 molecules
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?
Hydroxychloroquine
What is the onset time and half life of Hydroxychloroquine?
3-6 months
– half life = 23 days
What csDMARD is SAFE with pregnancy?
Hydroxychloroquine
What are 4 possible adverse effects of Hydroxychloroquine?
Retinal damage
Cardiac disease
Skin hyperpigmentation
Neuromyotoxicity/cytopenias
Sulfasalazine is metabolized to ____
Sulfapyridine
Can Sulfasalazine be used in pregnancy?
Seems OK – not much studies done
What are possible side effects with Sulfasalazine (2)?
GI issues
Skin reactions due to it being a sulfa drug
What is the MOA for Leflunomide?
(-) dihydroorotate dehydrogenase to block synthesis of rUMP and (-) T cell proliferation
What drug (-) dihydroorotate dehydrogenase to block synthesis of rUMP and (-) T cell proliferation?
Leflunomide
What is the half life of Leflunomide?
16.5 days
What are 2 possible adverse effects of Leflunomide?
Hepatotoxic
Increased risk of infections
With LOW disease activity, what is the order of drugs that you should pick?
- Hydroxychloroquine
- Sulfasalazine
- Methotrexate
- Leflunomide
With MODERATE-HIGH disease activity, what csDMARD should you try first?
Methotrexate
What csDMARDS can be used as “triple therapy”?
Methotrexate
Hydroxychloroquine
Sulfasalazine
