DLA12, 13- OA, RA drugs (abridged)

Question 1

(1) is drug of choice for initial OA therapy, except in (2) situations, where (3) is preferred

Answer 1

1- acetaminophen
2- signs of inflammation (swelling)
3- NSAIDs (2nd choice if tylenol fails)

Question 2

list the ‘other drugs’ used for OA therapy, indicate route of administration and purpose

Answer 2

• Duloxetine, oral, chronic MSK pain
• Tramadol, oral, moderate chronic pain
• Opioid, oral, last resort
• Capsacin, topical, for NSAID intolerance
• Corticosteroid, joint injection, for persistent pain in one or few joints

Question 3

briefly describe the two categories of drugs used for RA therapy

Answer 3

1) Acute use: NSAIDs, glucocorticoids
- treats pain, inflammation
- does not stop progression of disease or joint destruction

2) DMARDs (disease modifying antirheumatic drugs)
- delays and possibly stops disease progression
- may take 6wks-6mos for effects

Question 4

list the DMARDs by category

Answer 4

Non-biologics: MTX, leflunomide, hydroxychloroquine, sulfasalazine, cyclosporin, azathioprine, cyclophosphamide

Biologics: anti-TNF-α agents (adalimumab, infliximab, etanercept), anakinra, rituximab, abatacept

Question 5

• (1) is the first choice DMARD for mild to moderate RA

- (2) are generally reserved for severe RA, particularly (3)

Answer 5

1- MTX

2- biologics
3- anti-TNF-α agents: adalimumab, infliximab, etanercept

Question 6

describe initial therapy once DMARD is prescribed

Answer 6

since effects may take 6wks to 6mos to take effect, give with:

• NSAIDs
• short course of glucocorticoids

Question 7

(1) is the key screening tool before starting DMARD therapy, (2) is contrindicated during DMARD therapy

Answer 7

1- vaccination status: must have flu, pneumococcal, HepB, VZV vaccines

2- no live vaccines