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LOCO2 > DMARDs > Flashcards

DMARDs Flashcards

1
Q

Is RA symmetrical or asymmetrical

A

Symmetrical

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2
Q

Do DMARDs affect RA disease progression

A

Yes

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3
Q

What are DMARDs combined with to treat newly diagnosed RA

A

Methotrexate
Short term glucocorticoid
Another DMARD

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4
Q

When is DMARD mono therapy used in RA

A

Pregnancy
Co morbidities

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5
Q

How should DMARD therapy be changed in recent onset RA where control is satisfactory

A

Decr dose

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6
Q

How do DMARDs effect radiographic progression, number of swollen joints, and fatigue severity

A

Improve radiographic progression and number of swollen joints
No effect on fatigue

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7
Q

What is the anchor drug for RA

A

Methotrexate

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8
Q

What is given to women before staring methotrexate

A

Pregnancy test

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9
Q

How is methotrexate administered for RA

A

Oral
SC or IM can be used if oral ineffective

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10
Q

How does methotrexate dose change over RA treatment

A

Start on high dose and decrease

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11
Q

Which enzymes do methotrexate inhibit to prevent DNA and RNA production

A

Dihydrofolate reductase
Thymidylate synthetase

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12
Q

What assessments do patients on methotrexate need every 1-3 months

A

Full blood count
Liver function tests

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13
Q

Methotrexate MOA

A

inhibiting dihydrofolate reductase + thymidylate synthetase -> decr RNA + DNA synthesis
JNK activation -> incr ROS -> Induce apoptosis and cell cycle arrest
Inhibit IL1 and NF-kB production

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14
Q

Salfasalazine

A

Sulphur based antibiotic combining sulfapyridine and 5-amino salicylic acid

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15
Q

Does sulfasalazine act locally or systematically

A

Sulfapyridine absorbed systematically
5-ASA has local anti inflam action

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16
Q

Sulfasalazine MOA

A

Not well understood
Concentrates in CT and serous fluid
Suppresses superoxide radical and cytokine production

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17
Q

What other condition is sulfasalazine mainly used for

A

Ulcerative colitis

18
Q

Hydroxychloroquine main use

A

Antimalarial

19
Q

Hydroxychloroquine MOA in RA

A

Increases pH in lysozymes decreasing protein modifications
Blocks TLR 9 decreasing dendritic cell activation

20
Q

Leflunomide MOA

A

Inhibits pyramiding biosynthesis by inhibiting dihydroorotate dehydrogenase

21
Q

D penecillin MOA in RA

A

copper chelator
Decr immune response and IL1 generation
Prevents fibrosis

22
Q

D pencillamine main side effect

A

Kidney damage

23
Q

Why are gold salts not often used for RA treat,ent

A

Side effects

24
Q

Traditional DMARDs

A

Methotrexate
Sulfasalazine
Hydroxychloroquine
Leflunomide
D pencillamine
Gold salts

25
Q

Cells/molecules inhibited by Biological DMARDs

A

TNFa
IL1, 6, 17, 23
B cells
T cells
IL6
JAK

26
Q

TNFa blocker MOA

A

Remove TNFa from system before it reaches TNFa receptor

27
Q

Etanercept

A

TNFa blocker
Fusion protein of human TNF receptor 2 and human IgG1

28
Q

Infliximab

A

TNFa blocker
Monoclonal antibody against TNFa

29
Q

Adalimumab

A

Human monoclonal antibody for TNFa

30
Q

Which molecule is targeted by anakinra canakinumab and rilonacept

A

IL1
Anakinra - IL1 receptor antagonist
Canakinumab - IL1 monoclonal antibody
Riloncept - binds to IL1

31
Q

Rituximab

A

Monoclonal antibody against CD20 on B cells

32
Q

How does rituximab destroy normal and malignant B cells

A

Complement dependent cytotoxicity
Antibody dependent cellular cytotoxicity
Recognition by macrophages
Activates apoptosis

33
Q

What cells do abatacept and balatacept target and what process do they effect

A

T cells
Disrupt cell signalling through CD28

34
Q

Which drug is rituximab, and tocilizumab given in combination with

A

Methotrexate

35
Q

Tocilizumab

A

Humanised monoclonal antibody against membrane and soluble IL6 receptor

36
Q

What drug type are tofacitinib, baricitinib, and upadacitinib

A

JAK inhibitor

37
Q

What is JAK

A

Janus kinase

38
Q

How are biological DMARDs generated

A

Genetic engineering

39
Q

What IL does secukinumab and ustekinumab target

A

Secukinumab - IL17
Ustekinumab - IL23

40
Q

Which condition are IL17 and IL23 mainly used for

A

Psoriasis

41
Q

Difference between neutralising and non neutralising anti drug antibodies

A

Neutralising directly interferes with biological drugs ability to work
Non neutralising forms immune complexes around injection site reducing drug conc and pharmacokinetics

42
Q

What molecule made by the body decreases the effectiveness of biological DMARDs

A

Anti drug antibodies

LOCO2 (26 decks)

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