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Pharm Midterm 2 > DMARDs > Flashcards

DMARDs Flashcards

1
Q

What are the Non-biological DMARDs

A 
MTX
Leflunomide
Hydroxychloroquine
Sulfasalazine
Cyclosporine
Azathioprine
Cyclophosphamide
Gold sodium thiomalate
Auranofin
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2
Q

What are the Biological DMARDs

A

Adalimumab
Infliximab
Etanercept
Anakinra

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3
Q

What are used, but not real DMARDs

A

Glucocorticoids

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4
Q

What is the only purpose of NSAID administration in RA

A

Sx relief

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5
Q

What is the purpose of DMARD administration

A

Control Sx and delay disease progression

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6
Q

How long does it take for DMARDs to kick in

A

6 weeks to 6 months

Some bio in 2wks

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7
Q

What is the DOC for RA

A

MTX

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8
Q

What does MTX do

A

Decrease purine synthesis

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9
Q

How do you reduce MTX toxicity

A

Add Leucovorin or folate

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10
Q

What does Leflunomide do

A

Arrest cells in G1

Decrease pyrimidine synthesis

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11
Q

Used for UC Tx

A

Sulfasalazine

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12
Q

What do you give with Hydroxychloroquine

A

MTX

Sulfasalazine

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13
Q

How does Hydroxychloroquine work

A

Little gnomes in the blood

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14
Q

What must be done before Hydroxychloroquine administration

A

Opthalmologic exam

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15
Q

What are the Hydroxychloroquine AE

A

Hemolysis with G6PD deficiency

Retinal damage

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16
Q

What does MTX do

A

Inhibit AICAR transformylase
No IMP formation
Adenosine accumulation

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17
Q

What does a high amount of adenosine lead to

A

Decreased NF-kappaB

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18
Q

What are the MTX AE

A

Nausea
Ulcers
Hepatotoxicity
Pseudolymphomatous Rxn

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19
Q

When is MTX contraindicated

A

Pregnancy

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20
Q

What is MTX important in inhibiting in cancer

A

DHF reductase

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21
Q

How does Leflunomide act

A

Inhibits Dihydroorotate dehydrogenase
Decreases UMP
Inhibits autoimmune B, T cell prolif

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22
Q

What happens if you mix Leflunomide with MTX

A

Severe hepatotoxicity

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23
Q

What are the Leflunomide AE

A

Frequent diarrhea
Alopecia, rash
Myelosuppression
Increased aminotransferase activity

24
Q

When is Leflunomide contraindicated

A

Pregnancy

25
Q

What is the active form of Sulfasalazine

A

Sulfapyridine

26
Q

What happens to Sulfasalazine in the colon

A

Metabolized to Sulfapyridine and 5-ASA

27
Q

What are the Sulfasalazine AE

A 
Nausea
Anorexia
Rash
Hepatitis
Leukopenia
SLE
28
Q

What can happens with Sulfasalazine in G6PD deficiency

A

Hemolysis

29
Q

Is Sulfasalazine safe in pregnancy

A

Yes

30
Q

What does Cyclosporine do

A

Inhibits Ag-induced signal transduction in T-cells

31
Q

How does Cyclosporine work

A

Complex with Cyclophillin
Prevents NFAT dephos by calcineurin
Decreased IL-2

32
Q

Main AE of Cyclosporine

A

Nephrotoxicity
Hirsutism
Gum hyperplasia

33
Q

What is a purine antimetabolite

A

Azathioprine

34
Q

When is Azathioprine administered as a DMARD

A

Refractory RA

35
Q

How does Azathioprine work

A

Converted to 6-MP
Inhibition of de novo purine synth
Suppression of B and T cells

36
Q

When should you reduce the Azathioprine dose

A

Pt taking Allopurinol

Inhibition of xanthine oxidase

37
Q

What are the Azathioprine AE

A

BM suppression
GI disturbance
Infection/Malignancy

38
Q

When do you give Cyclophosphamide

A

Severe RA

39
Q

How does Cyclophosphamide work

A

Alkyklating agent crosslinks DNA

No cell replication

40
Q

What is the main AE of Cyclophosphamide

A

Hemorrhagic Cystitis

41
Q

How do you treat the main AE of Cyclophosphamide

A

Mesna

42
Q

What are the other Cyclophosphamide AE

A

BM suppression, Infertility
Infection/Malignancy
Fanconi’s Anemia

43
Q

What are the Macrophage poisons

A

Gold sodium thiomalate

Auranofin

44
Q

How is GST administered

A

IM

45
Q

How is Auranofin administered

A

PO

46
Q

What do GST and Auranofin do

A

Suppress phagocytosis and lysosomal activity

47
Q

What is the fully human IgG1 anti-TNF Ab

A

Adalimumab

48
Q

What is the chimeric anti-TNF Ab

A

Infliximab

49
Q

What is the recombinant anti-TNF Ab

A

Etanercept

50
Q

How do anti-TNF Abs work

A

Bind TNFalpha and prevent receptor interaction

Downregulation of T-cell and macrophage function

51
Q

What should be done before anti-TNF Ab Tx

A

Screening for latent TB

52
Q

What is the main AE of anti-TNF Ab

A

Serious infection

53
Q

What is the Il-1 receptor antagonist

A

Anakinra

54
Q

When are Glucocorticoids given in RA

A

Short term Sx relief until positive DMARD effect is seen

55
Q

What do Glucocorticoids do

A

Inhibit PLA2 and COX-2

56
Q

What are the AE with chronic Glucocorticoid use

A 
Osteoporosis
Weight gain
Ulcers
HTN
Hyperglycemia
57
Q

What do you never give as combinatino therapy

A

Multiple biological DMARDs

Pharm Midterm 2 (52 decks)

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