DMARDs

Question 1

gold salts MOA (4)

Answer 1

suppress cellular immunity by:
inhibiting phagocytosis
inhibiting proteolytic enzymes
inhibiting cellular resp. by uncoupling oxidative phosphorylation
preventing PG synthesis

Question 2

penicillamine (cuprimine) MOA & usage (2)

Answer 2

chelating drug

Wilson’s & RA

Question 3

penicillamine (Cuprimine) adverse rxns (4)

Answer 3

agranulocytosis/aplastic anemia
proteinuria
nephrotic syndrome
lupus

Question 4

Hydroxychloroquine (Plaquenil) receptor properties (3)

Answer 4

antihistamine
anticholinesterase
antiprotease

Question 5

Hydroxychloroquine (Plaquenil) MOA (4)

Answer 5

decreases PG synthesis, mucopolysaccharides
decreased response to chemotactic stimuli & phagocytosis
stabilizes lysosomes
reacts w/ nucleic acids & tissue proteins

Question 6

Hydroxychloroquine (Plaquenil) SE (5)

Answer 6

pruritis
hemolysis (G6PD deficient)
ototoxicity
retinopathy
neuropathy

Question 7

Sulfasalazine use (2)

Answer 7

IBD

RA

Question 8

Sulfasalazine SE & cautions

Answer 8

SE: GI, rash, etc

monitor for hepatitis and bone marrow problems during the first 3 mo. of treatment

Question 9

infliximab (Remicade) MOA (1) & use (3)

Answer 9

monoclonal Ab targeting TNFa

Crohn’s
RA
combined w/ MTX, given IV

Question 10

Infliximab (Remicade) SE (2)

Answer 10

HA

reactions at infusion site

Question 11

Infliximab (Remicade) contraindications (4)

Answer 11

pregnancy
breastfeeding
children
infections

Question 12

Adalimumab (Humira) MOA (2) & use (2)

Answer 12

IgG1 monoclonal Ab for TNFa
has 100% human peptide sequences

monotherapy for RA
subQ

Question 13

Adalimumab (Humira) SE (4)

Answer 13

rash
flu-like sx
fatigue
HA

Question 14

Etanercept (Enbrel) MOA and dose

Answer 14

TNF inhibitor

subQ

Question 15

Etanercept (Enbrel) SE (3)

Answer 15

injection site rxn
infections
increased incidence of Ab fxn

Question 16

Etanercept (Enbrel) contraindications (5)

Answer 16

bone marrow suppression
breastfeeding
children
diabetes
infection

Question 17

Rituximab (Rituxan) MOA & use

Answer 17

binds to CD20 on B-lymphocytes. CD20 is only expressed on NHL B-cells, not normal

relapsed B-cell NHL, possible CLL

Question 18

abatacept (Orencia) MOA

Answer 18

blocks T-cell activation

disturbs inflammation & joint destruction in RA

Question 19

Leflunomide (Arava) MOA (2)

Answer 19

inhibits dihydroorotate DH (DHODH)

inhibits induction of COX-2

Question 20

Leflunomide (Arava) SE (4)

Answer 20

GI
back pain
oral ulceration
elevated hepatic enzymes

Question 21

Leflunomide (Arava) contraindications (3)

Answer 21

pregnancy
breast feeding
hepatic/renal failure

Question 22

Mycophenolate mofetil (Cellcept) MOA

Answer 22

inhibits lymphocyte purine synthesis by inhibiting inosine monophosphate DH (IMPDH)

Question 23

Mycophenolate mofetil (Cellcept) contraindications (5)

Answer 23

active GI disease
diarrhea
pregnancy
breast feeding
infections

Question 24

Anakinra (Kineret) MOA and use

Answer 24

IL-1 receptor antagonist

RA: improvement of swollen/painful joints within 4-13 weeks

Question 25

Tocilizumab (Actemra) MOA

Answer 25

IL-6 receptor Ab

Question 26

Tofacitinib (Xeljanz) MOA and use

Answer 26

inhibits JAK1 and JAK3

adults w/ severe RA that can’t take MTX

Question 27

Tofacitinib (Xeljanz) SE (2)

Answer 27

can precipitate serious infections, malignancy