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MSS 2 > DMARDS > Flashcards

DMARDS Flashcards

1
Q

What are DMARDs?

A
  • disease-modifying antirheumatic drugs (DMARDs)
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2
Q

What is the role of NSAIDs in rheumatic disease?

A
  • to reduce ACUTE inflammation, thereby decreasing pain and improving function.
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3
Q

Are NSAIDs ALONE typically sufficient to change the course of rheumatic disease or RA or prevent joint destruction?

A
  • NO

* use when starting therapy though.

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4
Q

When are CORTICOSTEROIDS used for rheumatic diseases?

A
  • EARLY disease as temporary ADJUNCTIVE therapy, while waiting for DMARDs to exert their anti-inflammatory effects.
  • CHRONIC ADJUNCTIVE therapy in pts with severe disease that is not well controlled.
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5
Q

What corticosteroids are commonly used for rheumatic diseases?

A
  • prednisone
  • methylprednisolone
  • both have anti-inflammatory and immunoregulatory activity.
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6
Q

What are the specific remission-inducing agents for rheumatic diseases?

A
  • gold preparations
  • antimalarials
  • penicillamine
  • cytotoxic drugs
  • immunologic agents
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7
Q

*** What are the 2 GOLD PREPARATIONS?

A
  1. gold sodium thiomalate= suppresses arthritis and synovitis (IM)
  2. auroanofin= oral
    - takes 4-6 months
    * old drugs
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8
Q

How do the gold preparations work?

A
  • inhibit maturation of mononuclear phagocytes, thereby suppressing immune responsiveness.
  • decreases concentrations of rheumatoid factor and immunoglobulin in pts.
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9
Q

How are the gold preparations excreted?

A
  • via the kidney
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10
Q

What ADRs will you see with the gold preparations?

A
  • erythema to severe exfoliative dermatitis

- thrombocytopenia, leukopenia, agranulocytosis, aplastic anemia…

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11
Q

Can you use the gold preparations during pregnancy or breast feeding?

A
  • NO
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12
Q

** What are the 2 ANTIMALARIALS?

A
  1. HYDROXYCHLOROQUINE
  2. CHLOROQUINE
    * takes 2-4 months
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13
Q

Are antimalarials safe in pregnancy?

A
  • YES
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14
Q

How do the antimalarials work?

A
  • possibly by stabilizing leukocyte lysosomal membranes
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15
Q

How are the antimalarials excreted?

A
  • kidney
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16
Q

What are some ADRs of the antimalarials?

A
  • retinal damage (irreversible).

- GI (anorexia, nausea, vomiting…)

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17
Q

What is D-penicillamine?

A
  • older immunosuppressive drug, with unknown MOA.
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18
Q

What are some ADRs of D-penicillamine?

A
  • GI
  • Leukopenia, aplastic anemia…
  • dermatologic
  • renal
19
Q

** What are the 3 CYTOTOXIC drugs used for rheumatoid diseases?

A
  1. METHOTREXATE
  2. LEFLUNOMIDE
  3. AZATHIOPRINE
20
Q

How does methotrexate work?

A
  • inhibits dihydrofolate reductase, thereby stopping production of dTMP (thymidine), which is necessary for DNA, RNA, and protein synthesis.
  • will see negative regulation via build up of AMP.
  • first-line therapy for moderate to severe active RA.
21
Q

Can you use methotrexate in combination with other agents?

A
  • YES, but try as monotherapy first.
22
Q

What should you do before using methotrexate?

A
  • labs for CBC, serum creatinine, AST, and ALT
23
Q

** What are the ADRs of methotrexate?

A
  • pulmonary fibrosis
  • macrocytic anemia
  • hepatitis
  • mucositis
24
Q

Can methotrexate be used in pregnancy?

A
  • NOOOO!!!! It is also used for abortions.
25
Q

** What is leflunomide?

A
  • dihydroorotate dehydrogenase inhibitor leading to anti-inflammatory activity.
26
Q

Can you combine leflunomide with NSAIDs or low dose corticosteroids?

A
  • YES

* but not with other DMARDs

27
Q

What are the ADRs of leflunomide?

A
  • hepatotoxicity
28
Q

Can you give leflunomide in pregnancy?

A
  • NO!!
29
Q

** What is azathioprine? (PICMONIC)

A
  • immunosuppressive agent used in severe refractory RA.
30
Q

What are the ADRs of azathioprine?

A
  • leukopenia, thrombocytopenia

- nausea and vomiting

31
Q

** What is sulfasalazine?

A
  • suppresses T cell responses and indirectly B cell responses.
  • used for RA, IBD, ankylosing spondylitis, and juvenile chronic arthritis.
32
Q

What are the ADRs of sulfasalazine?

A
  • toxicity in 30% of pts.
33
Q

** What is the biologic agent ETANERCEPT? (PICMONIC; anti-TNF inhibitors)

A
  • TNF decoy receptor, which binds to TNF and blunts the immune response.
  • used for severe RA and ankylosing spondylitis.
34
Q

Can you use etancercept with methotrexate?

A
  • YES
35
Q

Can you use etanercept with other biologics?

A
  • NO
36
Q

What are the side effects of etanercept?

A
  • infection
  • headache
  • injection site reaction
  • rhinitis
  • dizziness
  • potential for autoimmune antibodies developing.
37
Q

** What is INFLIXIMAB? (PICMONIC)

A
  • monoclonal antibody that binds to and inactivates TNF-alpha.
  • used for severe RA and Crohn’s disease.
38
Q

** What is ADALIMUMAB (humira)?

A
  • monoclonal antibody that binds to and inactivates TNF-alpha.
39
Q

** What is ANAKINRA?

A
  • nonglycosylated competitive antagonist of the IL-1 receptor.
  • used for severe RA
40
Q

Can you use anakinra with methotrexate?

A
  • YES

* but do not use with other biologics.

41
Q

What is the main ADRS of anakinra?

A
  • serious infections

* DO NOT give live vaccines to these pts.

42
Q

** What is TOFACITINIB?

A
  • JAK inhibitor, thus affecting type I and II cytokine receptors.
  • used for moderate to severe RA
  • can use with methotrexate.
43
Q

What are the side effects of tofacitinib?

A
  • upper resp. infections
  • headache
  • diarrhea
  • serious infections
  • malignancies (lymphoma)
44
Q

** What is TOCILIZUMAB?

A
  • IL- 6 inhibitor used when TNF-alpha inhibitors don’t work.

MSS 2 (15 decks)

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