DMARDS

Question 1

DMARDs (biologic TNF Inhibitor)

Answer 1

adalimumab (Humira)

etanercept (Enbrel)

Question 2

DMARDS INDICATION

Answer 2

Rheumatoid Arthritis!

Methotrexate: RA, lupus
Hydroxychloroquine: RA, lupus, malaria

Question 3

DMARDs (non-biologic), folate antimetabolite

Answer 3

Methotrexate

Question 4

DMARDs (non-biologic)

Answer 4

Sulfasalazine

Question 5

DMARDs (biologic Non-TNF Inhibitor)

Answer 5

Rituximab (Rituxan)

Question 6

DMARDs (non-biologic), antimalarial

Answer 6

Hydroxychloroquine (Plaquenil)

Question 7

DMARDS ROA

Answer 7

Methotrexate: PO - once a week
Sulfasalazine, hydroxychloroquine: PO

DMARDS biologic: IV, subcut

Question 8

Methotrexate MOA

Answer 8

possibly impacting IL-1, TNF-alpha, and leukotriene levels

Question 9

Methotrexate AE

Answer 9

Common: N/V/D, alopecia, malaise. Less common: increased liver function tests, hepatotoxicity, nephrotoxicity, thrombocytopenia, bone marrow suppression

Question 10

Methotrexate PT SPECIFIC CONSIDERATIONS

Answer 10

keep pt hydrated, review labs, careful with strengthening, stretching, deep tissue work. Lupus infection control: wash hands, clean equipment, etc. Photosensitivity.

Question 11

Methotrexate PK/PD

Answer 11

Comb. of MTX with another DMARD can increase efficacy (but also toxicity). Give with folic acid to reduce GI, hepatic and hematology toxicity

Question 12

Methotrexate OTHER

Answer 12

Gold Standard for Rheumatoid Arthritis….LOTS of Boxed Warnings (GI, pulmonary, derm,bone marrow depression, increase risk serious infection) Lupus - immunosuppressants, boxed warning for serious infecton, secondary malignancy.

Question 13

Sulfasalazine MOA

Answer 13

impacts mediators of inflammatory response

Question 14

Sulfasalazine AE

Answer 14

nausea, rash, hepatitis, pneumonitis, bone marrow suppression

Question 15

Sulfasalazine PT SPECIFIC CONSIDERATIONS

Answer 15

keep pt hydrated

Question 16

Sulfasalazine PK/PD

Answer 16

DMARDS + high-dose steriods = catabolic effect

Question 17

DMARDs (biologic TNF Inhibitor) MOA

Humira, Enbrel

Answer 17

bind TNF-alpha receptors to modulate downstream effects on inflammatory processes

Question 18

DMARDs (biologic TNF Inhibitor) AE

Humira, Enbrel

Answer 18

Common: headache, infection, antibody development, IV infusion reactions (fever, hypotension, urticaria) Boxed Warnings: serious infections, secondary malignancies like lymphoma

Question 19

DMARDs (biologic TNF Inhibitor) PT SPECIFIC CONSIDERATIONS

Humira, Enbrel

Answer 19

Talk with them about possible concerns and pass it on to their provider, wash hands so not to cause infections, inspect for skin rashes, keep pt hydrated

Question 20

DMARDs (biologic TNF Inhibitor) OTHER

Humira, Enbrel

Answer 20

If self-administered, disease progression may inhibit adherence. Boxed warning (serious infections, secondary malignancies)

Question 21

Rituximab MOA

Answer 21

basic MOA impacts inflammation process

Question 22

Rituximab AE

Answer 22

injection/infusion reactions, increased LFTs, antibody development

Question 23

Rituximab PT SPECIFIC CONSIDERATIONS

Answer 23

Talk with them about possible concerns and pass it on to their provider, wash hands so not to cause infections, inspect for skin rashes, keep pt hydrated

Question 24

Rituximab OTHER

Answer 24

Self-admin., progression may inhibit adherence but some devices designed to address this

Question 25

Hydroxychloroquine (DMARD non-biological / antimalarial): MOA

Answer 25

impacts mediators of imflammatory response

Question 26

Hydroxychloroquine AE

Answer 26

dyspepsia, nausea, abdominal pain, rashes, nightmares, and visual disturbances

Question 27

Hydroxychloroquine PT SPECIFIC CONSIDERATIONS

Answer 27

keep pt hydrated

Question 28

Hydroxychloroquine OTHER

Answer 28

RA - Addresses symptoms but not progression. In lupus - reduces disease progression and prolongs survival