DMARDS Flashcards
DMARDs (biologic TNF Inhibitor)
adalimumab (Humira)
etanercept (Enbrel)
DMARDS INDICATION
Rheumatoid Arthritis!
Methotrexate: RA, lupus
Hydroxychloroquine: RA, lupus, malaria
DMARDs (non-biologic), folate antimetabolite
Methotrexate
DMARDs (non-biologic)
Sulfasalazine
DMARDs (biologic Non-TNF Inhibitor)
Rituximab (Rituxan)
DMARDs (non-biologic), antimalarial
Hydroxychloroquine (Plaquenil)
DMARDS ROA
Methotrexate: PO - once a week
Sulfasalazine, hydroxychloroquine: PO
DMARDS biologic: IV, subcut
Methotrexate MOA
possibly impacting IL-1, TNF-alpha, and leukotriene levels
Methotrexate AE
Common: N/V/D, alopecia, malaise. Less common: increased liver function tests, hepatotoxicity, nephrotoxicity, thrombocytopenia, bone marrow suppression
Methotrexate PT SPECIFIC CONSIDERATIONS
keep pt hydrated, review labs, careful with strengthening, stretching, deep tissue work. Lupus infection control: wash hands, clean equipment, etc. Photosensitivity.
Methotrexate PK/PD
Comb. of MTX with another DMARD can increase efficacy (but also toxicity). Give with folic acid to reduce GI, hepatic and hematology toxicity
Methotrexate OTHER
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.
Sulfasalazine MOA
impacts mediators of inflammatory response
Sulfasalazine AE
nausea, rash, hepatitis, pneumonitis, bone marrow suppression
Sulfasalazine PT SPECIFIC CONSIDERATIONS
keep pt hydrated
Sulfasalazine PK/PD
DMARDS + high-dose steriods = catabolic effect
DMARDs (biologic TNF Inhibitor) MOA
Humira, Enbrel
bind TNF-alpha receptors to modulate downstream effects on inflammatory processes
DMARDs (biologic TNF Inhibitor) AE
Humira, Enbrel
Common: headache, infection, antibody development, IV infusion reactions (fever, hypotension, urticaria) Boxed Warnings: serious infections, secondary malignancies like lymphoma
DMARDs (biologic TNF Inhibitor) PT SPECIFIC CONSIDERATIONS
Humira, Enbrel
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
DMARDs (biologic TNF Inhibitor) OTHER
Humira, Enbrel
If self-administered, disease progression may inhibit adherence. Boxed warning (serious infections, secondary malignancies)
Rituximab MOA
basic MOA impacts inflammation process
Rituximab AE
injection/infusion reactions, increased LFTs, antibody development
Rituximab PT SPECIFIC CONSIDERATIONS
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
Rituximab OTHER
Self-admin., progression may inhibit adherence but some devices designed to address this
Hydroxychloroquine (DMARD non-biological / antimalarial): MOA
impacts mediators of imflammatory response
Hydroxychloroquine AE
dyspepsia, nausea, abdominal pain, rashes, nightmares, and visual disturbances
Hydroxychloroquine PT SPECIFIC CONSIDERATIONS
keep pt hydrated
Hydroxychloroquine OTHER
RA - Addresses symptoms but not progression. In lupus - reduces disease progression and prolongs survival
