DMARDs Flashcards
TNF alpha is produced by _______ and stimulates production of_________
macrophages
prostaglandin
what are NSAIDs used for in chronic inflammatory disease?
tx of sx
DMARDs have what effect on chronic inflammatory diseases?
modify course of disease
do DMARDs have analgesic properties?
no
describe the onset of effects for DMARDs
generally weeks to months
Which DMARD?
suppress cellular immunity
causes bone marrow damage and enterocolitis
Gold Salts
This is a chelating DMARD that is effective in RA and Wilson’s disease
penicillamine
The below are the toxicities of…
- high incidence of reaction
- thrombocytopenia, leukopenia, agranulocytosis, aplastic anemia
- lupus, pemphigus, goodpastures
- nephrotic syndrome
penicillamine
This drug has antihistamine, anticholinesterase and antiprotease properties.
It stabilizes the lysosomes and reacts with nucleic acids/proteins
hydroxychloroquine
This drug:
- inhibits prostaglandin synthesis
- inhibits mucopolysaccharaide synthesis
- inhibits chemotaxic responses and phagocytosis
hydroxychloroquine
The below are toxicities to which drug?
- pruritis
- hemolysis in G6PD
- ototoxicity, retinopathy, peripheral neuropathy (cinchonism)
hydroxychloroquine
This is an IBD drug now used to treat RA.
it is better tolerated and as effective as older therapies…
sulfasalazine
how long must you monitor for hepatitis and marrow suppression when starting sulfasalazine?
2-3 weeks q 1st 3 months
TNF Alpha inhibitors are often combined with…
MTX
Which TNF Alpha inhibitor?
Chimeric
composed of human constant region
murine variable region
IgG1k mAb
infliximab
4 C/I for TNF alphas?
pregnancy, breast feeding, children, infx
route of admin for infliximab?
IV
infliximab is approved for…(2)
Chron Disease and RA
Which TNF Alpha inhibitor?
IgG1
100% human derived
monotherapy for RA
adalimumab
adalimumab is administered ________ and has a half-life of…
SC
8-10 days
the below are S/Es for…
rash flu sxs fatigue HA pruritis N/V
TNF-A inhibitors
esp. adalimumab
2 “me too” drugs of adalimumab…
certrolizumab
golimumab
Which TNF Alpha inhibitor?
dimeric fusion protein via recombinant DNA
acts as false TNF receptor
etenercept
The below are contraindications of…
bone marrow suppression breast feeding children DM Infx Sepsis Vaccination Varicella
etanercept
2 inhibitors of B/T cells
rituxumab
abatacept
Which T/B cell inhibitor?
chimeric mAb
IgG that binds to CD20 on B-Cells
Rituximab
CD-20 is expressed on > 90% of B-Cells in _______
Non-Hodgkin Lymphoma
Which T/B cell inhibitor?
fully human recombinant fusion protein
T-cell activation blocker
Competes w/ CD-28
Abatacept
This drug disrupts key mechanisms of inflammation and joint destruction in RA
may also affect defenses against infx and malignancy via T cell inhibition
abatacept
Inhibitor of nucleic acid synthesis…
leflunomide
Which drug?
inhibits DHODH, enzyme that catalyzes de novo pyramidine synth
leflunomide
Which drug?
inhibits the induction of COX-2
leflunomide
route of leflunomide
PO
3 C/Is for leflunomide
pregnancy
breast feeding
hepatic/renal failure
Which drug?
inhibits lymphocyte purine synth by reversible inhibition of IMPDH
mycophenolate mofetil
C/Is for mycophenolate mofetil… (5)
Active GI disease Diarrhea Pregnancy Breast Feeding Infx
IL-1 receptor antagonist…
anakinra
mAb against IL-6 receptor.
compete w. IL-6 to bind
similar acts to other immunosuppressants
tocilizumab
When should JAK inhibitors be considered?
severe RA w. intolerance to MTX
Tofacitinib is what class?
JAK inhibitor
tofacitinib can precipitate… (2)
malignancy & serious infx
Which JAK inhibitor?
Primarily inhibits JAK1 and JAK3
Tofacitinib
Which JAK inhibitor?
Primarily inhibits JAK1 and JAK2
Baricitinib
This JAK inhibitor may be used as monotherapy or in combo w. MTX or other non-biologic DMARDs
baricitinib
