DMARDs, Biological Tharapies, Steroids Flashcards
How are DMARDs broadly classified?
affect the disease process
affect the immine system
give examples of DMARDs that affect the disease process
gold
penicillamine
sulfasalazine
give examples of DMARDs that affect the immune system
methotrexate hydroxychloroquine ciclosporin azathioprine leflunomide
what is sulfasalazine used for?
RA
psoriatic arthritis
IBD (most activity is in the bowel as it is poorly absorbed)
what is the active metabolite of sulfasalazine?
5-ASA
what are the ADRs of sulfasalazine?
agranulocytosis
thrombocytopaenia
hepatitis
what tpe of drug is methotrexate?
antimetabolite and antifolate
what are some contraindications to using methotrexate
PREGNANACY
liver impairment
immunosuppressed
active infection
what are the side effects of methotrexate?
myelosuppression liver toxicity pulmonary toxicity ulcerative stomatitis very very teratogenic!!! (use to induce abortion, and antifolate)
what is methotrexate used to treat?
RA
psoriatic arthritis
SLE
cancer
what adive should you give to patients regarding diet and methotrexate?
take folate supplements
what type of drug is hydroxychloroquine?
antimalarial
what are the side effects of hydroxychloroquine?
retinopathy
what is hydroxychloroquine used to treat?
RA
SLE
good for photosensitive skin problems associated with autoimmune diseases
juvenile arthritis
what is azathioprine used to treat?
SLE vasculitis IBD (RA) cancer transplants
how does azathioprine work?
metabolised to 6 mercaptopurine
antimetabolite that decreases DNA and RNA synthesis
what must you check before initiating azathioprine therapy?
TPMT levels
explain why TPMT deficiency is bad
TPMT converts 6-MP to inactive analogues
deficiency of TPMT means more 6-MP builds up and is converted by HGPRT pathway to cytotoxic analogues =(
what are the warning symptoms you should advise patients to seek healthcare about if they get them while on DMARDs?
- Sore throat
- Fever and other signs of infection
- Unexpected bleeding or bruising
- Purpura and rashes
- Mouth ulcers
- Cough or breathlessness
give examples of TNF-alpha inhibitors
infliximab
etanercept
adalimumab
give some advantages of monoclonal antibodies compared to DMARDs
faster onset of action
LESS sides effects
no need for regular blood tests for monitoring
when would you consider starting a biological therapy in a patient with RA?
when in addition to low dose steroids, 2 trials of six months of traditional DMARD monotherapy or combination therapy (at least one including methotrexate) should fail to control symptoms or prevent disease progression
what type of drug is rituximab?
anti-CD20
what are some side effects of monoclonal antibodies?
immunosuppresion reactivation of TB reactivation of hepatitis B lymphoma drug-induced lupus
