DMARDs (Disease Modifying Anti-Rheumatic Drugs) Flashcards
Quinolones
Class: Antimalarial
Mech: Reduces T-cell activation and chemotaxis
Thera: Rheumatoid, SLE
Tox: Chloroquine (only) will cause retinal damage
Misc: Used for patients who no longer respond to NSAIDs or cannot tolerate other DMARDs
Glucocorticoids
Class: N/A
Mech: Inhibits phospholipase A2 (inhibiting release of AA and thus formation of prostaglandins)
Inhibits cytokine production (prevents induction of COX-2)
Thera: Rheumatoid, Acute gouty arthritis (can use intraarticular injection for local relief)
Tox: Cushingoid symptoms
Misc: Started initially (fast acting) before other drugs become effective. Can be oral or injection
Sulfasalazine
Class: N/A
Mech: Likely inhibits IL-1 and TNF-alpha release
Thera: Rheumatoid
Tox: headaches, nausea, vomiting, skin rashes, neutropenia (30% d/c this drug bc of SEs)
Misc: Acts more quickly than other drugs
Methotrexate
Class: Folate inhibitor
Mech: Inhibition of aminoimidazolecarboxamide (AICAR) transformylase and thymidylate synthetase with secondary effects on PMN chemotaxis.
Causes adenosine accumulation which inhibits inflammation
Thera: Rheumatoid
Tox: Nausea, stomatitis, hepatotoxicity
Misc: Takes several weeks to start working
Gold standard therapy
Leflunomide
Class: N/A
Mech: Inhibits dihydroorate dehydrogenase which inhibits T-lymphocyte response to stimuli.
Thera: Rheumatoid
Tox: Diarrhea, hepatotoxicity
Misc: Takes several weeks to start working
Oral prodrug