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PHRM 864 > E4 Rheumatoid Arthritis > Flashcards

E4 Rheumatoid Arthritis Flashcards

1
Q

2 major cell types associated with pannus

A

T lymphocytes
macrophages

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2
Q

major cell type associated with synovial fluid

A

neutrophils

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3
Q

what is the main diagnostic thing we look for in RA?

A

how many joints are involved

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4
Q

pts are diagnosed with RA if there is a score of __ or more

A

6

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5
Q

3 most common joints involved in rA

A

hands
wrists
feet

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6
Q

give a few of the extra articular manifestations of RA

A

nodules
vasculitis
pulmonary
cardiac
feltys
ocular

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7
Q

when are rheumatoid nodules more common

A

in erosive disease

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8
Q

how do i know when to treat nodules in RA?

A

if pt has symptoms

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9
Q

inflammation of small, superficial blood vessels

A

vasculitis

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10
Q

what serious thing can vasculitis lead to?

A

necrosis and stasis ulcers

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11
Q

what two things can RA cause in the pulmonary system

A

pleural effusions
pulmonary fibrosis

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12
Q

what can RA cause in the ocular system?

A

sjogrens syndrome and itchy dry eyes with inflammation

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13
Q

3 things RA can cause in cardiac system

A

pericarditis
conduction abnormalities
rare: myocarditis

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14
Q

what tf is feltys syndrome

A

inflamed spleen and presence of neutropenia

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15
Q

T or F:
RA can also cause thrombocytosis and renal disease

A

false, renal disease is associated with treatment not RA

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16
Q

what is ESR?

A

erythrocyte sedimentation rate (lab indicator for RA)

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17
Q

normal ESR

A

0-20 mm/hr

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18
Q

is ESR decreased or increased in RA?

A

increased so above 20

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19
Q

normal CRP

A

0-0.5 (diagnostic criteria for RA)

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20
Q

a CRP > ? can indicate bacterial infection

A

10

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21
Q

what is RF?

A

rheumatoid factor, it is an antibody specific for IgM

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22
Q

T or F:
Not all pts with RA diagnosis are RF+

A

tru

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23
Q

what is CCP/ACPA

A

auto antibody presence test (this is a new diagnostic method)

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24
Q

what is ANA?

A

antinuclear antibodies

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25
Q

ANA more indicative of ?

A

SLE

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26
Q

elevated ANA titers suggest ___________ disease

A

autoimmune

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27
Q

what is joint aspiration?

A

evaluating fluid in joint space

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28
Q

what is the turbidity in joint space due to?

A

WBC count in that space

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29
Q

Joint aspiration:
glucose: _____ to _____ compared to serum

A

normal to low
i have no idea what this means

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30
Q

hallmark way to diagnose RA?

A

radiographic changes -> joint space narrowing and erosions of bone

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31
Q

5 classes used in treating RA

A

NSAIDs
Corticosteroids
DMARDs
Biologics (Anti-TNF)
Biologics (Non-TNF)

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32
Q

T or F:
NSAIDs hinder the progression of RA

A

false, specifically says DO NOT alter

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33
Q

NSAIDs are typically used in combo with?

A

DMARDs

34
Q

Corticos are used for what 2 properties

A

anti inflam
immunosuppressive

35
Q

T or F:
corticos are typically used as mono therapy

A

false, never. combo w/ DMARDs

36
Q

two bullet points under corticos for “use in ___”

A

acute flates
pts w/ extra-articular manifestations

37
Q

T or F:
corticos and DMARDs have steroid sparing effects

A

false, NSAIDs and DMARDs

38
Q

which two classes should NEVER be used as monotherapy?

A

NSAIDs and corticos

39
Q

T or F:
in regards to NSAIDs, inflammatory dosing is higher than pain dosing

A

true, 600-800 for inflammation

40
Q

which NSAID should not be used if pt has a sulfa allergy

A

celecoxib

41
Q

corticos are specifically good during ?

A

acute flares

42
Q

4 short term cortico adverse effects ***

A

hyperglycemia
gastritis
mood changes
elevated BP

43
Q

5 long term cortico adverse effects **

A

aseptic necrosis
cataracts
obesity
growth failure
osteoporosis

44
Q

2 baseline monitoring parameters for corticos

A

BP
BG

45
Q

what is DMARD

A

Disease Modifying Anti-Rheumatic Drugs

46
Q

DMARDs have the potential to decrease/prevent ______ damage & preserve _____ integrity

A

joint
joint

47
Q

T or F:
onset of DMARDs is rapid

A

false, onset of action is delayed

48
Q

4 DMARDs they want us to know

A

MTX
sulfasalazine (SSZ)
HCQ
Leflunomide

49
Q

most predictable benefit
A. MTX
B. sulfasalazine (SSZ)
C. HCQ
D. Leflunomide

A

A

50
Q

MOA of MTX

A

inhibit dihydrofolic acid reductase (inhibits neutrophil adhesion and chemotaxis)

51
Q

Dose of MTX *

A

7.5 mg per week po or IM
(up to 15-20 mg- weekly dose can be taken in one day)

52
Q

onset of mTX

A

1-2 months

53
Q

MTX has _______ metabolism with some ______ excretion

A

hepatic
renal

54
Q

highlighted hematologic adverse effect for MTX *

A

bone marrow suppression

55
Q

2 highlighted GI adverse effects for MTX

A

N/V/D
stomatitis/mucositis

56
Q

what do you prescribe with MTX to reduce sxs

A

1mg/day of folic acid

57
Q

2 pulmonary AEs of MTX

A

pneumonitis
fibrosis

58
Q

3 derm AEs of MTX

A

rash
urticaria
alopecia

59
Q

T or F:
avoid MTX in pts with liver dysfunction

A

true

60
Q

T or F:
avoid MTX in immunodeficiency

A

True

61
Q

MTX CI in CrCl <__

A

40

62
Q

5 baseline monitoring for MTX

A

CXR
CBC
SCr
LFTs
ALbumin

63
Q

Leflunomide MOA

A

inhibit de novo biosyn of pyrimidines -> interfering with TK activity -> inhibit cell cycle progression

64
Q

T or F:
MTX is a prodrug

A

false, but leflunomide is

65
Q

T or F:
Leflunomide requires a loading dose

A

true

66
Q

half life of leflunomide

A

14-16 days damn

67
Q

use caution when giving MTX and ______ together b/c liver toxicity

A

leflunomide

68
Q

5 AEs leflunomide

A

diarrhea
rash
alopecia
LFTs
teratogenicity

69
Q

3 monitoring things for leflunomide

A

CBC
SCr
LFT

70
Q

MOA of sulfasalazine

A

inhibit IL-1

71
Q

T or F:
Sulfasalazine is a prodrug

A

true, cleaved in colon to sulfapyridine and 5-ASA

72
Q

unique AE of sulfasalazine (SSZ)

A

photosensitivity from sulfa component

73
Q

3 monitoring parameters for SSZ

A

CBC
SCr
LFT

74
Q

T or F:
HCQ is more effective in treatment than leflunomide

A

false

75
Q

HCQ MOA

A

modification of cytokine infiltration in joint

76
Q

unique AE of HCQ

A

retinal toxicity

77
Q

T or F:
take HCQ with food

A

true, relives GI sxs

78
Q

only monitoring thing for HCQ

A

vision exam

79
Q

biologic DMARDs

A

TNF neutralizers
etanercept
infliximab
adalimumab
golimumab
certolizumab

80
Q
A

PHRM 864 (28 decks)

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