Exam 4 - Rheumatoid Arthritis Schellhase Flashcards by Rehman Hameed

which of the following classes are always used adjunct for RA? SELECT ALL THAT APPLY

a. DMARDs
b. NSAIDs
c. Corticosteroids
d. Anti-TNF biologics
e. Non-TNF biologics

b. NSAIDs
c. Corticosteroids

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low dose of prednisone is < ___ mg/day

< 10 mg/day

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short-term corticosteroid therapy is < ___ months of therapy

< 3 months

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which is NOT a short-term AE of corticosteroids?

a. hyperglycemia
b. gastritis
c. osteoporosis
d. mood changes
e. elevated BP

c. osteoporosis (long-term)

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which of the following is NOT a long-term corticosteroid AE?

a. aseptic necrosis
b. cataracts
c. obesity
d. growth failure
e. osteoporosis
f. gastritis

f. gastritis

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two things to monitor baseline for RA

BP and BG readings

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4 traditional/conventional DMARDs (slide 13)

methotrexate
sulfasalazine
hydroxychloroquine
leflunomide

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MOA: inhibit dihydrofolic acid reductase (inhibits neutrophil adhesion and chemotaxis)

a. methotrexate
b. sulfasalazine
c. hydroxychloroquine
d. leflunomide

a. methotrexate

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methotrexate dose per week

7.5 mg per week PO or IM; up to 15-20 mg

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methotrexate onset: ___-___ months

1-2 months

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which AEs of methotrexate can we prescribe folic acid with to reduce symptoms? SELECT ALL THAT APPLY

a. bone marrow suppression
b. N/V/D
c. stomatitis/mucositis
d. cirrhosis
e. hepatitis
f. fibrosis

a. bone marrow suppression
b. N/V/D
c. stomatitis/mucositis

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which is NOT a CI for methotrexate?

a. pregnancy
b. CrCl < 40
c. immunodeficiency
d. pleural/peritoneal effusions
e. they are all CI

e. they are all CI

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methotrexate monitoring: which of the following do we check both at baseline and maintenance? SELECT ALL THAT APPLY (3 of them)

a. CXR
b. CBC
c. SCr
d. LFTs
e. albumin

b. CBC
c. SCr
d. LFTs

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how often should we monitor CBC, SCr, and LFTs for pts on methotrexate, leflunomide, sulfasalazine, ?

< 3 months: ___-___ weeks
3-6 months: ___-___ weeks
> 6 months: ___ weeks

2-4
8-12
12

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MOA:
-Inhibit de novo biosynthesis of pyrimidines
-Interferes with tyrosine kinase activity
-Inhibit cell cycle progression

a. methotrexate
b. leflunomide
c. sulfasalazine
d. hydroxychloroquine

b. leflunomide

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half-life of leflunomide

14-16 days

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leflunomide AE (5 of them; slide 23)

-diarrhea
-rash
-alopecia
-inc LFTs
-teratogenicity

which of the following is a prodrug cleaved in colon to sulfpyradine and 5-ASA that is also an IL-1 inhibitor?

a. methotrexate
b. leflunomide
c. sulfasalazine
d. hydroxychloroquine

c. sulfasalazine

which drug’s works by modification of cytokine infiltration in the joint and has an onset of 2-4 months?

a. methotrexate
b. leflunomide
c. sulfasalazine
d. hydroxychloroquine

d. hydroxychloroquine

hydroxychloroquine has no _________, hepatic, or renal toxicities

myelosuppression

monitoring for hydroxychloroquine (only one)

vision exam (baseline, and every 6-12 months)

which of the following has an AE of retinal toxicity?

a. methotrexate
b. leflunomide
c. sulfasalazine
d. hydroxychloroquine

d. hydroxychloroquine

T or F: leflunomide and methotrexate are ok in pregnancy

T or F: HCQ has no myelosuppression

T or F: TNF inhibitors and IL-1s should be used in combo for RA

which drug/drug class for RA can exacerbate CHF? a. TNF inhibitors b. HCQ c. sulfasalazine d. IL-1 inhibitors

a. TNF inhibitors

T or F: anakinra is only used in combination for mod-severe RA in pts who have failed one or more DMARDs

F (can be used alone or in combo)

anakinra drug class a. IL-1 antag b. IL-6 antag c. TNF inhibitor d. anti-CD 20 antibody

a. IL-1 antag

monitoring for anakinra a. eye exams b. neutrophil counts c. LFTs d. CBC, SCr

b. neutrophil counts

abatacept drug class a. IL-6 inhibitor b. TNF inhibitor c. selective T-cell co-stim modulator d. JAK inhibitor

c. selective T-cell co-stim modulator

T or F: abatacept CANNOT be used in combo with a TNF inhibitor or IL-1 antagonist

T (but it can be used in combo with a different DMARD)

tocilizumab and sarilumab drug class a. IL-1 antag b. IL-6 antag c. TNF inhibitor d. anti-CD 20 antibody

b. IL-6 antag

which of the following is FALSE about IL-6 inhibitors? a. BBW for serious infections b. tocilizumab is given IV every 4 weeks c. sarilumab is given SC every 4 weeks d. lipid abnormalities are an adverse effect

c. sarilumab is given SC every 4 weeks (SC every 2 weeks)

do not use JAK inhibitors if: -Hemoglobin < ____ mg/dL -ANC < _____ cells/mm3 -ALC < _____ cells/mm3

< 9 < 1000 < 500

ACR 20 is a measurement for clinical trials and is defined as: ___% improvement in the tender and swollen joint count ___% improvement in ___ of 5 parameters

20% 20% 3

20 questions covers 8 domains (ADL) a. health assessment questionnaire b. modified sharp score

a. health assessment questionnaire

– Joint Space Narrowing (42 joints evaluated) – Erosions (46 joints evaluated) – Evaluations are on a point scale a. health assessment questionnaire b. modified sharp score

b. modified sharp score

which is the only IV biologic DMARD for RA?

infliximab

MTX is CI in CrCl < ___

< 40

T or F: MTX can cause alopecia and urticaria

selective JAK inhibitor a. tofacitinib b. upadacitinib

b. upadacitinib

non-selective JAK inhibitor a. tofacitinib b. upadacitinib

a. tofacitinib