Exam 4 - Rheumatoid Arthritis Schellhase Flashcards
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
low dose of prednisone is < ___ mg/day
< 10 mg/day
short-term corticosteroid therapy is < ___ months of therapy
< 3 months
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)
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
two things to monitor baseline for RA
BP and BG readings
4 traditional/conventional DMARDs (slide 13)
methotrexate
sulfasalazine
hydroxychloroquine
leflunomide
MOA: inhibit dihydrofolic acid reductase (inhibits neutrophil adhesion and chemotaxis)
a. methotrexate
b. sulfasalazine
c. hydroxychloroquine
d. leflunomide
a. methotrexate
methotrexate dose per week
7.5 mg per week PO or IM; up to 15-20 mg
methotrexate onset: ___-___ months
1-2 months
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
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
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
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
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
half-life of leflunomide
14-16 days
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
F
T or F: HCQ has no myelosuppression
T
T or F: TNF inhibitors and IL-1s should be used in combo for RA
F
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
T
selective JAK inhibitor
a. tofacitinib
b. upadacitinib
b. upadacitinib
non-selective JAK inhibitor
a. tofacitinib
b. upadacitinib
a. tofacitinib
