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PHRM 864 Therapeutics > Exam 4 - Rheumatoid Arthritis Schellhase > Flashcards

Exam 4 - Rheumatoid Arthritis Schellhase Flashcards

1
Q

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

A

b. NSAIDs
c. Corticosteroids

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2
Q

low dose of prednisone is < ___ mg/day

A

< 10 mg/day

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3
Q

short-term corticosteroid therapy is < ___ months of therapy

A

< 3 months

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4
Q

which is NOT a short-term AE of corticosteroids?

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

A

c. osteoporosis (long-term)

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5
Q

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

A

f. gastritis

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6
Q

two things to monitor baseline for RA

A

BP and BG readings

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7
Q

4 traditional/conventional DMARDs (slide 13)

A

methotrexate
sulfasalazine
hydroxychloroquine
leflunomide

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8
Q

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

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

A

a. methotrexate

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9
Q

methotrexate dose per week

A

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

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10
Q

methotrexate onset: ___-___ months

A

1-2 months

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11
Q

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

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

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12
Q

which is NOT a CI for methotrexate?

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

A

e. they are all CI

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13
Q

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

A

b. CBC
c. SCr
d. LFTs

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14
Q

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

A

2-4
8-12
12

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15
Q

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

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

A

b. leflunomide

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16
Q

half-life of leflunomide

A

14-16 days

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17
Q

leflunomide AE (5 of them; slide 23)

A

-diarrhea
-rash
-alopecia
-inc LFTs
-teratogenicity

18
Q

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

A

c. sulfasalazine

19
Q

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

A

d. hydroxychloroquine

20
Q

hydroxychloroquine has no _________, hepatic, or renal toxicities

A

myelosuppression

21
Q

monitoring for hydroxychloroquine (only one)

A

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

22
Q

which of the following has an AE of retinal toxicity?

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

A

d. hydroxychloroquine

23
Q

T or F: leflunomide and methotrexate are ok in pregnancy

A

F

24
Q

T or F: HCQ has no myelosuppression

A

T

25
Q

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

A

F

26
Q

which drug/drug class for RA can exacerbate CHF?

a. TNF inhibitors
b. HCQ
c. sulfasalazine
d. IL-1 inhibitors

A

a. TNF inhibitors

27
Q

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

A

F (can be used alone or in combo)

28
Q

anakinra drug class

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

A

a. IL-1 antag

29
Q

monitoring for anakinra

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

A

b. neutrophil counts

30
Q

abatacept drug class

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

A

c. selective T-cell co-stim modulator

31
Q

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

A

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

32
Q

tocilizumab and sarilumab drug class

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

A

b. IL-6 antag

33
Q

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

A

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

34
Q

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

A

< 9
< 1000
< 500

35
Q

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

A

20%
20%
3

36
Q

20 questions
covers 8 domains (ADL)

a. health assessment questionnaire
b. modified sharp score

A

a. health assessment questionnaire

37
Q

– Joint Space Narrowing (42 joints evaluated)
– Erosions (46 joints evaluated)
– Evaluations are on a point scale

a. health assessment questionnaire
b. modified sharp score

A

b. modified sharp score

38
Q

which is the only IV biologic DMARD for RA?

A

infliximab

39
Q

MTX is CI in CrCl < ___

A

< 40

40
Q

T or F: MTX can cause alopecia and urticaria

A

T

41
Q

selective JAK inhibitor

a. tofacitinib
b. upadacitinib

A

b. upadacitinib

42
Q

non-selective JAK inhibitor

a. tofacitinib
b. upadacitinib

A

a. tofacitinib

PHRM 864 Therapeutics (28 decks)

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