Lecture 3: Arthritis Flashcards
DMARD’s stands for…
Disease Modifying Anti-Rheumatic Drugs
What are four Non-Biological DMARD’s?
- Hydroxychloroquine Sulfate
- Methotrexate
- Sulfasalazine
- Leflunomide
Entanercept and Infliximab are:
A. Non-Biological DMARD’s
B. Non-TNF Inhibitors
C. TNF Inhibitors
C. TNF Inhibitors
Anakinra are:
A. Non-Biological DMARD’s
B. Non-TNF Inhibitors
C. TNF Inhibitors
B. Non-TNF Inhibitors
True or False: Due to their toxicity, DMARD’s are often reserved for progressive disease
True
True or False: Glucocorticoids are used to treat chronic inflammation
False - for acute flares
Salicylates (Aspirin) can be used as an anti-inflammatory agent, typically used at ___ grams/day
3
True or False: GI intolerance is the most common side effect seen with salicylate use
True
True or fAlse: Typically use of COX1 and 2 NSAID’s result in less GI complaints (exception is indomethacin)
True
TNFInhibitors, such as: Infliximab or Etanercept, are often used with _____
Methotrexate
True or False: Methotrexate can be used to treat arthritis
True
_____: A non-biologic DMARD that inhibits T Lymphocyte activation and cytokines AND is deposited into tissues (EYES!) !!!
A. Hydroxychloroquine
B. Glucocorticoids
C. Salicylates
A. Hydroxychloroquine
What is the most serious AE associated with Hydroxychloroquine?
A. HTN
B. Hemorrhaging
C. Ocular toxicity
D. Suicidal Ideation
C. Ocular toxicity
- Progressive and irreversible
- Also retinopathy
True or False: Hydroxychloroquine can be deposited into both patient tissues (e.g eyes) and fetal uveal tissues
True
Sulfasalazine is composed of: 5-aminosalicylic acid (5-ASA) and sulfapyridine. Where does the major therapeutic action reside?
A. 5-aminosalicylic acid
B. sulfapyridine
A. 5-aminosalicylic acid
True or False: Sulfasalazine has low affinity for connective tissue and has immunoactivating properties
False - high affinity and immunosuppressive properties
Sulfasalazine is composed of: 5-aminosalicylic acid (5-ASA) and sulfapyridine. Which is responsible for the toxicity?
A. 5-aminosalicylic acid
B. sulfapyridine
B. sulfapyridine
True or False: Slow acetylators of sulfapyridine are more likely to experience the AE of Sulfasalazine
True
What is the most serious side effect associated with Sulfasalazine?
A. Alopecia - irreversible
B. Neutropenia - reversible
C. Kidney damage
D. Liver damage
B. Neutropenia - reversible
Sulfasalazine is a second line agent for treating severe RA. It is often used with other second line agents, such as ____ and ____
methotrexate; hydroxychloroquine
Which drug inhibits dihydroorotate dehydrogenase (enzyme involved in pyrimidine synthesis) and has anti-proliferative activity?
A. Methotrexate
B. Hydroxychloroquine
C. Leflunomide
C. Leflunomide
Which enzyme allows for the conversion of Dihydroorotate to Orotate and, ultimately, UMP?
dihydroorotate dehydrogenase
(inhibited by: Leflunomide)
What is the main AE associated with use of Leflunomide?
A. Hepatotoxicity
B. Alopecia
C. Ocular toxicity
D. Rash
A. Hepatotoxicity
_____ is a dimeric fusion protein consisting of ligand binding portion of human 75 kd TNF receptor linked to Fc portion of human IgG1
A. Leflunomide
B. Etanercept
C. Sulfasalazine
B. Etanercept
How many TNF molecules does Etanercept bind?
Two
____ binds specifically to TNFa/b, inhibiting their binding to cell surface TNF-R, rendering TNF-a and beta biologically inactive
A. Leflunomide
B. Etanercept
C. Sulfasalazine
B. Etanercept
True or False: TNF plays an important role in adult and juvenile RA. Elevated levels are found in synovial fluid of RA patients.
True
What are the three Black Box Warnings associated with Etanercept and Infliximab?
- Infections (Bacterial, Virus, Tb)
- Sepsis
- Lymphoma/Malignancies
What is the clinical use of Etanercept?
Moderate to active RA (often used with methotrex)
____ is a chimeric IgG1 monoclonal antibody that is composed of human constant region and murine variable region
A. Leflunomide
B. Etanercept
C. Sulfasalazine
D. Infliximab
D. Infliximab
How does Infliximab neutralize the biological activity of TNF-a?
Binding to its soluble and transmembrane forms, inhibits TNF-alpha receptor binding
True or False: Infliximab neutralizies TNF-beta
False - it does NOT
Which drug could result in hypersensitivity reaction due to murine origin of variable region?
A. Infliximab
B. Leflunomide
C. Etanercept
D. Sulfasalazine
A. Infliximab
Synovial tissue of individuals with RA show ____ cells that secrete immunoglobulins induce autoantibody rheumatoid factor, which can be identified in 80% of affect individuals
B cells
True or False: In the synovial tissue of individuals with RA, there are inflammatory mediators such as (prostaglandins, leukotrienes, cytokines, etc.)
True
Which group of drugs are first line therapy for RA?
Salicylates and NSAIDS
1. Aspirin - initial DOC
2. NSAID’s for pts who do not tolerate salicylates
True or False: Concurrent use of aspirin and NSAIDs are unlikely to produce drug interactions
False - it IS likely to occur!
All NSAID’s EXCEPT ____ and ____ can be used to treat RA?
Ketorolac and Meloxicam
True or False: High dose corticosteroid therapy is used as a bridge between first (NSAID’s and Aspirin) and second line agents (DMARD’s) in RA treatment
False - low dose corticosteroids is used as bridge
Which two low-dose corticosteroids can be used to bridge first and second line agents for RA treatment?
Prednisone
Prednisolone
True or False: Progression of RA is treated with high dose corticosteroids
False - with DMARD’s (second line agent)
True or False: DMARD’s have fast onset of action and low toxicity
False - slow onset and high toxicity
True or False: Early RA is disease duration that is less than 6 months while Establish RA is disease duration greater than 6 mths
True
If a patient has early RA that is mild, ____ is used
A. DMARD combination
B. DMARD monotherapy
C. TNF inhibitor + Methotraxate
B. DMARD monotherapy
If patient has early RA that is moderate or high, ___ is used:
A. DMARD combination
B. DMARD monotherapy
C. TNF inhibitor + Methotraxate
A. DMARD combination
True or False: If a patient has early RA that is moderate or high, one can use either: A) DMARD combination or B) TNF Inhibitors + Methotrexate
True
Why should you worry about prescribing Aspirin to a child for Juvenile RA?
Reye’s Syndrome
Which two drugs are the only NSAID’s labelled for Juvenille RA?
Naproxen and Tolmetin
Which drug should be AVOIDED in children under 14, due to the possibility of serious AE?
A. Naproxen
B. Indomethacin
C. Tolmetin
D. Methotrexate
B. Indomethacin
If a juvenile RA patient does not show any benefit with NSAID use, which DMARD should be used?
A. Naproxen
B. Indomethacin
C. Tolmetin
D. Methotrexate
D. Methotrexate
If methotrexate (DMARD) is not well tolerated in juvenile RA patient, which drug should be trialed?
Sulfasalazine
What is the drug of choice for juvenile RA patient if Sulfasalazine fails?
Hydroxychloroquine
What is the chief hazard associated with Hydroxychloroquine?
Ocular Toxicity
Which biological agent is used to treat JRA (only used when DMARD’s fail)?
A. Indomethacin
B. Tolmetin
C. Sulfasalazine
D. Hydroxychloroquine
E. Etarnecept
E. Etarnecept
Why should oral corticosteroids not be administered to treat JRA?
Possible growth retardation
Which simple analgesic can be used to treat osteoarthritis?
Acetaminophen
Which three NSAIDS should NOT be used to treat osteoarthritis?
Ketorolac and Mefenamic Acid and COX-2 Inhibitor
True or False: Etanercept neutralizes TNF-alpha only while Infliximab binds to TNF-alpha and beta
False - Etanercept binds with TNF-a and beta; Infliximab neutralizes TNF-a only!
True or False: HACA antibodies and hypersensitivity reactions are seen with Etanercept
False - seen with Infliximab
