Management of RA Flashcards
What are the 2 goals for drug treatment for a patient with RA
Decrease joint inflammation
Decrease or stop the progression of the disease
What are the 3 categories of drugs that are used to treat RA?
NSAIDs, glucocorticoids, DMARDs
T/F NSAIDs including COX-2 inhibitors usage for treating RA has declined since DMARDs, but still play an important role
True
Why are NSAIDs still prescribed for patients with RA?
to reduce inflammation and pain management
What drug is used with early progression of RA, can decrease joint erosion, and damage?
Glucocorticoids & DMARDs
Why might a patient start on a glucocorticoid while also taking a DMARD?
DMARDs take several weeks to become effective so using a glucocorticoids initially with a DMARD can help control pain and inflammation until the DMARD takes effect
T/F Glucocorticoids can be used during acute flare-ups or exacerbations of RA or even injured directly into a joint to manage exacerbations
True
How do glucocorticoids work?
Bind to receptor in the cytoplasm of certain cells and form a glucocorticoid receptor complex. the complex then moves to the cell’s nucleus where it binds to genes that regulate the inflam process by inhibiting the production of pro inflam substances and production of anti-inflam proteins occurs
List 6 major side effects of taking glucocorticoids
Osteoporosis – especially when used at higher doses for prolonged periods of time
Muscle wasting and weakness
HTN
Aggravation of DM
Glaucoma
Cataracts
Increased risk of infection
What is a nonbiological traditional DMARDs and why might it be used?
Antimalarials (hydroxychloroquine) - an option for those that cannot tolerate other DMARDs
How does Antimalarials (hydroxychloroquine) work?
These drugs work by affecting immune cell responses
What are the major side effects of Antimalarials (hydroxychloroquine)?
High doses can cause irreversible retinal damage (Recommend regular eye exams for patients)
Small risk of headache and GI distress
(Considered very safe compared to other DMARDs)
What was the first drug found as DMARDs and how does it work?
Gold compounds – bind to enzymes in immune cells which suppresses the ability for autoimmune responses
When would gold compounds be used to treat someone with RA and why?
Used only for patients who don’t respond to other DMARDs - suppresses the immune system long term, so dont use as often
Biological DMARDs use what type of inhibitors and how do they work?
tumor necrosis factor inhibitors (TNF) – blocks TNF-alpha, which is released during the inflam process & promotes joint erosion & inflammation with RA
What are the only 2 ways Biological DMARDs can be given to a patient?
subcutaneous injection or by slow IV fusion
What is a contraindication for prescribing a biological DMARD?
Contraindicated in people who have infections
If a patient is not responding well to traditional DMARDs, what could a physician prescribe and what are the dangers of it?
Other DMARDs that are more toxic
Why might a physician prescribe methotrexate for a patient with RA and what is the ideal timeline for length of taking the medication?
it slows the effects of RA and has a greater therapeutic effect than other DMARDs with a rapid onset of 2-3 weeks ONLY due to being a very toxic drug
What is the cornerstone drug used in combination with other DMARDs?
Methotrexate often combined with TNF-alpha
Why might a physician choose to use a combination of DMARDs to treat a patient with RA and what is the risk?
A combination of 2 or more drugs can have optimal benefits and a low dose can be used of each & may provide the best success through RA remission
Increased potential for toxicity and drug interaction when combining DMARDs
What are 3 things you would recommend to a patient with RA pertaining to diet?
Suggest: high in fish oral and omega-3 fatty acids to control inflammation, antioxidant properties, and AVOID high meat and proteins as well as smoking
