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Pharmacology Test #3 > Medications for Rheumatoid Arthritis > Flashcards

Medications for Rheumatoid Arthritis Flashcards

1
Q

What is rheumatoid arthritis?

A

chronic autoimmune disorder that causes painful inflammation in the joints.

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2
Q

What is the end result wanted for treatment of rheumatoid arthritis?

A

controlling the painful inflammation, decrease swelling, decrease joint stiffness, increase joint mobility.

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3
Q

Will any of the medications discussed cure rheumatoid arthritis?

A

NO

they are used to relieve symptoms and slow progression

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4
Q

What are DMARDS?

A

disease-modifying antirheumatic drugs

these are a variety of medications use to treat rheumatoid arthritis

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5
Q

How are DMARDS classified?

A

based on the order in which they are prescribed

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6
Q

Describe DMARDS I.

A

these are usually the first DMARDS prescribed

Consist of:
Immune suppressant - methotrexate (rheumatrex) – (lower doses decrease cytotoxic effect like when used for chemotherapy)
antimalarial agent - hydroxychloroquine (Plaquenil) – (has been shown to decrease inflammation)
tetracylcline antibiotic - minocycline (Minocin) – (controls inflammatory response)

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7
Q

Describe DMARDS II.

A

Usually used when DMARDS I are not effective

Consist of Tumor necrosis factor antagonists:

  • — These directly target cytokines responsible for inflammatory process— have more adverse effects
    • etanerecept (Enbrel)
    • Infliximab (Remicade)
    • adalimumab (Humira)
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8
Q

Describe DMARDS III.

A

these are not frequently prescribed, used when DMARDS II are not effective

Consist of:

    • gold salts - auranofin (Ridaura)
    • penicillamine (Depen) (decreases inflammation)
    • Immune suppressants - cyclosporine (Neoral) (suppress immune respone)
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9
Q

What do gold salts do?

A

block cellular molecules that are responsible for inflammatory process.

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10
Q

What are two other drug classes that are used in conjunction with DMARDS to treat rheumatoid arthritis? Why?

A

NSAIDS and glucocorticoids

both of these suppress the inflammatory response

THESE ARE THE FIRST THING PRESCRIBED WHEN DIAGNOSED WITH RHEUMATOID ARTHRITIS BECAUSE OF THEIR FASTER ONSET OF ACTION IN COMPARISON TO DMARDS

DMARDS take months to reach full effect

NSAIDS are pretty immediate

glucocorticoids may take a couple days to take effect

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11
Q

What is the pharmacological action of DMARDS?

A

slow joint degeneration and progression of rheumatoid arthritis (maintenance of joint function, slow/delay worsening of disease, management of inflammatory bowel disease as well)

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12
Q

What is the pharmacological action of glucocorticoids for treatment of rheumatoid arthritis?

A

provide symptomatic relief of inflammation and pain (analgesia for pain swelling and joint stiffness, slow/delay worsening of disease, short-term therapy until long-acting DMARDS take effect, prevention of organ rejection in transplants, and management of inflammatory bowel disease as well)

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13
Q

What is the pharmacological action of NSAIDs for treatment of rheumatoid arthritis?

A

provide rapid symptomatic relief of inflammation and pain (analgesia for pain swelling and joint stiffness, short-term therapy until long-acting DMARDS take effect)

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14
Q

What are immunosuppressants also used for?

A

management of inflammatory bowel disease and prevention of organ rejection in transplant

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15
Q

What drugs in the DMARDS classes cause bone marrow suppression and what would be some nursing considerations for it?

A

methotrexate

etanercept

infliximab

cyclosporine

gold salts

monitor CBC, WBC, platelets and patients need to get a CBC, WBC every 3-6 months

also report bruising, bleeding gums, bleeding in general (reduction of platelets)

report signs of infection (sore throat, fever)

COMMON ADVERSE EFFECT, ALL DMARDS GROUPS CAN CAUSE THIS

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16
Q

What drugs in the DMARDS classes (and one other drug not in DMARDS for rheumatic arthritis treatment) cause a risk for infection and what would be some nursing considerations for it?

A

methotrexate

etanercept

infliximab

cyclosporine

gold salts

glucocorticoids

SAME DRUGS AS BONE MARROW SUPPRESSION EXCEPT ADD GLUCOCORTICOIDS

report signs of infection (sore throat, fever)

17
Q

What drugs in the DMARDS classes are nephrotoxic and what are some nursing considerations for it?

A

methotrexate

cyclosporine

gold salts

MONITOR LABS

18
Q

What drugs in the DMARDS classes are hepatotoxic and what are some nursing considerations for it?

A

gold salts

cyclosporine

MONITOR LABS AND EDUCATE ABOUT SIGNS OF DYSFUNCTION

19
Q

What drug in the DMARDS I class can cause retinal damage and what are some nursing considerations for it?

A

hydroxychloroquine (antimalarial agent)

REMEMBER THIS

baseline eye exam and follow-up every 6 months with opthalmologist

20
Q

What drugs in the DMARDS classes can cause skin reactions/rashes?

A

gold salts

etanercept

infliximab

OTHER DMARDS II (injected subcutaneously) like adalimumab

REPORT THIS EFFECT

21
Q

What are some other adverse effects of glucocorticoids other than risk for infection and what are some nursing considerations for them?

A

fluid retention, hypokalemia, hyperglycemia – monitor for these and report symptoms.

osteoporosis (long term use)– take calcium supplements, vitamin D, and biphosphonates

22
Q

What drugs in the DMARDS classes cause heart failure and what are some nursing considerations for this?

A

etanercept

infliximab

MONITOR (tachycardia, decreased CO, signs of left and right sided heart failure)

23
Q

What pregnancy category is methotrexate?

A

cat X (two forms of birth control)

24
Q

What is something to watch out for when administering infliximab IV, what do we do if it happens?

A

an IV infusion reaction

stop the infusion, notify provider, monitor patient for 2 hours after the IV infusion (with or without the occurence of an infusion reaction)

25
Q

What can methotrexate do to the GI tract and what is a nursing consideration for this reason?

A

stomatitis/ GI ulcerations

take medication with food

26
Q

How are etanercept and adalimumab adminstered and what is a nursing consideration for this reason?

A

subcuntaneous

we need to monitor the site for any skin rashes/reaction after injection

also make sure that the solution to be injected is clear and without particles (this is supposed to be done with any injections)

27
Q

How should we give the first dose of cyclosporine? why? and what should be done during and after infusion?

A

administer the first dose over 2-4 hours because of the infusion reaction that can happen

monitor for a reaction during and after infusion is done

28
Q

When are glucocorticoids contraindicated?

A

systemic fungal infections

live virus vaccines

29
Q

Do we stop glucocorticoids suddenly if long term use, what is considered long term use? why?

A

NO NO NO

7-10 days is considered long term use

adrenal insufficiency can happen

30
Q

Do DMARDS have many drug-drug interactions?

A

YES YES YES

31
Q

What are some patient teaching points for DMARDS?

A

report signs of illness - avoid illness and crowds (bone marrow suppression and glucocorticoids)

keep lab appointments - renal, liver, CBC, every 3-6 months

avoid grapefruit juice with cyclosporine

take NSAIDS and methotrexate with food

monitor for signs of bleeding (methotrexate, etanercept, infliximab, cyclosporine, gold salts) (bone marrow suppression)

take medications as directed - dont stop glucocorticoids suddenly

many drug-drug interactions

3-6 months to reach full effectiveness (except glucocorticoids and NSAIDS)

avoid alcohol (gold salts, cyclosporine) (hepatotoxicity)

baseline eye exam and follow-up every 3-6 months (hydroxychloroquine)

methotrexate is a pregnancy category X

32
Q

What DMARD should be taken with food and what other adjunct drug should be taken with food as well?

A

methotrexate (stomatitis/GI ulcers)

NSAIDS (peptic ulcers)

33
Q

What DMARD should you avoid taking grapefruit juice with?

A

cyclosporine (increases risk of toxicity)

34
Q

`Why should we avoid alcohol with gold salts and cyclosporine?

A

because of the hepatotoxicity

35
Q

Why do we need to get a baseline eye exam and follow-up every 6 months for patients on hydroxychloroquine?

A

because of the possible retinal damage the drug can cause

Pharmacology Test #3 (8 decks)

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