Module 8: Unit D

Question 1

Common gluccocoritcoids

Answer 1

prednisone
prednisolone
methylprednisolone
betamethasone
dexamethasone

Question 2

Indications glucocorticoids

Answer 2

RA
SLE
IBS
Inflammatory disorders
Allergic reactions
Asthma
Dermatological conditions

Question 3

MOA glucocorticoids

Answer 3

Glucocorticoids produce anti-inflammatory and immunosuppressive effects when administered at pharmacologic doses (vs. physiologic dosage). Glucocorticoids activate receptors within the cellular cytoplasm, forming an active receptor-steroid complex which produces mRNA in the nucleus to code for specific regulatory proteins.

Question 4

Cautions, contraindications, D2D of glucocorticoids

Answer 4

Contraindicated: systemic fungal infections; patients receiving live virus vaccines (MMR, rotavirus, varicella, FluMist)

Caution: pediatric patients, pregnant or breastfeeding women, HTN, renal impairment, HF, DM, osteoporosis, gastritis, esophagitis, treatment-resistant infection, glaucoma.
Caution: NSAIDs, oral hypoglycemics, insulin, digoxin, potassium-sparing diuretics.

Question 5

AE and SE of glucocorticoids

Answer 5

Potentially harmful withdrawal symptoms if long-term or high-dose stopped abruptly.
Risk of adrenal suppression
AE: osteoporosis, infection, ↓ wound healing, hyperglycemia, myopathy, fluid and electrolyte imbalance, growth delay, psychological disturbance, cataracts and glaucoma, peptic ulcer disease, iatrogenic Cushing’s disease, ↑ risk of GI bleed, adrenal suppression

Question 6

Monitoring needed with glucocorticoids

Answer 6

Baseline: V/s, BMI, height, weight, DXA, CBC, CMP, lipids, then one month after starting treatment and every 6 months when stable
Establish baseline, monitor, and identify high risk patients or situations
Eye exams-advise pts. to notify you of any vision changes
Glucose testing - sliding scale or med adjustment at necessary

Question 7

Conventional synthetic csDMARDs:

Answer 7

methotrexate (Trexall)
leflunomide (Arava)
sulfasalazine (Azulfidine)
hydroxychloroquine (Plaquenil)

Question 8

Biologic DMARDS

Answer 8

TNF inhibitors
etanercept (Enbrel)
adalimumab (Humira)
infliximab (Remicade)

Question 9

Targeted synthetic tsDMARDs:

Answer 9

Janus kinase inhibitor

Question 10

Methotrexate indication

Answer 10

RA, psoriasis, acute lymphoblastic leukemia, polyarticular juvenile idiopathic arthritis

Question 11

Leflunomide indication

Answer 11

active RA

Question 12

Indication sulfasalazine

Answer 12

RA, IBS

Question 13

hydroxychloroquine indication

Answer 13

RA (adjunct to methotrexate)

Question 14

Methotrexate MOA

Answer 14

folate antagonist which DNA synthesis, repair, and cellular replication in active, proliferative cells. In RA, methotrexate may ↓ activity of B and T lymphocytes leading to immunosuppression.

Question 15

leflunomide MOA

Answer 15

prodrug converted to metabolite 1 which inhibits T-cell proliferation and ↓ inflammation

Question 16

Sulfasalazine MOA

Answer 16

Exact MOA unknown. 5-ASA (active component) may attenuate local mediators of the inflammatory response (leukotrienes), May also function as a free radical scavenger or an inhibitor of tumor necrosis factor (TNF)

Question 17

Hydroxycloroquine MOA

Answer 17

exact MOA unknown; thought to ↓ movement neutrophils, and eosinophils; impairs complement-dependent antigen-antibody reactions

Question 18

Contraindications DMARDS

Answer 18

Pregnancy, hypersensitivity, dyscrasias, immunodeficiency, liver disease

Question 19

BBW methotrexate

Answer 19

cause numerous and potentially fatal toxicities of the bone marrow, liver, lungs, and kidneys. Other fatalities have occurred with skin reactions, hemorrhagic enteritis, and GI perforation. Pregnancy. Hypersensitivity.

Question 20

SE leflunomide

Answer 20

hepatotoxic, SJS, serious infection, diarrhea, alopecia, interstitial lung disease, peripheral neuropathy, teratogen- discontinuation protocol

Question 21

SE sulfasalazine

Answer 21

GI- nausea, vomiting, anorexia, pain; rash, SJS, pruritus,

Question 22

SE/Safety hydroxychloroquine

Answer 22

Retinal damage, cardiomyopathy, AV block, BBB, prolonged QT, hypoglycemia, myopathy, neuropathy, worsening of psoriasis, GI distress

Question 23

TNF-Inhibitors Biologic bDMARDs:

Answer 23

etanercept (Enbrel)
adalimumab (Humira)
infliximab (Remicade)

Question 24

Indications TNF inhibitors:
etanercept (Enbrel)
adalimumab (Humira)
infliximab (Remicade)

Answer 24

Primarily RA
Also used for inflammatory disorders like psoriatic arthritis, Crohn’s, and ankylosing spondylitis.

Question 25

MOA: TNF inhibitors:
etanercept (Enbrel)
adalimumab (Humira)
infliximab (Remicade)

Answer 25

Suppresses inflammation by inhibiting TNF by forming a TNF-receptor complex, preventing TNF from binding with natural receptors on cells

Question 26

TNF inhibitors SE:
etanercept (Enbrel)
adalimumab (Humira)
infliximab (Remicade)

Answer 26

Sepsis, active infection, hypersensitivity
Risk for serious infection, bacterial sepsis, invasive fungal infection, hepatitis B, TB, HF, liver failure, dyscrasias, cancer, neuro concerns

Question 27

BBW TNF inhibitors

Answer 27

TNFIs: Serious systemic infections and sepsis
infliximab: serious and potentially fatal infections

Question 28

Janus kinase inhibitors

Answer 28

Targeted synthetic tsDMARDs
tofacitinib (Xeljanz)
baricitinib (Olumiant)

Question 29

Indications for Janus kinase inhibitors: tofacitinib (Xeljanz)
baricitinib (Olumiant)

Answer 29

Moderate to severe RA not responding to methotrexate
psoriatic arthritis
ulcerative colitis

Question 30

MOA janus kinase inhibitors: tofacitinib (Xeljanz)
baricitinib (Olumiant)

Answer 30

Reduce immune and inflammatory responses by blocking JAK enzyme signaling and interrupting the STAT pathway

Question 31

Safety considerations Janus Kinase inhibitors:
tofacitinib (Xeljanz)
baricitinib (Olumiant)

Answer 31

Active infection, hypersensitivity
infection, HA, ↑ cholesterol, gastroenteritis, bone marrow suppression, thrombosis, dysrhythmias, CA,

Question 32

BBW janus kinase inhibitors:
tofacitinib (Xeljanz)
baricitinib (Olumiant)

Answer 32

serious and potentially fatal infections