MSK disorders Flashcards
What drugs are indicated for RA treatment?
NSAIDs, steroids, and DMARDS
MOA of non-biologic (traditional) DMARDS?
- Reduces B and T lymphocyte activity
- Inhibits folic acid metabolism which prevents cell reproduction leading to death of rapidly replicating cells.
Which traditional DMARD is the gold standard?
Methotrexate
What are adverse effects of traditional DMARDS?
hepatotoxicity, bone marrow suppression, GI ulceration, kidney damage, pneumonitis, and fetal death
What labs should we monitor when giving DMARDs?
Kidney function
Liver: hepatotoxicity
CBC and platelet counts: risk of infection and bleeding
What are other indications for traditional DMARDS?
cancer, psoriasis, and abortion
MOA of biological DMARDS?
Neutralizes tumor necrosis factors (TNF) which promotes destruction of B lymphocytes and inhibits activation of T lymphocytes
Adverse effects of biologic DMARDS?
infection, reactivation of HBV and TB; new onset or worsening HF; increase risk for lymphoma or other malignancies; neutropenia, thrombocytopenia, and aplastic anemia.
Contraindications for biologic DMARDS?
demyelinating disorders (MS), severe HF, active HBV and TB
Who should be cautious in taking biologic DMARDS?
immunocompromised, mild HF, liver dysfunction, latent HBV, and DM
What is TNF?
Causes joint distortion in RA
What should we tell a patient who has latent TB before taking biologic DMARDS?
Need to have a negative TB test
Which vaccines should not be taken before taking biologic DMARDS?
live vaccines like herpes zoster and shingles vaccine
What is neutropenia?
neutrophils < 1,500
What is aplastic anemia?
leads to pancytopenia (reduction in RBC, WBC, and platelets)
Indications for colchicine?
acute gout exacerbations
Colchicine MOA?
unknown but it does not alter urate production or removal
Why should grapefruit be avoided when taking colchicine?
It disrupts the hepatic enzyme (CYP3A4) needed for metabolism
Adverse effects of colchicine?
GI toxicity and bone marrow suppression (infection)
Which labs should be assessed when taking Colchicine and why?
CBC due to bone marrow suppression