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NMSKP Exam II > MSK: DMARDs > Flashcards

MSK: DMARDs Flashcards

1
Q

What drugs are first-line for Rheumatoid arthritis?

A

NSAIDs

  • acetaminophen
  • -opoids are generally not necessary
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2
Q

MOA of glucocorticoids?

A

block transcription of NF-kB and AP1 transcription factors

-decreases immune cell and inflammatory cytokine (IL-1) production=anti-inflammatory

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3
Q

What is the clinical application of glucocorticoids in rheumatoid arthritis?

A

Relieves pain and inflammation while waiting for other DMARDs to kick in
-also treats flares of RA

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4
Q

ROI of glucocorticoids?

A

PO, IM, or intra-articular

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5
Q

What are some adverse effects of glucocorticoids?

A

Adrenal insufficiency*
Cushing syndrome*
Hypothyroidism
Diabetes mellitus

And many more

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6
Q

What gene is activated by glucocorticoids to inhibit Phospholipase A2 (PLA2)?

A

Lipocortin

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7
Q

How long are glucocorticoids effective for in RA?

A

usually < 6 months

-not used on chronic basis, only for flares

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8
Q

How many joints are inflammed in mild RA?

A

< or =5 joints

-any more it becomes moderate-severe

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9
Q

MOA of methotrexate?

A

Inhibits dihydrofolate reductase

-causes thymineless death of cells

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10
Q

What is the overcomplex mechanism of action for methotrexate that Wolff has listed?

A

Results in AICAR buildup, which binds to purinergic GPCRs on cell surfaces and has anti-inflammatory effects

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11
Q

Is methotrexate fast or slow onset?

A

Faster onset than other DMARDs; evident in 3-6 weeks

-works for 80% of patients

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12
Q

ROI for methotrexate?

A

Once per week oral or injection

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13
Q

What should you supplement patients on when giving methotrexate?

A

Folate

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14
Q

Are there many adverse effects with methotrexate? If so, what are they?

A

Yeah, high doses have many life threatening effects

  • Bone marrow suppression
  • hepatic fibrosis
  • GI ulceration
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15
Q

Is methotrexate safe during pregnancy?

A

Absolutely not

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16
Q

MOA of hydroxychloroquine

A

Is lipophilic and accumulates in lysosomes where it is protonated, which results in even higher concentrations

-disrupts MCH II presentation

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17
Q

Clinical uses of hydroxychloroquine

A

Antimalarial

Often combined with methotrexate or sulfasalazine

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18
Q

Is hydroxychloroquine safe during pregnancy?

A

Yes

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19
Q

How long is the half life of hydroxychloroquine?

A

23 days

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20
Q

How can you speed up the benefits of hydroxychloroquine?

A

use a loading dose

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21
Q

What is the toxicity associated with hydroxychloroquine?

A

retinal damage

-low doses carry less of this risk

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22
Q

MOA of sulfasalazine

A

Metabolized into sulfapyridine to cause immunosuppression

-doesnt list how?

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23
Q

Clinical application of sulfasalazine

A

Used as monotherapy for RA or combined with hydroxychloroquine and/or methotrexate (triple therapy)

24
Q

Is sulfasalazine safe in pregnancy?

A

Seems okay, but not studied well

25
Q

Adverse effects of sulfasalazine?

A

GI side effects (N/V, Diarrhea)

Sulfa drug–watch for allergies

26
Q

MOA of leflunomide

A

inhibits mito enzyme dihydroorotate dehydrogenase

-blocks synthesis and inhibits T cell proliferation

27
Q

Clinical use of leflunomide?

A

Alternative DMARD to methotrexate

-second line

28
Q

What is the half life of leflunomide?

A

16.5 days, so loading dose is needed

29
Q

What are the most common adverse effects of leflunomide?

A

diarrhea, URI, reversible alopecia, rash and nausea

30
Q

Can biologic DMARDs be combined with other biologics?

A

No! Can be combined with other non-biologic DMARDs though

31
Q

What are the pros and cons of the biologic DMARDs?

A

Pros: Faster onset and high rate of response

Cons: expensive and increase risk of adverse events

32
Q

What do the following suffixes mean:

  • cept
  • mab
  • ximab
  • zumab
  • umab
A
  • cept=fusion of a receptor to Fc region of IgG
  • mab=monoclonal antibody
  • ximab=chimeric ab
  • zumab=humanized mAb
  • umab=human mAb origin
33
Q

TNF antagonists MOA?

A

Work by neutralizing TNF

-great for RA, after non-biologics

34
Q

Clinical indications for TNF-a antagonists

A

Moderate to severe RA

-after non-biologics did not work

35
Q

What other drug is TNF-antagonsits combined with?

A

Methotrexate

36
Q

Adverse effects of TNF antagonists

A

Immunosupression
-TB

Severe allergic rxns

37
Q

What drugs are the TNF inhibitors?

A

Etanercept (SubQ QD or BID)
Infliximab (IV every 6 weeks)
Adalimumab (SubQ biweekly)

38
Q

MOA of rituximab

A

monoclonal Ab directed at CD20 on B cells

-depletes B cells to decrease levels of autoantibodies

39
Q

What other drug is rituximab combined with?

A

methotrexate

40
Q

What autoantibodies improves the likelihood of ritixumab working?

A

Rheumatoid factor and Anti-CCP

41
Q

What adverse effects are associated with rituximab?

A

Infusion reactions and serum sickness

42
Q

MOA of abatacept

A

prevents CD28 from binding to CD80/56

43
Q

Clinical applications of abatacept

A

Moderate to severe RA

-can be combined with non-biologic DMARDs

44
Q

Adverse reactions of abatacept

A

Generally well tolerated
-headache, URI, nausea

Can increase chance of infections

45
Q

MOA of tocilizumab

A

humanized anti-IL6 receptor Ab

-blocks receptor limiting inflammation

46
Q

Clinical application of tocilizumab

A

Moderate to severe RA after other drugs havent worked

-can be used alongside methotrexate

47
Q

Adverse effects of toxilizumab

A

URIs*-most common

Life threatening infections (TB)

48
Q

MOA of tofacitinib

A

inhibits JAK3

-decreases DNA transcription of cytokines and T/B cells

49
Q

Clinical application of tofacitinib

A

Moderate to severe RA after other drugs havent worked

-can be used alongside methotrexate

50
Q

ROI of tofacitinib

A

Oral

51
Q

Is tofacitinib an expensive drug?

A

Yes, $2055 a month

52
Q

Adverse effects of tofacitinib

A

Fatal infections with opportunistic infections

Can increase malignancies

53
Q

MOA of anakinra

A

Recombinant drug of human IL-1 receptor antagonist

-decrease inflammation

54
Q

Clinical use of anakinra?

A

Moderate to severe RA after other drugs haven’t worked

considered less effective than other DMARDs

55
Q

Adverse effects of anakinra

A

Increase incidence of serious infections

Hypersensitivity reactions

NMSKP Exam II (4 decks)

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