Nonbiologic DMARD

Question 1

Sulfasalazine Class

Answer 1

non-biologic DMARD

Question 2

Sulfasalazine MOA

Answer 2

systemic: inhibits PG, decrease IgA, IgM
local: colon reduces inflammatory response

Question 3

Sulfasalazine Indication

Answer 3

1. RA
2. ulcerative colitis
3. Crohns Disease

Question 4

Sulfasalazine SE

Answer 4

1. reversible oligospermia
2. jaundice
3. photosensitivity

Question 5

Sulfasalazine Contra

Answer 5

1. GI/GU obstruction
2. G6PD Deficiency
3. folate deficiency

Question 6

Sulfasalazine dx-dx

Answer 6

1. increase oral hypoglycemics

2. NSAIDs increase impact

Question 7

Sulfasalazine Other

Answer 7

1. only 10-20% oral dose absorbed

2. reversible infertility in men

Question 8

Tofacitinib Class

Answer 8

Nonbiologic DMARDs, JAK inhibitor

Question 9

Tofacitinib MOA

Answer 9

Inhibits JAK enzymes, decrease IgG, IgM, IgA

Question 10

Tofacitinib Indications

Answer 10

RA in adults not responding to methotrexate

Question 11

Tofacitinib SE

Answer 11

1. infection (20%)
2. HTN
3. HA
4. GI perforation
5. hepatotoxicity
6. TB
7. lipid abnormalities

Question 12

Tofacitinib Contra

Answer 12

1. hepatitis!
2. TB
3. egfr

Question 13

Tofacitinib dx-dx

Answer 13

1. MAJOR CYP3A4 substrate!!

2. concurrent BDMARDs

Question 14

Tofacitnib other

Answer 14

1. BLACK BOX WARNING: TB, infection

2. monotherapy or NBDMARD

Question 15

Hydroxychloroquine Class

Answer 15

Nonbiologic DMARD

Question 16

Hydroxychloroquine MOA

Answer 16

suppression of T cells

Question 17

Hydroxychloroquine Indications

Answer 17

1. RA
2. SLE
3. Malaria

Question 18

Hydroxychloroquine SE

Answer 18

1. abd pain
2. nightmares
3. ocular toxicity (need eye exams q6 months)
4. myopathy

Question 19

Hydroxychloroquine Contra

Answer 19

1. psoriasis

2. G6PD def

Question 20

Hydroxychloroquine Other

Answer 20

1. avoid ethanol
2. extensive in melanin tissues (eyes)
3. t1/2 45 days

Question 21

Methotrexate Class

Answer 21

Nonbiologic DMARD

Question 22

Methotrexate MOA

Answer 22

Inhibits dihydrofolate, inhibits cytokines

Question 23

Methotrexate PG

Answer 23

X!

Question 24

Methotrexate Indications

Answer 24

recent RA (

Question 25

Methotrexate SE

Answer 25

1. pulmonary fibrosis
2. hepatotoxicity
3. Stevens-Johnson
4. subacute toxicity

Question 26

Methotrexate Contra

Answer 26

1. renal/liver disease
2. bone marrow disease
   3, AIDs

Question 27

Methotrexate dx-dx

Answer 27

1. live vaccines
2. warfarin
3. ethanol

Question 28

Methotrexate other

Answer 28

Initial response: 3-4 weeks
full response: 3-6 months

folic acid w/treatment

Question 29

Cellcept Class

Answer 29

semisynthetic DMARD

Question 30

Cellcept MOA

Answer 30

immunosuppression of T and B lymphocytes

Question 31

Cellcept PG

Answer 31

D

Question 32

Cellcept Indications

Answer 32

1. RA

2. post organ transplant

Question 33

Cellcept SE

Answer 33

1. decrease CBC
2. hyper/hypotension
3. chest pain
4. tachycardia
5. insomnia
6. elevated BS

Question 34

Cellcept Contra

Answer 34

Infections

Question 35

Cellcept Monitor

Answer 35

glucose!

Question 36

Cyclophosphamide Class

Answer 36

Anti-neoplastic Alkylating Agent

Question 37

Cyclophosphamide MOA

Answer 37

prevents cell division by cross-linking DNA, decreasing DNA synthesis, cell phase nonspecific

Question 38

Cyclophosphamide PG

Answer 38

D

Question 39

Cyclophosphamide Indications

Answer 39

1. RA
2. Cancers (leukemia, breast, lymphoma, myeloma)
3. corticoid refractory nephrotic syndrome

Question 40

Cyclophosphamide SE

Answer 40

1. cardiotoxicity
2. decreased fertility
3. hepatic/pulm toxicity
4. hyponatermia

Question 41

Cyclophosphamide Contra

Answer 41

1. urinary tract outflow obstruction

2. myelosuppression

Question 42

Cyclophosphamide dx-dx

Answer 42

1. clozepine
2. echinacea
3. tofacitinib
4. vaccines

Question 43

Cyclophosphamide other

Answer 43

prodrug, requires hepatic activation