OA and RA Flashcards
1
Q
Which Non-Biologic DMARDs are ProDrugs
A
Leflunomide, Sulfasalazine
2
Q
Which Non-Biologic DMARDs are teratogenic
A
MTX, Leflunomide
3
Q
Which Non-Biologic DMARDs has the ocular side effects
A
HCQ - hydroxychloroquine
4
Q
Which Non-Biologic DMARDs has a loading dose
A
Leflunomide
5
Q
What are the Non-Biologic DMARDs
A
MTX
Leflunomide
Hydroxychloroquine
Sulfasalazine
6
Q
What are Lab values to look at for RA
A
- ESR
- CRP
- RF
- ACPA
- ANA
- Joint Aspiration
- Radiographic Changes
7
Q
What are the most common joints affected in RA
A
Hands, wrist, feet
not so much knee and hip
8
Q
what are some of the extra-articular manifestations
A
- Rheumatoid Nodules
- Vasculitis
- Pulmonary
- Ocular
- Cardiac
- Feltys
9
Q
Diagnostic Criteria for RA
A
- Joint involvement
- Serology
- Duration of Sx
- Acute Phase Reactants
10
Q
Diagnostic Criteria for RA: Duration of Sx - trait and points
A
- if < 6 wks - 0 pts
- if > 6 wks - 1 pt
11
Q
what are the acute phase reactants used for diagnosing RA
A
ESR and ERP
12
Q
what serology tests are used for diagnosing RA
A
RF and ACPA
13
Q
RA or OA? Occurs at any age
A
RA
14
Q
RA or OA? Occurs generally over age 40
A
OA
15
Q
RA or OA? Systemic Distribution
A
RA
16
Q
RA or OA? Localized to joint
A
OA
17
Q
RA or OA? Elevated ESR
A
RA
18
Q
RA or OA? Normal ESR
A
OA
19
Q
RA or OA? Inflammation present
A
RA
20
Q
RA or OA? Bilateral/Symmetric Joint involvement
A
RA
21
Q
RA or OA? asymmetric/unilateral joint involvement
A
OA
22
Q
RA or OA? Osteophyte present
A
OA
23
Q
RA or OA? Pannus present
A
RA
24
Q
RA or OA? RF present
A
RA
25
RA or OA? Subcutaneous nodules present
RA
26
RA or OA? has diffuse swelling
RA
27
RA or OA? has irregular/knobby swelling
OA
28
RA or OA? can have malaise, fever, fever
RA
29
RA or OA? has deep, aching pain
OA
30
Caution with what adjunct therapy for RA because of Sulfa allergy
CELEBREX - COx 2 inhibitor
31
for Treating RA: what agents are used for ADJUNCT THERAPY - aka dont use as monotherapy
NSAIDs/COX 2 inhibitor
| Corticosteroids
32
which non-biologic DMARD is it appropriate to add 1 mg/day of folic acid? and why add folic acid?
Methotrexate; used to decrease GI side effects
33
What are the classes of biologic response modifiers/DMARDs
- TNF neutralizers
- IL-1 receptor antagonists
- IL-6 receptor inhibitors
- Janus Kinase Inhibitors
34
Biologic DMARDs - TNF Neutralizers
| What are the black box warnings
- malignancies
- demyleinating disorders
- congestive heart failure
35
Do not use TNF neutralizers with ________ due to increased risk of infection
IL-1 receptor antagonist/Ankinra
36
Do not use TNF neutralizers with Ankinra due to____________
increased risk of infection
37
While using biologics - can you give live vaccine administration?
NO - can give live vaccines before the start of biologics to get that protection tho
38
What kind of test should be done before the start of a biologic
TB Test - because if latent it might get fired up/become active once biologics start
39
Enbrel generic = ?
Entanercept
40
Enbrel - what kind of biologic
TNF neutralizer
41
Enbrel and MTX "relationship"
Enbrel can be give with MTX or by itself
42
Remicade generic = ?
Infliximab
43
Remicade - what kind of biologic
TNF Neutralizer
44
Remicade and MTX "relationship"
Remicade HAS to be taken with MTX
45
which biologic DMARD has special dosing for CHF patients
Remicade
46
All TNF Neutralizer biologics do not need lab monitoring - True or false
false - Simponi does
47
Which biologics are the TNF Neutralizers
- Enbrel
- Remicade
- Humira
- Simponi
- Cimizia
48
Humira and methotrexate "relationship"
can be done alone or combination with MTX
49
Which TNF Neutralizer biologic needs lab monitoring
Simponi
50
Simponi and methotrexate "Relationship"
has to be used with combination MTX
51
Cimizia and methotrexate "relationship"
with or without a NON-BRM DMARD
52
"weird" dosing note about Cimizia
has OXO good grips aka makes it easier to use/better dexerity
53
Biologic is the IL-1 Receptor Antagonist
Anakinra (Kineret)
54
How often is Anakinra given?
DAILY
55
How often is MTX given?
WEEKLY
56
Biggest warning about Abatacept
DO NOT USE with TNF antagonist or IL-1 antagonist
57
which biologic is the IL-6 Receptor inhibitor
Tocilizumbab
58
which biologic has the lipid abnormalities as an adverse effect
Tocilizumab
59
Blackbox Warning for Tocilizumab
Serious infections - therefore do hella monitoring parameters
60
Tocilizumab is contraindicated in what patients
- liver toxicity
- thrombocytopenia
- neutropenia
61
which biologic is known as the "last resort"
Rituximab
62
why is Rituximab known as the "last resort" biologic
it has 3 black box warnings!!
63
What are the 3 black box warnings for Rituximab
- fatal infusion rxns
- tumor lysis syndrome
- mucocutaneous reactions
64
What other "weird" things do you have to look for in Rituximab
- bowel obstruction
| - Cardiac arrhytmia
65
what is the MOA for Tofacitinib
it inhibits janus kinase
66
how is Tofacitinib given?
by mouth!
67
Tofacitinib has what blackbox warnings
Risk of infection and Risk of malignancy
68
What special criteria has to be met before you can start Tofacitinib
Hemoglobin, ANC, and Lymphocyte have to be above certain levels
69
How does Menthol/Camphor/Oil of Wintergreen work
Topical counter irritant
70
MOA for Capsaicin Cream
Depletes substance P
71
Which topical agent has a gross garlic smell
Diclofenac Topical Solution
72
MOA for Glucosamine and Chondroitin:
stimulate proteoglycan synthesis from articular cartilage
73
ADEs from Glucosamine/Chondroitin:
Gas, bloating, cramping, nausea
74
what things should be monitored for an OA pt on NSAIDs
- BP
- Edema/Wt gain
- BUN/SCr
- Hgb/Hct
- signs of dehydration
75
Why do Hyaluronate Injections work/what is the MOA
temporarily increases viscosity of joint
76
What joints are most commonly affected in OA
Hips, Knee, DIP in hands
*DIP = distal interphalangeal joint
77
which topical option for OA - is for the KNEE ONLY
Diclofenace Topical Solution 1.5%
78
Duloxetine - should be avoided taken with what other med used for OA?
tramadol!
