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