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Therapeutics 1 Kappa Epsilon Version > OA and RA > Flashcards

OA and RA Flashcards

1
Q

Which Non-Biologic DMARDs are ProDrugs

A

Leflunomide, Sulfasalazine

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2
Q

Which Non-Biologic DMARDs are teratogenic

A

MTX, Leflunomide

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3
Q

Which Non-Biologic DMARDs has the ocular side effects

A

HCQ - hydroxychloroquine

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4
Q

Which Non-Biologic DMARDs has a loading dose

A

Leflunomide

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5
Q

What are the Non-Biologic DMARDs

A

MTX
Leflunomide
Hydroxychloroquine
Sulfasalazine

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6
Q

What are Lab values to look at for RA

A
  • ESR
  • CRP
  • RF
  • ACPA
  • ANA
  • Joint Aspiration
  • Radiographic Changes
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7
Q

What are the most common joints affected in RA

A

Hands, wrist, feet

not so much knee and hip

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8
Q

what are some of the extra-articular manifestations

A
  • Rheumatoid Nodules
  • Vasculitis
  • Pulmonary
  • Ocular
  • Cardiac
  • Feltys
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9
Q

Diagnostic Criteria for RA

A
  • Joint involvement
  • Serology
  • Duration of Sx
  • Acute Phase Reactants
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10
Q

Diagnostic Criteria for RA: Duration of Sx - trait and points

A
  • if < 6 wks - 0 pts

- if > 6 wks - 1 pt

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11
Q

what are the acute phase reactants used for diagnosing RA

A

ESR and ERP

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12
Q

what serology tests are used for diagnosing RA

A

RF and ACPA

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13
Q

RA or OA? Occurs at any age

A

RA

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14
Q

RA or OA? Occurs generally over age 40

A

OA

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15
Q

RA or OA? Systemic Distribution

A

RA

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16
Q

RA or OA? Localized to joint

A

OA

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17
Q

RA or OA? Elevated ESR

A

RA

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18
Q

RA or OA? Normal ESR

A

OA

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19
Q

RA or OA? Inflammation present

A

RA

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20
Q

RA or OA? Bilateral/Symmetric Joint involvement

A

RA

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21
Q

RA or OA? asymmetric/unilateral joint involvement

A

OA

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22
Q

RA or OA? Osteophyte present

A

OA

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23
Q

RA or OA? Pannus present

A

RA

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24
Q

RA or OA? RF present

A

RA

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25
Q

RA or OA? Subcutaneous nodules present

A

RA

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26
Q

RA or OA? has diffuse swelling

A

RA

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27
Q

RA or OA? has irregular/knobby swelling

A

OA

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28
Q

RA or OA? can have malaise, fever, fever

A

RA

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29
Q

RA or OA? has deep, aching pain

A

OA

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30
Q

Caution with what adjunct therapy for RA because of Sulfa allergy

A

CELEBREX - COx 2 inhibitor

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31
Q

for Treating RA: what agents are used for ADJUNCT THERAPY - aka dont use as monotherapy

A

NSAIDs/COX 2 inhibitor

Corticosteroids

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32
Q

which non-biologic DMARD is it appropriate to add 1 mg/day of folic acid? and why add folic acid?

A

Methotrexate; used to decrease GI side effects

33
Q

What are the classes of biologic response modifiers/DMARDs

A
  • TNF neutralizers
  • IL-1 receptor antagonists
  • IL-6 receptor inhibitors
  • Janus Kinase Inhibitors
34
Q

Biologic DMARDs - TNF Neutralizers

What are the black box warnings

A
  • malignancies
  • demyleinating disorders
  • congestive heart failure
35
Q

Do not use TNF neutralizers with ________ due to increased risk of infection

A

IL-1 receptor antagonist/Ankinra

36
Q

Do not use TNF neutralizers with Ankinra due to____________

A

increased risk of infection

37
Q

While using biologics - can you give live vaccine administration?

A

NO - can give live vaccines before the start of biologics to get that protection tho

38
Q

What kind of test should be done before the start of a biologic

A

TB Test - because if latent it might get fired up/become active once biologics start

39
Q

Enbrel generic = ?

A

Entanercept

40
Q

Enbrel - what kind of biologic

A

TNF neutralizer

41
Q

Enbrel and MTX “relationship”

A

Enbrel can be give with MTX or by itself

42
Q

Remicade generic = ?

A

Infliximab

43
Q

Remicade - what kind of biologic

A

TNF Neutralizer

44
Q

Remicade and MTX “relationship”

A

Remicade HAS to be taken with MTX

45
Q

which biologic DMARD has special dosing for CHF patients

A

Remicade

46
Q

All TNF Neutralizer biologics do not need lab monitoring - True or false

A

false - Simponi does

47
Q

Which biologics are the TNF Neutralizers

A
  • Enbrel
  • Remicade
  • Humira
  • Simponi
  • Cimizia
48
Q

Humira and methotrexate “relationship”

A

can be done alone or combination with MTX

49
Q

Which TNF Neutralizer biologic needs lab monitoring

A

Simponi

50
Q

Simponi and methotrexate “Relationship”

A

has to be used with combination MTX

51
Q

Cimizia and methotrexate “relationship”

A

with or without a NON-BRM DMARD

52
Q

“weird” dosing note about Cimizia

A

has OXO good grips aka makes it easier to use/better dexerity

53
Q

Biologic is the IL-1 Receptor Antagonist

A

Anakinra (Kineret)

54
Q

How often is Anakinra given?

A

DAILY

55
Q

How often is MTX given?

A

WEEKLY

56
Q

Biggest warning about Abatacept

A

DO NOT USE with TNF antagonist or IL-1 antagonist

57
Q

which biologic is the IL-6 Receptor inhibitor

A

Tocilizumbab

58
Q

which biologic has the lipid abnormalities as an adverse effect

A

Tocilizumab

59
Q

Blackbox Warning for Tocilizumab

A

Serious infections - therefore do hella monitoring parameters

60
Q

Tocilizumab is contraindicated in what patients

A
  • liver toxicity
  • thrombocytopenia
  • neutropenia
61
Q

which biologic is known as the “last resort”

A

Rituximab

62
Q

why is Rituximab known as the “last resort” biologic

A

it has 3 black box warnings!!

63
Q

What are the 3 black box warnings for Rituximab

A
  • fatal infusion rxns
  • tumor lysis syndrome
  • mucocutaneous reactions
64
Q

What other “weird” things do you have to look for in Rituximab

A
  • bowel obstruction

- Cardiac arrhytmia

65
Q

what is the MOA for Tofacitinib

A

it inhibits janus kinase

66
Q

how is Tofacitinib given?

A

by mouth!

67
Q

Tofacitinib has what blackbox warnings

A

Risk of infection and Risk of malignancy

68
Q

What special criteria has to be met before you can start Tofacitinib

A

Hemoglobin, ANC, and Lymphocyte have to be above certain levels

69
Q

How does Menthol/Camphor/Oil of Wintergreen work

A

Topical counter irritant

70
Q

MOA for Capsaicin Cream

A

Depletes substance P

71
Q

Which topical agent has a gross garlic smell

A

Diclofenac Topical Solution

72
Q

MOA for Glucosamine and Chondroitin:

A

stimulate proteoglycan synthesis from articular cartilage

73
Q

ADEs from Glucosamine/Chondroitin:

A

Gas, bloating, cramping, nausea

74
Q

what things should be monitored for an OA pt on NSAIDs

A
  • BP
  • Edema/Wt gain
  • BUN/SCr
  • Hgb/Hct
  • signs of dehydration
75
Q

Why do Hyaluronate Injections work/what is the MOA

A

temporarily increases viscosity of joint

76
Q

What joints are most commonly affected in OA

A

Hips, Knee, DIP in hands

*DIP = distal interphalangeal joint

77
Q

which topical option for OA - is for the KNEE ONLY

A

Diclofenace Topical Solution 1.5%

78
Q

Duloxetine - should be avoided taken with what other med used for OA?

A

tramadol!

Therapeutics 1 Kappa Epsilon Version (17 decks)

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