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Pharm 2 > OA, RA > Flashcards

OA, RA Flashcards

1
Q

1st line for osteomyelitis empiric

A

Vanc + cefepime/ ceftriaxone

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2
Q

targets of RA treatment

A

Targets immune components involved: T lymphocytes, cytokines, B lymphocytes, kinases

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3
Q

do NSAIDs treat underlying dz?

A

no

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4
Q

MOA: Inhibits phospholipase A2. Inhibits cytokines and inflammatory mediators

A

“Prednisone
Methylprednisolone”

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5
Q

steroids for RA

A

“Prednisone
Methylprednisolone”

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6
Q

glucocorticoid interaction

A

NSAIDs (also thin stomach lining – use caution)

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7
Q

which class? Do not initiate during active infx. Consult rheumatology about holding during severe infx, surgery.

A

DMARDs

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8
Q

considerations before starting DMARDs

A

All patients must be screened for Hep B, Hep C AND latent TB before starting DMARDs. Give any needed live vaccines before initiating DMARDs

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9
Q

MTX dose frequency

A

1x/wk

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10
Q

MOA: Inhibitor of dihyrofolate reductase enzyme which is essential for DNA replication (making new cells quickly!)

A

MTX

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11
Q

non-bio DMARDs for RA

A

Methotrexate PO, SC, IM, dosed once weekly
Hydroxychloroquine (Plaquenil)
Sulfasalzine
Leflunomide (Arava®)”

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12
Q

1st line for RA

A

MTX

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13
Q

MTX contras

A

pregnancy (BBW), lactation, severe liver dz (BBW), use of Bactrim. Avoid in renal impairment, skin cancer

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14
Q

AEs: rash, liver/lung/bone marrow toxicity (BBW), folic acid deficiency, n/v/d, gastric ulcer, anorexia, pulm fibrosis, pneumonitis, anemia, leukopenia, thrombocytopenia, pancytopenia, opportunistic infx (BBW), alopecia.

A

MTX

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15
Q

MTX interactions

A

Bactrim, probenecid, NSAIDs (BBW)

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16
Q

pts must take what if on MTX

A

must take folate 1mg QD

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17
Q

AEs: Nausea, vomiting, diarrhea (less than MTX), QTc prolongation. Retinal damage and vision changes (due to highly protein binding of ocular tissue)

A

Hydroxychloroquine (Plaquenil)

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18
Q

monitoring for Hydroxychloroquine (Plaquenil)

A

MUST HAVE A BASELINE EYE EXAM AND THEN ANNUALLY ON THIS MEDICATION.

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19
Q

Sulfasalzine
contras

A

sulfa allergy, hepatic dysfunction

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20
Q

AEs: HA, n/v, dyspepsia, fever, rash, photosensitivity, oligospermia. Rare: leukopenia, aplastic/hemolytic anemia, agranulocytosis, pancreatitis, hepatitis

A

sulfasalazine

21
Q

pt counseling for sulfasalazine

A

men must stop 3 mo before trying to conceive

22
Q

monitoring for sulfasalazine

A

Monitor CBC and LFTs before starting therapy then routinely Q3 mo

23
Q

on the mitochondrial level – inhibits RNA and DNA synthesis. Decreases T and B cell proliferation

A

”

Leflunomide (Arava®)”

24
Q

”

Leflunomide (Arava®)”
contras

A

pregnancy, lactation

25
Q

AEs: Nausea, diarrhea, abdominal pain, HTN, HA. BBW: Hepatotoxicity. When combined with MTX, there is a dramatic rise in hepatotoxicity

A

”

Leflunomide (Arava®)”

26
Q

Leflunomide (Arava®)”
monitoring

A

LFTs

27
Q

main types of biologic DMARDs for RA

A

TNF-alpha inhibitors, IL-1 and IL-6 antagonists

28
Q

5 TNF-alpha inhibitors to treat RA

A

Etanercept (Enbrel®)
Infliximab (Remicade®) IV only
Adalimumab (Humira®)
Golimumab (Simponi®)
Certolizumab (Cimzia®)

29
Q

indications: maintaining remission in CD, UC, RA, psoriasis and psoriatic arthritis, hidradenitis suppuritiva, juvenile RA, ankylosing spondylitis

A

TNF-alpha inhibitors

30
Q

AEs: “HA, sinusitis, URI, injection site reaction.
BBW: Increases risk of serious infections (possibly fatal). Worse if also on MTX or steroids. risk for listeria, invasive fungal dz. BBW: lymphoma / skin cancer in kids”

A

TNF-alpha inhibitors

31
Q

pt counseling for TNF-alpha inhibitors

A

rotate injection sites, apply cold pack after administration and 1% hydrocortisone cream. Must get periodic skin exams

32
Q

Anakinra (Kineret®) class

A

Interleukin-1 Antagonist

33
Q

Interleukin-1 Antagonist indications

A

Adults who have failed non-biologic DMARDs. Systemic RA and continued disease activity after trial of NSAIDs and glucocorticoids. Not FDA-approved for JIA. alone or in combo w/ MTX

34
Q

AEs: Injection site reaction. Increased risk of infection (rare; URI). Neutropenia. Increased risk of malignancy

A

Interleukin-1 Antagonist: Anakinra (Kineret®)

35
Q

monitoring for Interleukin-1 Antagonist: Anakinra (Kineret®)

A

neutrophils

36
Q

AEs: Rash. BBW: Fatal infusion related reactions, Mucocutaneous reactions (SJS, TEN)

A

Rituximab (Rituxan®)

37
Q

class: Tocilizumab (Actemra®)
Sarilumab (Kevzara®)

A

IL-6 Antagonist:

38
Q

class: “only PO options
Tofacitinib (Xeljanz®)
Tofacitinib extended release (Xeljanz XR®)
Upadacitinib (Rinvoq®)”

A

Janus-Kinase Inhibitors

39
Q

contras: Janus-Kinase Inhibitors

A

Hx of VTE/DVT/PE

40
Q

AEs: GI perforation. Esophageal candidiasis. Risk of skin cancer and lymphomas. Altered lipid profile. increases risk of herpes zoster (so must get vax). BBW: serious infx (URI, UTI most common), malignancies, thrombosis

A

Janus-Kinase Inhibitors

41
Q

Janus-Kinase Inhibitors interactions

A

biologic DMARD (due to increased immunosuppression and risk of infection). CYP3A4

42
Q

Janus-Kinase Inhibitors monitoring

A

lipid profile

43
Q

1st line for mod-severe OA

A

NSAIDs

44
Q

MOA: induces release of substance P (primary chemomediator of pain impulses from peripheral sensory neurons to CNS)

A

“topical capsaicin OTC
apply 3-4x/d”

45
Q

AEs: “application site edema and pain
Decreased sensory function (patch)
PAIN if gets into eyes or genitals”

A

“topical capsaicin OTC
apply 3-4x/d”

46
Q

pt counseling for capsaicin

A

wash hands well after application or use gloves

47
Q

intra-articular Corticosteroids for OA

A

(methylprednisolone; triamcinolone)

48
Q

indications: 2nd line to PO and topical agents for pain. Does NOT reverse dz progression, only relieves symptoms

A

corticosteroid injections

Pharm 2 (29 decks)

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