Osteoarthritis and Rheumatoid Arthritis Flashcards
Difference between Bouchards and Herberdens Nodes
Bouchards - PIP joints
Herberdens- DIP joints
What are typical first line options for pain due Osteoarthritis?
What is this medication fails?
Acetaminophen
Topical or oral NSAIDS
What is the primary goal when treating Osteoarthritis?
Pain relief
What are contraindications of NSAIDS
Liver failure
Renal failure
What are some monitoring parameters of NSAIDS?
complete blood count
serum creatinine
hepatic transaminase levels
What are toxicities associated with NSAIDS
GI toxicity
Cardiovascular risk
When is topical NSAIDS recommended vs oral?
What topical is preferred
Recommended for patients older than 75 years to decrease the risks of systemic toxicity
Ketoprofen most common
How is Rheumatoid Arthritis defined?
Most common systemic inflammatory disease characterized by symmetrical joint involvement
What is the Goal of treatment for RA
Achieve remission or low disease activity referred to as “Treat to Target”
What are complications that can occur with Rheumatoid arthritis?
Marked ulnar deviation,
swan-neck deformity,
active synovitis,
nodules.
What are first line treatment options for RA?
Disease-modifying antirheumatic drugs (DMARDs) or biologic agents within the first 3 months diagnosis
What are first line treatment options for RA?
Which drug is most preferred?
Disease-modifying antirheumatic drugs (DMARDs)
Methotrexate
What treatment options can you use if one DMARDS doesn’t work?
Combo therapy with 2 DMARDS OR
DMARD plus biologic agent
What are the non-biological DMARD?
Methotrexate Leflunomide Hydroxychloroquine Sulfasalazine Minocycline Tofacitinib
MOA of Methotrexate
Inhibits cytokine production,
inhibits purine biosynthesis,
and may stimulate release of adenosine–leads to its antiinflammatory properties
Which nutrient does Methotrexate block the production of?
Folic acid antagonist—leading to deficiency
Contraindications for Methotrexate?
Pregnancy-teratogenic and nursing women Chronic liver disease Immunodeficiency Pleural or peritoneal effusions Leukopenia, thrombocytopenia, CrCl <40ml/min
What are toxicities of Methotrexate
Stomatitis—may see first (sores in the mouth)
hematologic-thrombocytopenia
pulmonary fibrosis and pneumonitis
hepatic-elevated liver enzymes
What should be monitored when taking Methotrexate
CBC
LFT
CXR
What is the MOA of non-biological Leflunomide?
inhibits pyrimidine synthesis–> decrease in lymphocyte proliferation and modulation of inflammation
Toxicities of Leflunomide?
GI, hair loss, liver, bone marrow toxicity
Contraindications fo Leflunomide?
liver disease
teratogenic
What is the MOA of Hydroxychloroquine
dampen antigen–antibody reactions at sites of inflammation
Toxicities of Hydroxychloroquine?
Lacks myelosuppressive -
Hepatic and renal toxicities
GI-N/V/D—take with food
Ocular-Visual changes including a decrease in night or peripheral vision
What is the MOA of non-biologic Sulfasalazine
slide 45
What are ADE of Sulfasalazine that may want you to decease the drug dose
Elevated hepatic enzymes
May turn skin to a yellow-orange color—no clinical consequence
Absorption can be decreased when antibiotics destroy colonic bacteria
Binds iron supplements—decrease sulfazalazine absorption
Can potentiate warfarin’s effects-displace from protein binding
What is Minocycline a derivative of?
What is it’s MOA?
Tetracylcine
inhibit metalloproteinases active in damaging articular cartilage
What is the MOA of Tofacitinib
inhibition of JAK- a tyrosine kinase–modulation and suppression of the immune system through cytokine signal reduction
When is Tofacitinib used?
moderate to severe RA who have failed or intolerance to methotrexate
What are ADE of Tofacitinib?
serious infections
lymphomas, and other malignancies
tested and treated for latent tuberculosis
elevated plasma liver enzymes and lipids
live vaccinations should not be given during treatment
Definition of Biologic agents that treat RA?
Genetically engineered protein molecules block the pro-inflammatory cytokines
What are the TNF-alpha drugs?
Infliximab, entanercept, adalimumab, golimumab, certolizumab
IL-1 drug?
IL-6 drug?
IL-1: anakinra
IL-6: tocilizumab
MOA of TNF-alpha drugs?
Contraindications?
ADE?
Block the proinflammatory cytokins TNF-α
Contraindications
CHF
ADEs
MS-like illness or exacerbate MS
Increased risk of lymphoproliferative cancer
MOA of IL-1 Anakinra?
binds to CD80/CD86 receptors on antigen-presenting cells
inhibits interactions between the antigen-presenting cells and T cells
prevents T-cell activation to promote the inflammatory process
What should not be given when taking Anakinra?
Live vaccines should not be given to patients during treatment with Anakinra therapy
MOA of IL-6 Tocilizumab?
Attaches to IL-6 receptors preventing the cytokine from interacting with the IL-6 receptors
ADE of Tocilizumab?
Increased infection risk Elevated plasma lipids Elevated liver enzymes Risk of Gastrointestinal perforation Inducer of CYP450 3A4 (warfarin)
What should be avoided when taking Tocilizumab?
Tested and treated for latent tuberculosis
Live vaccinations should not be given during treatment
What should be avoided when taking Tocilizumab?
Tested and treated for latent tuberculosis
Live vaccinations should not be given during treatment
What is the MOA of biologic DMARD Riuximab?
What should be avoided when taking this?
Binds to B cells
nearly complete depletion of peripheral B cells
No live vaccines while in treatment
What is the MOA of biologic DMARD Abatacept?
Binds to CD80/86 on T cells to prevent the costimulation needed to fully activate T cells
What are ADE of Abatacept?
HA, nasopharyngitis, dizziness, cough, back pain, HTN, dyspepsia, UTI, rash, extremity pain
What should be avoided with Abatacept?
No live vaccines during treatment or for 3 months after completion of therapy
