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PT2 Neuro 10-11 and Pain 1-4 > pain and RA therapeutics > Flashcards

pain and RA therapeutics Flashcards

1
Q

classification of acute pain

A
  • short term <=3 months
  • nociceptive
  • result of actual or pending tissue damage
  • resolves as healing progresses
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2
Q

classification of chronic pain

A
  • lasts >3 months
  • non-purposeful pain
  • difficult to quantify
  • perception is variable
  • malignant and nonmalignant processes
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3
Q

3 types of pain

A
  • somatic
  • visceral
  • neuropathic
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4
Q

somatic pain

A
  • musculoskeletal

- throbbing, constant, dull, localized

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5
Q

visceral pain

A
  • internal organs

- deep, dull, cramping, squeezing, poorly localized

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6
Q

neuropathic pain

A
  • nervous system

- burning, shooting, pins and needles

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7
Q

abnormal signs of pain

A
  • elevated BP
  • tachycardia
  • tachypnea (neonates)
  • sweating
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8
Q

mild pain values on the intensity scale

A

1-3

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9
Q

moderate pain values on the intensity scale

A

4-6

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10
Q

severe pain values on the intensity scale

A

7-10

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11
Q

difference in dosing between acute and chronic

A

acute is standard and chronic is individually titrated

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12
Q

signs and symptoms of RA

A
  • morning stiffness
  • warmth and swelling of joint
  • symmetrical distribution
  • fatigue
  • joint deformity
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13
Q

lab tests for RA

A
  • ACPA
  • Rheumatoid Factor
  • Radiograph of affected joints
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14
Q

contributing risk factors for RA

A
  • Fx
  • female gender
  • smoking
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15
Q

extra-articular involvement of RA

A
  • rheumatoid nodules
  • pleuropulmonary manifestations
  • cardiac involvement
  • secondary Sjorgren syndrome
  • Felty syndrome
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16
Q

3 tests for measuring RA disease activity

A
  • disease activity score in 28 joints
  • simplified disease activity index
  • clinical disease activity
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17
Q

non-pharm treatment for RA

A
  • rest, but not too much
  • occupational therapy
  • physical therapy
  • assisstive devices
  • weight reduction
  • surgical options
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18
Q

DMARDs that can be monotherapy

A

MTX
SSZ
HCQ
LEF

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19
Q

dual therapy DMARDs

A

MTX+SSZ
MTX+HCQ
SSZ+HCQ

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20
Q

triple DMARD therapy

A

MTX+SSZ+HCQ

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21
Q

treatment strategy for early RA

A

always prefer monotherapy DMARD over dual or triple therapy

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22
Q

methotrexate onset of action

A

1-2 months

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23
Q

methotrexate dosing

A

7.5-20 mg once weekly

NEVER dose daily

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24
Q

methotrexate adverse reactions

A
  • N/V/D
  • increased LFTs
  • hepatotoxicity
  • acute renal failure
  • rash
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25
Q

methotrexate contraindications

A
  • pregnancy
  • breastfeeding
  • alcoholism
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26
Q

methotrexate monitoring

A

BASELINE: Hepatitis, TB

0-3 months test CBC and LFTs q2-4 weeks

3-6 months q8-12 weeks

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27
Q

methotrexate DDIs to avoid

A
  • alcohol
  • sulfonamides and tacrolimus
  • cyclosporine
  • levitiracetam
28
Q

if disease activity remains after MTX in early RA what is the next step

A
  • add another DMARD or TNFi

- if symptoms still persist add glucocorticoid

29
Q

leflunomide adverse effects

A
  • increased LFTs
  • N/D
  • hepatotoxicity
  • HTN
30
Q

don’t use leflunomide if

A

active liver disease

31
Q

leflunomide contraindications

A
  • pregnancy
  • severe hepatic impairment
  • on teriflunomide
32
Q

leflunomide monitoring

A

month 0-6: LFTs and CBC

-BP

33
Q

leflunomide and pregnancy

A
  • MUST have negative pregnancy test before starting
  • must be using 2 forms of birth control
  • goes for males and females
34
Q

hydroxychloroquine contraindications

A

retinopathy

35
Q

hydroxychloroquine adverse reactions

A
  • loss of visual acuity
  • vision changes
  • anemia
  • leukopenia
  • thrombocytopenia
36
Q

hydroxychloroquine monitoring

A

baseline and every 3 months: eye exam, muscle strength

37
Q

hydroxychloroquine in pregnancy

A

try to avoid but it can be used

38
Q

how to take hydroxychloroquine

A

with food or milk

39
Q

how to take sulfasalazine

A

with food and 8 oz of water

40
Q

sulfasalazine contraindications

A

-patients with sulfa or salicylate allergy

41
Q

sulfasalazine adverse reactions

A
  • severe skin reaction
  • anorexia
  • dyspepsia
  • N/V/D
  • oligospermia
42
Q

sulfasalazine in pregnancy

A

can be used, just need to take enough folate

43
Q

sulfasalazine monitoring

A

CBC and LFTs

44
Q

avoid use of tofacitinib with what

A
  • strong 3A4 inducers

- live vaccines

45
Q

screen for what before using tofacitinib

A

active and latent TB

46
Q

tofacitinib adverse reactions

A
  • URI
  • UTI
  • GI perforation
47
Q

treatment sequence of established RA

A
  1. MTX
  2. TNFi +/- MTX
  3. non-TNFi biologic +/- MTX
  4. another non-TNFi or tofacitinib +/- MTX
48
Q

biologics use in RA

A
  • do not use 2 at once
  • add on therapies unless initial presentation is severe
  • no live vaccines
  • TB test prior to therapy
49
Q

anti-TFA alpha biologics

A

etanercept
adalimumamb
infliximab

50
Q

anti-TNF alpha biologics boxed warnings

A
  • fatal infections

- must screen for latent TB before starting

51
Q

anti-TNF alpha biologics adverse reactions

A
  • infections
  • injection site rxn
  • headache
  • nausea
52
Q

anti-TNF alpha biologics monitoring

A
  • TB testing

- hepatitis

53
Q

non-TNF biologics

A

abatacept

rituximab

54
Q

rituximab use

A

must be used alone

55
Q

rituximab boxed warnings

A
  • must screen for hepatitis
  • serious skin reactions
  • Progressive multifocal leukoencephalopathy
56
Q

rituximab adverse reactions

A
  • HTN

- angioedema

57
Q

abatacept warnings

A

use with caution in COPD

58
Q

abatacept adverse reactions

A
  • injection site rxn

- infections

59
Q

abatacept monitoring

A

signs of infection

60
Q

do not shake which biologic

A

abatacept

61
Q

DMARD ok to use in lactation

A

hydroxychloroquine

62
Q

when to screen for TB

A

before starting any biologic

63
Q

live vaccine to avoid in biologics

A

herpes zoster

64
Q

criteria for decreased disease activity/remission

A
  • tender and swollen joint count <=1
  • C-reactive protein <=1 mg/dL
  • patient global assessment <=1
65
Q

what to do if patients disease is in remission

A

do not discontinue all RA therapies

PT2 Neuro 10-11 and Pain 1-4 (5 decks)

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