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
2
Q
classification of chronic pain
A
- lasts >3 months
- non-purposeful pain
- difficult to quantify
- perception is variable
- malignant and nonmalignant processes
3
Q
3 types of pain
A
- somatic
- visceral
- neuropathic
4
Q
somatic pain
A
- musculoskeletal
- throbbing, constant, dull, localized
5
Q
visceral pain
A
- internal organs
- deep, dull, cramping, squeezing, poorly localized
6
Q
neuropathic pain
A
- nervous system
- burning, shooting, pins and needles
7
Q
abnormal signs of pain
A
- elevated BP
- tachycardia
- tachypnea (neonates)
- sweating
8
Q
mild pain values on the intensity scale
A
1-3
9
Q
moderate pain values on the intensity scale
A
4-6
10
Q
severe pain values on the intensity scale
A
7-10
11
Q
difference in dosing between acute and chronic
A
acute is standard and chronic is individually titrated
12
Q
signs and symptoms of RA
A
- morning stiffness
- warmth and swelling of joint
- symmetrical distribution
- fatigue
- joint deformity
13
Q
lab tests for RA
A
- ACPA
- Rheumatoid Factor
- Radiograph of affected joints
14
Q
contributing risk factors for RA
A
- Fx
- female gender
- smoking
15
Q
extra-articular involvement of RA
A
- rheumatoid nodules
- pleuropulmonary manifestations
- cardiac involvement
- secondary Sjorgren syndrome
- Felty syndrome
16
Q
3 tests for measuring RA disease activity
A
- disease activity score in 28 joints
- simplified disease activity index
- clinical disease activity
17
Q
non-pharm treatment for RA
A
- rest, but not too much
- occupational therapy
- physical therapy
- assisstive devices
- weight reduction
- surgical options
18
Q
DMARDs that can be monotherapy
A
MTX
SSZ
HCQ
LEF
19
Q
dual therapy DMARDs
A
MTX+SSZ
MTX+HCQ
SSZ+HCQ
20
Q
triple DMARD therapy
A
MTX+SSZ+HCQ
21
Q
treatment strategy for early RA
A
always prefer monotherapy DMARD over dual or triple therapy
22
Q
methotrexate onset of action
A
1-2 months
23
Q
methotrexate dosing
A
7.5-20 mg once weekly
NEVER dose daily
24
Q
methotrexate adverse reactions
A
- N/V/D
- increased LFTs
- hepatotoxicity
- acute renal failure
- rash
25
methotrexate contraindications
- pregnancy
- breastfeeding
- alcoholism
26
methotrexate monitoring
BASELINE: Hepatitis, TB
0-3 months test CBC and LFTs q2-4 weeks
3-6 months q8-12 weeks
27
methotrexate DDIs to avoid
- alcohol
- sulfonamides and tacrolimus
- cyclosporine
- levitiracetam
28
if disease activity remains after MTX in early RA what is the next step
- add another DMARD or TNFi
| - if symptoms still persist add glucocorticoid
29
leflunomide adverse effects
- increased LFTs
- N/D
- hepatotoxicity
- HTN
30
don't use leflunomide if
active liver disease
31
leflunomide contraindications
- pregnancy
- severe hepatic impairment
- on teriflunomide
32
leflunomide monitoring
month 0-6: LFTs and CBC
-BP
33
leflunomide and pregnancy
- MUST have negative pregnancy test before starting
- must be using 2 forms of birth control
- goes for males and females
34
hydroxychloroquine contraindications
retinopathy
35
hydroxychloroquine adverse reactions
- loss of visual acuity
- vision changes
- anemia
- leukopenia
- thrombocytopenia
36
hydroxychloroquine monitoring
baseline and every 3 months: eye exam, muscle strength
37
hydroxychloroquine in pregnancy
try to avoid but it can be used
38
how to take hydroxychloroquine
with food or milk
39
how to take sulfasalazine
with food and 8 oz of water
40
sulfasalazine contraindications
-patients with sulfa or salicylate allergy
41
sulfasalazine adverse reactions
- severe skin reaction
- anorexia
- dyspepsia
- N/V/D
- oligospermia
42
sulfasalazine in pregnancy
can be used, just need to take enough folate
43
sulfasalazine monitoring
CBC and LFTs
44
avoid use of tofacitinib with what
- strong 3A4 inducers
| - live vaccines
45
screen for what before using tofacitinib
active and latent TB
46
tofacitinib adverse reactions
- URI
- UTI
- GI perforation
47
treatment sequence of established RA
1. MTX
2. TNFi +/- MTX
3. non-TNFi biologic +/- MTX
4. another non-TNFi or tofacitinib +/- MTX
48
biologics use in RA
- do not use 2 at once
- add on therapies unless initial presentation is severe
- no live vaccines
- TB test prior to therapy
49
anti-TFA alpha biologics
etanercept
adalimumamb
infliximab
50
anti-TNF alpha biologics boxed warnings
- fatal infections
| - must screen for latent TB before starting
51
anti-TNF alpha biologics adverse reactions
- infections
- injection site rxn
- headache
- nausea
52
anti-TNF alpha biologics monitoring
- TB testing
| - hepatitis
53
non-TNF biologics
abatacept
| rituximab
54
rituximab use
must be used alone
55
rituximab boxed warnings
- must screen for hepatitis
- serious skin reactions
- Progressive multifocal leukoencephalopathy
56
rituximab adverse reactions
- HTN
| - angioedema
57
abatacept warnings
use with caution in COPD
58
abatacept adverse reactions
- injection site rxn
| - infections
59
abatacept monitoring
signs of infection
60
do not shake which biologic
abatacept
61
DMARD ok to use in lactation
hydroxychloroquine
62
when to screen for TB
before starting any biologic
63
live vaccine to avoid in biologics
herpes zoster
64
criteria for decreased disease activity/remission
- tender and swollen joint count <=1
- C-reactive protein <=1 mg/dL
- patient global assessment <=1
65
what to do if patients disease is in remission
do not discontinue all RA therapies
