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SUMPHARM > PAIN-RA, PsA, BIOS > Flashcards

PAIN-RA, PsA, BIOS Flashcards

1
Q

These BIOLOGIC DMARDs are for all PsA, RA, AS?NOT OA

A

TNF Alpha-inhib- Class SE- Infx HEP B, TB. CHF, Malignancy, Demyelinating. INJ $$$
Alpha inhb-ALL

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2
Q

These IL inhibitors are indicated for PsA

A 
Ixekizumab, Secukinumab, Ustekinumab
PleSA
See
Ure
Internist
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3
Q

These IL inhibitors are indicated for RA

A 
Anakinra, Sarilumab, Secukinumab, Tocilizumab
RaJ
Susi
Sec
Ana
Tonight
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4
Q

This is the only IL inhibitors indicated for AS

A

Secukinumab

“Secluded AS”

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5
Q

What is dosing of this TNF-a inhibitor for all arthritis except OA dosing?

A

**Adalimumab (Humira) 40mg SubQ QOW
SE- MC HA, Rash
“Aaa mmmy HEAD”

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6
Q

This SE of Enanercept is MC?

A

URI, optic neuritis

“Eye..nose..running”

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7
Q

What is the only IV TNF-a inhib?

A

Infliximab

“I..tuV. wyX”

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8
Q

Which TNF-a inhibitor has the only MC SE of HTN and ALT/AST elevation?

A

Golimumab- monitor BP and LFTs

“Go get BP check often”

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9
Q

What stimulate immune response during inflammation? What neutralize them?

A

Interleukins. MONOCLONAL antibodies bind to them

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10
Q

Which IL inhibitor binds to the receptor instead of the IL itself?

A

Anakinra

“ANA…Rides the Receptor”

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11
Q

What is unique dosing about IL inhibitor Ustekinumab?

A

<100KG (220) 45mg SQ at 0 and 4w,
then QO12wk. >100kg 90mb SQ
“U better check your wt”

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12
Q

Which IL inhibitor is not allowed to be started d/t abnormal count in this CBC finding?

A

Tocilizumab

  1. neutrophil count (ANC) below 2000 cells/mm(3),
  2. platelet count below 100,000 cells/mm(3),
  3. ALT or AST above 1.5 times

“Too cil neutrophils?

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13
Q

What are MC class SE for IL inhibitors?

A
  1. TB risk-TB screen reQ,
    2 INj site rxn
  2. Neutropenia
  3. Rare- malignancy
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14
Q

Which Biologic DMARD is IV Fusion, and needs premedication, BUT NO TB screen, BUT does require HEP PT like other biologics?

A

Rituximab

“R u kidding NO TB”

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15
Q

What TARGETED NON BIOLOGIC DMARD inhibits janus kinase?

A

Baricitnib, RA

Tofacitnib- RA, PsA

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16
Q

Blocking JAK will ultimately do what?

A

block intracellular signaling that initiates cytokines

17
Q

Which PO targeted DMARD can be combined with other non biologic DMARD, such as pt who FAIL w/ MTX, and combined with CYP inhibitor -azoles?

A

Tofacitnib- JAk inibit

18
Q

When should Tofacitnib be adjused?

A

IF neutrophils ANC persist btwn 500-1000. D/x and resume when returns >1000.
D/C if ANC <500

19
Q

When using Tofacitnib and Barcitinib this type of vaccine can inc infx/dec vaccine efficacy?

A

LIVE vaccine-neutrophils and dec immune responses via JAK inhib
Regular PPD TB test**

20
Q

What are side effect of Tofacitnib?

A
  1. INfx dz
  2. INC LDL
  3. AVOID other bilogics
21
Q

What TARGETED NON BIOLOGIC DMARD inhibits PDE4, primarily for plaque psoriasis and PsA?

A

Apremilast

22
Q

Apremilast works by blocking cAMP conversion to AMP, which facilitates what?

A

PKA to NF and CREB= DEC cytokines causing inflammation, and INC cytokines working against inflammation

23
Q

What are BBW of apremilast?

A

Suicidal ideation Depression
Anxiety, akathisia, irritability, panic attacks or
mood changes

24
Q

Is PPD req for apremilast?

A

NO TB PPD skin

25
Q

What can be used as an add on or until DMARD takes effect, BUT max is 10mg QD, USE LOW dose, short duration?

A

Prednisone- ADE- hypothalamic pituitary adrenal axis suppression, osteoporosis, DM, Cataracts, Wt gain, HTN, infx

26
Q

Which corticosteroid the produce inc in cortisol to dec immune response. (Cortisol is a stress hormone, SNS, INC Stretch mark, thins skin, INC HTN, DM-more sugar to release fo hyperactiviy, thus less able to fight infx) has Salt retaining 250mg, thus H2O retain, BUT NOT used for anti-inflammatory effect?

A

Fludrocortisone

27
Q

Overall how is RA TX?

A

1st- MTX DMARD

28
Q

What is preferred for 2nd line?

A
  1. Double DMARD
  2. Triple DMARD (MTX+ ADD ons
  3. Biologic TNF or IL +/- MTX 4. Tofactinib w/ MTX
29
Q

What are Disadvantage of NSAIDS and COX-2?

A

Does not slow Dz progression.

30
Q

What are CONS of DMARDS(immune dec)?

A

Slow onset, side effects

31
Q

Which Drugs are ideal of PsA?

A 
methotrexate (MTX), 
sulfasalazine (SSZ),
leflunomide (LEF), 
cyclosporine (CSA), 
Apremilast
(APR)
32
Q

What drugs should PsA switched if MTX+ fail?

A

Biologic such as TNF and IL- equivalent. Consider pt preference and conditions

33
Q

What drugs should be PsA biologics fail?

A

Switch to differ biologic +/- MTX

34
Q

When treated AS which drug is consider 1st-3rd?

A

1st- NSAID and PT or/and 2nd TNF inhib 3. Local parenteral corticosteroid if localized area

SUMPHARM (26 decks)

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