PAIN-RA, PsA, BIOS

Question 1

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

Answer 1

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

Question 2

These IL inhibitors are indicated for PsA

Answer 2

Ixekizumab, Secukinumab, Ustekinumab
PleSA
See
Ure
Internist

Question 3

These IL inhibitors are indicated for RA

Answer 3

Anakinra, Sarilumab, Secukinumab, Tocilizumab
RaJ
Susi
Sec
Ana
Tonight

Question 4

This is the only IL inhibitors indicated for AS

Answer 4

Secukinumab

“Secluded AS”

Question 5

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

Answer 5

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

Question 6

This SE of Enanercept is MC?

Answer 6

URI, optic neuritis

“Eye..nose..running”

Question 7

What is the only IV TNF-a inhib?

Answer 7

Infliximab

“I..tuV. wyX”

Question 8

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

Answer 8

Golimumab- monitor BP and LFTs

“Go get BP check often”

Question 9

What stimulate immune response during inflammation? What neutralize them?

Answer 9

Interleukins. MONOCLONAL antibodies bind to them

Question 10

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

Answer 10

Anakinra

“ANA…Rides the Receptor”

Question 11

What is unique dosing about IL inhibitor Ustekinumab?

Answer 11

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

Question 12

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

Answer 12

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?

Question 13

What are MC class SE for IL inhibitors?

Answer 13

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

Question 14

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

Answer 14

Rituximab

“R u kidding NO TB”

Question 15

What TARGETED NON BIOLOGIC DMARD inhibits janus kinase?

Answer 15

Baricitnib, RA

Tofacitnib- RA, PsA

Question 16

Blocking JAK will ultimately do what?

Answer 16

block intracellular signaling that initiates cytokines

Question 17

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?

Answer 17

Tofacitnib- JAk inibit

Question 18

When should Tofacitnib be adjused?

Answer 18

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

Question 19

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

Answer 19

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

Question 20

What are side effect of Tofacitnib?

Answer 20

1. INfx dz
2. INC LDL
3. AVOID other bilogics

Question 21

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

Answer 21

Apremilast

Question 22

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

Answer 22

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

Question 23

What are BBW of apremilast?

Answer 23

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

Question 24

Is PPD req for apremilast?

Answer 24

NO TB PPD skin

Question 25

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

Answer 25

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

Question 26

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?

Answer 26

Fludrocortisone

Question 27

Overall how is RA TX?

Answer 27

1st- MTX DMARD

Question 28

What is preferred for 2nd line?

Answer 28

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

Question 29

What are Disadvantage of NSAIDS and COX-2?

Answer 29

Does not slow Dz progression.

Question 30

What are CONS of DMARDS(immune dec)?

Answer 30

Slow onset, side effects

Question 31

Which Drugs are ideal of PsA?

Answer 31

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

Question 32

What drugs should PsA switched if MTX+ fail?

Answer 32

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

Question 33

What drugs should be PsA biologics fail?

Answer 33

Switch to differ biologic +/- MTX

Question 34

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

Answer 34

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