PDA

Question 1

Methotrexate Brand name

Answer 1

Trexall

Question 2

MOA of methotrexate

Answer 2

folate antagonist
Inhibits DHFR, TYMS, AICART
Increase adenosine
Decrease purine and pyrimidine pools

Question 3

Methotrexate DDI

Answer 3

Glucocorticoid decreases effectiveness
NSAIDs, PPIs, hydroxychloroquine increases toxicity

Question 4

Contraindications Methotrexate

Answer 4

pregnancy, breastfeeding, hepatic toxicity and renal impairment

Question 5

Antidote for methotrexate

Answer 5

Leucororin - folate

Question 6

ADR for methotrexate

Answer 6

GI
Cytopenia
Pulmonary toxicity
Lymphomas
Increased liver enzymes

Question 7

Leflunomide brand name

Answer 7

Arava

Question 8

MOA of leflunomide

Answer 8

immunomodulator
Inhibits dihydrooradate dehydrogenase (DHODH) to inhibit pyrimidine synthesis
B and T cell inhibition

Question 9

Why does leflunomide last so long in the serum?

Answer 9

prodrug (isoxazole ring broken by CYPs in liver to teriflunomide) and enterohepatic recirculation

Question 10

ADR of leflunomide

Answer 10

SJS/TEN
Increased liver enzymes (do not start if ALT over 2 times normal limit)
HTN

Question 11

BBW for leflunomide

Answer 11

Embryo fetal toxicity (cholestyramine washout)
Hepatotoxicity ( discontinue if ALT over 3 times the upper limit of normal)

Question 12

Brand name of sulfasalazine

Answer 12

Azulfidine

Question 13

MOA of sulfazalazine

Answer 13

Prodrug that breaks down in the colon into 5ASA (NSAID) and sulfapyridine (abx)
Anti inflammatory actions

Question 14

Contraindications for sulfazalazine

Answer 14

crystalluria
hypersensitivity to sulfa and or aspirin

Question 15

Cautions for sulfazalazine

Answer 15

G6PD deficient patients are more likely to experience hemolytic anemia
SJS/TEN

Question 16

DDI of sulfazalazine

Answer 16

decreases the absorption of folate and digoxin

Question 17

ADR of sulfazalazine

Answer 17

GI
Oligospermia
Photosensitivity
Alopecia
Orange yellow discoloration of the urine and skin

Question 18

brand name of hydroxychloroquine

Answer 18

Plaquenil

Question 19

MOA of hydroxychloroquine

Answer 19

Anti malarial, anti inflammatory, and immunomodulatory effects
Blocks activation of antigen presenting cells by preventing acidification of lysosome

Question 20

DDI of hydroxychloroquine

Answer 20

digoxin and antacids

Question 21

ADR of hydroxychloroquine

Answer 21

ocular toxicity
cardiac effects
GI effects
Vertigo and tinnitus

Question 22

Indications of hydroxychloroquine

Answer 22

SLE
RA