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Maddy - NMSP Exam III > Pharm - Disease-Modifying Anti-Rheumatic Drugs > Flashcards

Pharm - Disease-Modifying Anti-Rheumatic Drugs Flashcards

1
Q

what is the first drug of choice for RA pain relief

what can be added for additional relief

A

NSAIDs

acetominophen

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2
Q

MOA and effects glucocorticoids - prednisone

A

binds to glucocorticoid receptor which complexes with NF-kB and AP-1 transcription factors –> indirect mechanism for immunosuppression

reduces activity of immune system via suppression of IL-1,2,3,4,5,6,8 and IFN-y

suppresses neutrophil migration

decreases eosinophils in the blood and tissue

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3
Q

indications for glucocorticoids like prednisone

A

added to a regimen for RA for a short period to rapidly minimized disease activity while awaiting clinical response to a slower-acting disease-modifying anti-rheumatic drug (DMARD)

**effective for up to 6 months

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4
Q

adverse effects glucocorticoids

A
  • cushing’s
  • DM
  • fluid retention
  • menstrual irregularities

many side effects

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5
Q

how is “mild” RA classified

A

5 or less inflamed joints

normal to increased ESR and CRP

no extra-articular dz

no evidence of erosions or cartilage loss on plain radiographs

most pts lack RF or CCP antibodies

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6
Q

how is “moderate” RA classified

A

more than 5 inflamed joints

increased ESR and CRP

positive RF and/or CCP antibodies

evidence of inflammation on plain radiographs

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7
Q

MOA methotrexate

A

polyglutamation –> MTX-glu –> accumulates in cells over weeks –> blocks thymidylate synthase and 5-aminoimidazole-4-carboxamide ribodnucleotide (AICAR) transformylase –> accumulation of AICAR –> adenosine efflux –> binds to purinergic GPCRs –> ANTI-INFLAMMATORY EFFECTS

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8
Q

indications methotrexate

A

drug of first choice for RA

often used in combo w/ other traditional DMARD

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9
Q

administration of methotrexate

A

once per week either orally or injection

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10
Q

adverse effects methotrexate

A

bone marrow suppression

hepatic fibrosis

GI ulceration

pneumonitis

fetal death

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11
Q

MOA hydroxychloroquine

A

accumulates in lysosomes and then protonated –> increases pH of lysosome from 4 to 6 –> limits association of peptides with class II MHC –> slows dz progression

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12
Q

indications hydroxychloroquine

A

antimalarial

can be first choice for mild RA with lack of poor prognostic features

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13
Q

can hydroxychloroquine be used during pregnancy?

A

yep

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14
Q

half life of hydroxychloroquine

A

23 days so loading doses are needed to speed up onset

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15
Q

adverse effects hydroxychloroquine

A

retinal damage

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16
Q

MOA sulfasalazine

A

metabolized to sulfapyridine –> active moiety in RA patients

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17
Q

indications sulfasalazine

A

RA - used alone or in combo with hydroxychloroquine and/or methotrexate (triple therapy)

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18
Q

side effects sulfasalazine

A

GI side effects

sulfa drug reactions

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19
Q

MOA leflunomide

A

inhibition of mitochondrial enzyme dihydroorotate dehydrogenase to block the synthesis of the pyrmidine rUMP –> inhibits T cell proliferation

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20
Q

indications leflunomide

A

second choice drug for RA

21
Q

half life leflunomide

A

16.5 days, so loading doses are needed

22
Q

adverse effects leflunomide

A

diarrhea, respiratory infection, reversible alopecia, rash

stevens johnson syndrmoe

23
Q

should biologic DMARDs be combined?

A

NEVER

24
Q

what do these suffixes indicate:

  • cept
  • mab
  • ximab
  • zumab
  • umab
A
  • cept: fusion of receptor to Fc portion of human IgG1
  • mab: monoclonal antibody
  • ximab: chimeric monoclonal antibody
  • zumab: humanized monoclonal antibody
  • umab: human monoclonal antibody
25
Q

effects of TNF antagonists

A

reducing RA symptoms and dz progression

26
Q

indications for TNF antagonists

A

moderate to severe RA, generally after traditional DMARDs have been proven to be ineffective

often used in combo with methotrexate

27
Q

adverse effects TNF antagonists

A

developing serious infections including TB

28
Q

list the TNF antagonists

A

etanercept

infliximab

adalimumab (Humira)

29
Q

MOA, indications, and administration of etanercept

A

TNF antagonist

a number of forms of inflammatory arthritis including RA, psoriatic arthritis, ankylosing spondylitis

1 or 2 x weekly SC

30
Q

MOA, indications, and administration of infliximab

A

TNF antagonist

inflammatory arthritis, IBD

IV infusion every 6 weeks

31
Q

MOA, indications, and administration of adalimumab

A

TNF antagonist

RA, psoriatic arthritis, ankylosing spondylitis, crohn’s

IV infusion every 2 weeks

32
Q

MOA rituximab

A

antibody targeting CD20

33
Q

when taking rituximab, how do immunoglobulin levels stay in the normal range despite targeting CD20

A

plasma cells have a resistance to rituximab because they do not have CD20 on their surface

34
Q

indications rituximab

A

non-hodgkin’s lymphoma, chronic lymphocytic leukemia

RA pts who have not responded to TNF antagonists

positive testing for RF and CCP antibodies predict greater likelihood of responsiveness

35
Q

adverse effects rituximab

A

infusion related hypersensitivity rxns

stevens johnson syndrome

hep B reactivation

36
Q

MOA abatacept

A

compromises CTLA-4 and Fc portion of IgG1

prevents CD28 from binding to CD80/CD86

37
Q

indications abatacept

A

moderate to severe RA, generally not used until after failure of TNF antagonists

38
Q

adverse effects abatacept

A

headache, URI, serious infections

39
Q

MOA and effects of tocilizumab

A

humanized anti-human IL-6 receptor antibody

can’t activate JAK kinases and RAS mediated signaling

limits hepatic acute phase response and activation of T and B cells

40
Q

indications tocilizumab

A

moderate to severe RA if other DMARDs and TNF antagonists have been ineffective

41
Q

adverse effects tocilizumab

A

URIs

life threatening infections

42
Q

MOA tofacitinib

A

JAK3 antagonist

suppresses production of IL-17 and IFN-y and proliferation of CD4 T cells

43
Q

indications tofacitinib

A

moderately to severely active RA who had an inadequate response to methotrexate

44
Q

administration of tofacitinib

A

oral (unusual among the DMARDs) ***

45
Q

adverse effects tofacitinib

A

serious infections by opportunistic pathogens

increased malignancies

46
Q

MOA anakinra

A

IL-1 receptor antagonist

blocks pro-inflammatory activity of IL-1

47
Q

indications anakinra

A

moderate to severe RA that has not responded to DMARDs

48
Q

adverse effects anakinra

A

serious infections

hypersensitivity reactions

Maddy - NMSP Exam III (16 decks)

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