RA

Question 1

NSAIDs

Answer 1

• indomethacin, naproxen, COX2 inhibitors
• eliminate pain and some inflammation but they don’t slow disease progression

Question 2

Glucocorticoids

Answer 2

• DMARD
• inhibit PLA2 –> inhibits release of AA and formation of PGs
• inhibit production of cytokines –> prevents induction of COX2
• long-term use= hyperglycemia, osteoporosis, poor wound healing

Question 3

Gold Salts

Answer 3

• DMARD
• repress immune responsiveness by inhibiting macrophages
• rarely used today

Question 4

antimalarials (chloroquine)

Answer 4

• DMARD
• less efficacious than other DMARDs
• can cause irreversible retinal damage

Question 5

Sulfasalazine

Answer 5

• DMARD
• inhibits IL-1 and TNF-alpha
• acts quicker than other drugs
• adverse side effects: N and V, headaches, skin rashes, neutropenia (30% of PTS discontinue)

Question 6

Methotrexate

Answer 6

• DMARD (immunosuppressive)
• “gold standard” for DMARD tx
• 1. Inhibition of aminoimidazolecarboxamide(AICAR) transformylase and thymidylate synthetase, with secondary effects on PMN chemotaxis
• 2. Causes adenosine accumulation, which inhibits inflammation

Question 7

Leflunomide

Answer 7

• DMARD (immunosuppressive)
• inhibits DHODH (rate-limiting enzyme requred for de novo synthesis of pyrimidine (UMP) –> inhibition of T cell response
• oral prodrug

Question 8

Etanercept

Answer 8

• Biological response modifier
• TNF-alpha antagonist
• twice weekly subcutaneous injections

Question 9

Infliximab

Answer 9

• biological response modifier
• TNF alpha antagonist
• chimeric –> production of antimouse Abs!

**think infliximab inflicts the most pain (bc of antimouse Abs)

Question 10

Adalimumab

Answer 10

• biological response modifier
• TNF-alpha antagonist
• fully human Ab–> not antigenic
• as efficacious as etanercept but more convenient dosing (twice-monthly SQ injections)

**think aladin- magical

Question 11

Golimumab

Answer 11

• biological response modifier
• TNF-alpha antagonist
• human MAb that binds membrane-bound and soluble TNFalpha
• once monthly dosing but side effects (increased risk of infections like TB, fungal and opportunistic pathogens)

Question 12

Certolizumab

Answer 12

• bioglical response modifier
• TNF alpha antagonist
• humanized MAb conjugated to polyethylene glycol to delay metabolism

Question 13

Anakinra

Answer 13

• biological response modifier
• IL-1 receptor antagonist
• ** think Anak1nra
• short t1/2 –> frequent daily dosing

Question 14

Tocilizumab (Actemra)

Answer 14

• biological response modifier
• IL6 receptor antagonist
• **think Tocilizuma6
• risk for serious infections

Question 15

Abatacept (Orencia)

Answer 15

• biological response modifier
• co-stimulation modulator
• inhibits T cell activation and induces T cell apoptosis

Think A and T –> AbaTacepT= T-cell Activation, Apoptosis

Question 16

Rituximab

Answer 16

• biological response modifier
• co-stimulator modulator
• anti-CD20 mAb that reduces circulating B cells
• approved for RA refractory to TNF-alpha inhibitors