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Pharm Spring 2023 > RA > Flashcards

RA Flashcards

1
Q

what are the 2 types of pharmacologic therapy?

A

symptomatic treatment and chronic disease management

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2
Q

what drugs are included in symptomatic treatment for RA?

A
  • NSAIDs
  • steroids (oral and intra-articular) –> lowest effective dose
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3
Q

do NSAIDs slow RA disease progression?

A

No
*just help with pain

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4
Q

what are chronic treatment options for RA?

A
  • non-biologic DMARDs
  • anti-TNF (biologic) DMARDs
  • non-TNF (biologic) DMARDs
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5
Q

what are the conventional non-biologic DMARDs?

A
  1. methotrexate
  2. hydroxychloroquine
  3. leflunomide
  4. sulfasalazine
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6
Q

what are the target-specific non-biologic DMARDs?

A
  1. tofacitinib
  2. upadacitinib
  3. baricitinib
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7
Q

what is the MOA & dose of methotrexate?

A

MOA: folate antimetabolite
Dose: 7.5mg - 25mg PO,IM SQ

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8
Q

what are the ADRs of methotrexate?

A

Thrombocytopenia, leukopenia
GI: nausea, vomiting, diarrhea,
liver damage, stomatitis, alopecia, renal damage, folic acid deficiency

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9
Q

what is the onset of methotrexate?

A

3-6 weeks
- steroids might be used as a bridge

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10
Q

what are CI of methotrexate?

A
  1. Pregnancy (including male patients)
  2. alcoholism
  3. liver disease
  4. preexisting blood dyscrasias
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11
Q

what labs to get to monitor methotrexate?

A

CBC with diff, LFTs, sCr, Hep B & C, TB serology
Labs baseline, 2-4 wks for 3 mo, and continue to increase interval

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12
Q

what supplement do patients on methotrexate need?

A

folic acid
- 1 mg daily
- also folic acid 5 mg Q week

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13
Q

what are the ADRs of Leflunomide?

A
  1. Headache
  2. alopecia
  3. rash
  4. diarrhea
  5. nausea
  6. increased LFTs
  7. URTI
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14
Q

what are CIs of leflunomide?

A

pregnancy
- contraceptives for both males and females

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15
Q

if females become pregnant, what can be used to pull leflunomide out of the body?

A

cholestyramine

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16
Q

what are the labs for monitoring for leflunomide?

A
  1. pregnancy tests prior to initiation
  2. CBC
  3. LFTs
  4. hepatitis
  5. TB
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17
Q

what are the ADRs of sulfasalazine?

A
  1. GI side effects
  2. Headache
  3. rash
  4. nausea
  5. dyspepsia
  6. anorexia
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18
Q

what are CI are sulfasalazine?

A
  1. Hypersensitivity to sulfa or salicylate preparations, GI or GU obstruction
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19
Q

what are monitoring for sulfasalazine?

A
  1. CBC
  2. LFTs
  3. renal function
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20
Q

what is the onset of sulfasalazine?

A

more than 1 month

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21
Q

what is the onset of Hydroxychloroquine?

A

3-4 weeks

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22
Q

what are the ADRs of Hydroxychloroquine?

A
  1. retinopathy
  2. nausea
  3. vomiting
  4. diarrhea
  5. rash
  6. pigmentation changes
  7. increased LFTs
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23
Q

what are the warnings of Hydroxychloroquine?

A

1.cardiomyopathy
2. bone marrow suppression

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24
Q

what to monitor when taking Hydroxychloroquine?

A
  1. CBC
  2. LFTs
  3. sCr
  4. eye exams
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25
Q

Can a patient be on more than one csDMARD?

A

yes, could be on all 4

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26
Q

what is the onset of Tofacitinib? (Target specific non-biologic DMARDs)

A

2 weeks

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27
Q

what are the ADRs of Tofacitinib?

A
  1. infection
  2. diarrhea
  3. nausea
  4. headache
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28
Q

what are the warnings of Tofacitinib?

A
  1. bone marrow suppression
  2. decreased HR
  3. GI perforation
  4. hepatotoxic
29
Q

what to monitor when taking Tofacitinib?

A
  1. CBC
  2. LFTs
  3. sCr
  4. lipids
  5. hepatitis
  6. TB
30
Q

what is the BBW of Tofacitinib? (Oral drug)

A
  1. serious infection
  2. lymphoma and other malignancies
  3. thrombosis
  4. increased all cause mortality
  5. TB
31
Q

what are the ADRs of Upadacitinib?

A
  1. URTI
  2. neutropenia
  3. nausea
  4. thrombosis
  5. increased lipids
32
Q

what is the dose of Upadacitinib?

A

Daily

33
Q

What to monitor for Upadacitinib?

A
  1. CBC
  2. LFT
  3. Lipids
34
Q

What are the BBW of Upadacitinib?

A
  1. Serious infection
  2. Malignancies
  3. Thrombosis
35
Q

What are the ADRS of Baricitinib

A
  1. URTI
  2. Nausea
  3. Thrombosis
  4. Increased LFTs
  5. Lipids
36
Q

What to monitor for Baricitinib

A
  1. CBC
  2. LFTs
  3. Lipids
37
Q

What are the BBW of Baricitinib

A
  1. Serious infections
  2. Malignancies
  3. Thrombosis
38
Q

can a patient take both Methotrexate and tofacitinib?

A

Yes

39
Q

can a patient take both Tofacitinib and baracitinib?

A

No

40
Q

can a patient take Methotrexate, leflunomide, sulfasalazine, hydroxychloroquine and tofacitinib?

A

Yes

41
Q

what is the MOA of anti-TNF DMARDs?

A

monoclonal antibody that binds and inhibits tumor necrosis factor alpha (TNFα)

42
Q

what is the dose of Infliximab
(Remicade)?

A

3mg/IV

43
Q

what are the ADRs of Infliximab (Remicade)?

A
  1. Headache
  2. abdominal pain
  3. anemia
  4. increased LFTs
  5. flushing skin rash
  6. infection
44
Q

what is the dose of Adalimumab (Humira)?

A

40mg sub q

45
Q

what are the ADRs of Adalimumab (Humira)?

A
  1. Headache
  2. rash
  3. infection
  4. abdominal pain
  5. nausea vomiting
  6. increased CPK
46
Q

what are the CI/warnings of Inflixima (Remicade)?

A

less than 5 mg/kg in heart failure

47
Q

what labs to monitor for Infliximab (Remicade)?

A
  1. vitals every 2-10 minutes during infusion
  2. TB and HBV
  3. CBC
  4. LFT
48
Q

What is the place in therapy for Infliximab (Remicade) (indication)?

A

combination with methotrexate

49
Q

what is the CI/warnings of Adalimumab (Humira)?

A

Precaution in HF patients

50
Q

what labs to monitor for Adalimumab (Humira)?

A

1, CBC
2. TB
3. HBV

51
Q

when is Adalimumab (Humira) indicated?

A

Combination with monotherapy

52
Q

what are common warnings of anti-TNF DMARDs?

A
  • Don’t use with HF
  • Cardiovascular/cerebrovascular reactions
  • Hematologic disorders
  • Hepatic reactions
  • Hepatitis B reactivation
53
Q

all anti-TNF DMARDs BBW is?

A
  • *Severe infections
  • Lymphomas or other malignancies*
  • Tuberculosis
54
Q

what are the other TNF DMARDs?

A
  • Etanercept (Enbrel)
  • Golimumab (Simponi)
  • Certolizumab Pegol (Cimzia)
  • all subQ, have same side effects
55
Q

what are the non-TNF DMARDs?

A
  • Rituximab (Rituxan)
  • Tocilizumab (Acetemra)
  • Abatecept (Orencia)
  • Anakinra (Kineret)
  • Sarilumab (Kevzara)
56
Q

when are non-TNF DMARDs used?

A

when there are other CIs

57
Q

What are the ADRS for Rituximab (Rituxan), Tocilizumab (Acetemra), Abatecept (Orencia)

A

R: increased LFT
T: Increased cholesterol and LFT
A: headache, nausea, infections, URTI

58
Q

What are the ADRS for Anakinra (Kineret), Sarilumab (Kevzara)

A

A: headache, vomiting, infection, arthralgia, nausea
S: increased LFTs

59
Q

what are the csDMARDs? (Non-biologic DMARD)

A
  1. Methotrexate
  2. sulfasalazine
  3. hydroxychloroquine
  4. leflunomide
60
Q

What are the tsDMARD (non biologic DMARD)

A
  1. Tofacitinib
  2. Upadacitinib
  3. Baricitinib
    *All JAK inhibitors
61
Q

What are the BDMARDS? (Anti-TNF)

A
  1. Infliximab (remicade )
  2. Adalimumab (Humira)
    *etanercept (enbrel)
    *Golimumab
    *certolizumab
62
Q

What are the bDMARDS (non TNF)

A
  1. Rituximab
  2. Tocilizimab
  3. Abatecept
  4. Anakinra
  5. Sarilumab
63
Q

what are the treatment guidelines for RA?

A
  1. methotrexate
  2. combo of synthetic DMARDs or add biologic
  3. change to alternative bDMARD or tsDMARD
64
Q

if there is a CI to methotrexate, what to use?

A

another csDMARD - sulfasalazine, hydroxychloroquine, leflunomide

65
Q

all patients with RA (low and high-disease activity) should be started on?

A

methotrexate (unless CI)

66
Q

what drugs are recommended to be combined for RA?

A

csDMARDs are recommended in combination with bDMARDs or tsDMARDs

67
Q

T/F. biologic DMARDs should not be used in combination with other bDMARDs or tsDMARDs.

A

T

68
Q

can 2 bDMARDs be used together?

A

No

69
Q

can a JAK inhibitor and bDMARD be used together?

A

No

Pharm Spring 2023 (27 decks)

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