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Pharmacy 255 > RA > Flashcards

RA Flashcards

1
Q

What are the consequences of RA?

A

Loss of cartilage= permanent
Scar tissue
ligament lossening
tendon contracts

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2
Q

Who is more at risk of RA?

A

Women and younger

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3
Q

What are the symptoms of RA?

A

symmetrical joint pain
worse in morning
appetite decrease
swelling
nodules

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4
Q

What 2 things separate OA from RA?

A

RA is longer morning stiff and symmetrical

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5
Q

What other body signs of RA not on joints?

A

effects vessels
fribrosis of lung
eye loss
inflam of heart
bone softening
anemia

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6
Q

What labs can indicate RA?

A

R factor and high ER and CRP

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7
Q

Do we want to take it slow or treat aggressive with RA?

A

Aggressove

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8
Q

Non pharm for RA

A

rest, educate, diet

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9
Q

What are our go to DMARD

A

Methotrexate and leflunomide

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10
Q

How do MXT and leflonumide work?

A

M=antifolate= less DNA synth
Stop DNA synth of inflammatory

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11
Q

Onset for DMARD

A

1-2 months

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12
Q

What is dosing for MXT?

A

at least 15 mg -25 mg WEEKLYI

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13
Q

If renal what is dose of MXT

A

50%

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14
Q

Which is better MXT oral or SQ

A

SQ= more potent and no gi effects
BUT oral has better adherence

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15
Q

S/E of DMARDs

A

Fatigue, stomatitis, nausea hair loss, photosensitive

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16
Q

Most tolerated DMARD

A

Hydrozychloroquine

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17
Q

How can we stop s/e of MXT?

A

folate 1-5 mg
split dosing but take it same day
SQ
PPI

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18
Q

Serious side effects of hydroxychloroquine

A

ocular toxicity

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19
Q

How long can MXT male sterility last for?

A

up to a year

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20
Q

Serious s/e of MXT

A

hepatotx
pulmonary tox

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21
Q

Can you give MXT in pregnant?

A

NO

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22
Q

DI of MXT?

A

NSAIDs= not really
trimethoprim= BAD
PPI=no
Loop=no

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23
Q

Which one is more potent MXT or Leflonumide?

A

Both

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24
Q

Place of therapy for hydroxychloroquine and sulfasalazine?

A

Combo

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25
Q

What are the classes of Biologic DMARDS

A

TNF inhibitors
IL 1/6 inhibitors
T cell co stim inhibitors
B cell depletors

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26
Q

S/e of biologic DMARDs

A

Nausea, headache, diarrhea, injection site irritation, hypersensitivity, infection, neutropenia, cancer

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27
Q

What do you give prior to Biologic admin?

A

acet, anti histamine and steroid

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28
Q

Who is at risk of getting infections from biologic DMARDs and what infections?

A

> 65 or on high dose
pneumonia, TB, hepatitis

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29
Q

If infection occurs while on biologic DMARD what happens?

A

d/c for a bit

30
Q

What biologic is best if high risk of infection?

A

adacept

31
Q

Which cancers do biologic DMARDs give you?

A

skin and lymphoma

32
Q

Which biologic does not have antibodies against them?

A

IL1-6

33
Q

Which TNF drug is the best?

A

all good

34
Q

What is general dosing of TNF?

A

weekly or every 2 weeks

35
Q

Which TNF is IV?

A

infliximab

36
Q

Which TNF in renal impairment?

A

NONE

37
Q

Which TNF in pregnancy?

A

cetrolizumab

38
Q

Who cant get TNF?

A

severe infection or Heart failure

39
Q

Unique issue with TNF?

A

seizure risk and cause autoimmune diseases

40
Q

WHat IL-1or 6 inhibitor is the weakest/most tolerable?

A

Anakinra

41
Q

Any contraindications for IL?

A

No except severe infection in tocilizumab

42
Q

Which is is more potent TNF or IL?

A

equal

43
Q

What adjustment is needed for renal for IL?

A

NONE

44
Q

General dosing of IL?

A

every 2 weeks
anakinra= daily!

45
Q

Unique S/e of IL?

A

increase lipids, gi perforation

46
Q

What is the t cell co stimulation inhibitor?

A

abatacept

47
Q

Unique s/e of abatacept?

A

COPD
NO LIVER issues
BLOOD GLUCOSE

48
Q

What is the B cell depletor? General dosin?

A

rituximab
1 g IV 2 weeks apart
may need second course

49
Q

Unique s/e of Rituximab?

A

Gi perforation, HTN, BG increase, SJS, TEN

50
Q

I am a patient with severe liver issues. WHat drug for RA?

A

abatacept

51
Q

I am a patient with severe heart failure issues. What drug for RA?

A

NOT TNF

52
Q

I am a patient with seizures. What drug for RA?

A

NOT TNF

53
Q

I am a patient with BG issues. What drug for RA?

A

NOT ABATACEPT

54
Q

I am a patient with COPD. What drug for RA?

A

NOT ABATACEPT

55
Q

I am a patient with GI perforation risk. What drug for RA?

A

NOT IL or abatacept

56
Q

I am a patient with HTN/lipids. What drug for RA?

A

NOT IL/abatacept

57
Q

What is absolute last line for RA

A

C. Janus kinase inhibitors- tofacitinib

58
Q

What is good about janus kinase inhibitors?

A

ORAL MEDS

59
Q

IN regards to tolerability, how do janus kinase inhibitors stack up?

A

NOT tolerated= CV, Cancer, perforations
interactions with 3A4

60
Q

Which is better CS or NSAIDs?

A

CS

61
Q

What are the three ways that CS are used?

A

short course-10-15 mg
Chronic= 5-10
Pulse= high for a few days= NOT GOOD

62
Q

Issues with CS?

A

Cataracts, weight, osteoporosis

63
Q

Issues with CS intraarticular injection?

A

tendon rupture=rest joint

64
Q

What is strategy of NSAID use?

A

High dose, maybe add PPI

65
Q

What is general therapy for RA?

A

CS, NSAID, MXT and biologic

66
Q

If you enter remission can you taper of biologic?

A

Yes but cannot quit them

67
Q

What is first line for low risk RA per guidlines?

A

HCQ

68
Q

When should you stop MXT if planning to become pregnant? Male and female

A

3 months before contraception

69
Q

What are okay options if pregnant?

A

all biologics except B cell one
Certolizumab best
HCQ and SSZ okay

70
Q

During lactation what drugs should you avoid?

A

MXT and LEF

Pharmacy 255 (16 decks)

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