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PHRM 845 > RA > Flashcards

RA Flashcards

1
Q

Reumatoid arthritis characterized by what

A

systemic double join involvement

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2
Q

age of onset RA and gender

A

30-50 years
more common in females
shortens life span

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3
Q

race considerations in RA

A

no discrimination

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4
Q

what to consider to see if genetic?

A

MHC typing to get HLA level

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5
Q

etiology of RA

A

unknown

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6
Q

RA has synovial space in joints infiltrated with what

A

inflammatory cells
(macrophage, t cells, plasma cells)

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7
Q

what is pannus

A

inflamed proliferation synovium

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8
Q

what do the inflammatory cells do once they invade synovial

A

release cytokines that lead to cellular proliferatiion and death

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9
Q

what does a pannus do?

A

invades healthy cartilage and bone and produces erosions that destroy joint

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10
Q

clinical presentation of RA

A

stiffness and muscle ache - joint swelling
- fatigue
- weak
- loss appetite
- fever

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11
Q

clinical criteria for diagnosis of RA

A

score of 6 or more points
based on type of joint and number of joints involved

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12
Q

most common joints in RA

A

hands
wrists
feet

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13
Q

common joints in OA

A

hands
knee
hip

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14
Q

not as common places for joint inflammation in RA

A

elbows
shoulder
hip
ankle
knee

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15
Q

reumatoid nodules location

A

hands
elbow
forearm

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16
Q

reumatoid nodules when to treat

A

only if symptomatic
usually no intervention required

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17
Q

vasculitis symptoms

A

inflammation of small supervicial blood vessels
stasis ulcers
infarction leading to necrosis

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18
Q

pulmonary symptoms RA

A

pleural effusion
pulmonary fibrosis
inflam of arteries and lungs (pnemonitis)

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19
Q

ocular symptoms of RA

A

inflam of eye, nodules on sclera
keratconjunctivitis sicca - Sjorens syndrome
itchy dry eyes

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20
Q

cardiac effects RA

A

increase risk CV mortality
pericarditis
conduction abnormalities
myocarditis

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21
Q

Feltys sx RA

A

splenomegaly - inflamed spleen
neutropenia

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22
Q

additonall disease states that could happen from RA

A

lympadenopathy
renal disease
thrombocytosis
anemia
(could be from drugs taken)

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23
Q

erythrocyte sedimentation rate and C reactive protein used for what

A

to see if meds working, disease progression
both non-specific to RA

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24
Q

rheumatoid factor used for what

A

most patients are RF +
specfic antibody for IgM
higher titer = poorer prognosis

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25
Q

Anti-CCP or ACPA used how

A

high specificity
marker of poor prognosis

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26
Q

antinuclear antibodies (ANA)

A

suggest autoimmune disease
more suggestive of SLE

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27
Q

what is joint aspiration

A

take out fluid from joint to measure
turbid
WBC increased
glucose decreased

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28
Q

radiographic images used how

A

evaluate disease progression

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29
Q

what increases risk of poor prognosis

A

elevated CRP and ESR
RF high titers
elevated Anti-CCP / ACPA
erosions on Xray
duration of disease
swelling > 20 joints

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30
Q

goals of therapy

A

relieve symptoms
preserve function
prevent damage
control extra-articular manifestations

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31
Q

non-pharm treatment RA

A

rest
weight reduction
surgery
PT/OT
splints/prosthetics
support groups
education

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32
Q

adjunct therapies for RA

A

NSAIDs
corticosteroids

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33
Q

NSAIDs help with what

A

pain, swelling, stiffness
DO not alter disease progression

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34
Q

NSAIDs and coritcosteroids as monotherapy?

A

NO, use with DMARDs

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35
Q

NSAIDs dosed at what

A

anti-inflammatory doses

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36
Q

if sulfa allergy, what NSAID can we not use?

A

celecoxib

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37
Q

corticosteroids used for what

A

anti-inflammatory and immunosuppressive

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38
Q

when could we use corticosteroids?

A

acute flares
extra-articular manifestations

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39
Q

dose goal for steroids

A

physiological dose to reduce adverse effects

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40
Q

do not use intraarticular injections how freuntly

A

more than every 2-3 months

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41
Q

short term side effects corticosteroids

A

hyperglycemia
gastritis
mood changes
increased BP

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42
Q

long term side effects corticosteroids

A

aseptic necrosis
cataracts
obesity
growth failure
osteoporosis
HPA suppression

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43
Q

baseline monitoring for corticosteroids

A

BP
BG

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44
Q

maintenance monitoring for corticosteroids

A

BP
BG
every 3-6 months

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45
Q

what is a DMARD

A

disease modifying anti-reumatic drug

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46
Q

what can DMARDs do

A

decrease/prevent joint damage
preserve joint integrity

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47
Q

onset of action DMARDs

A

6 months, takes awhile

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48
Q

conventional synthetic DMARDs still used

A

methotrexate
sulfasalazine
hydroxychloroquine
leflunomide

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49
Q

DMARD of choice

A

methotrexate, best long term outcome

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50
Q

methotrexate dosing and onset

A

7.5 mg PO or IM weekly
(max 15-20 mg in 1 day)
onset 1-2 months

51
Q

how is methotrexate metabolized

A

hepatic w some renal

52
Q

methotrexate adverse effects

A

bone marrow supression
N/V/D, stomatitis, mucositis
cirrhosis, hepatitis, fibrosis
teratogenic
rash

53
Q

how long to wait after methotrexate to consider getting pregnant

A

3 months

54
Q

what can be given with methotrexate to decrease symptoms of BMS and stomatitis/mucosisit

A

folic acid 1 mg / day

55
Q

contraindications to methotrexate

A

pregnancy
pleural effusions
chronic liver disease/ alcohol abuse
immunodeficiency
blood dyscrasias
leukopenia
CrCl < 40 ml/min

56
Q

baseline monitoring for methotrexate

A

CXR
CBC
SCr
LFTs
Albumin
hep B and C studies

57
Q

maintenance monitorign for methotrexate

A

CBC, SCr, LFTs
< 3 month: 2-4 weeks
3-6 month: 8-12 weeks
6 month: 12 weeks

58
Q

leflunomide is a _____

A

prodrug

59
Q

leflunomide dosage form

A

oral

60
Q

leflunomide onset

A

1 month

61
Q

leflunomide caution

A

if taken with methotrexate may cause liver tox

62
Q

halflife of leflunomide and excretion

A

14-16 days
hepatobilliary

63
Q

leflunomide adverse effects

A

diarrhea
rash
alopecia
increased LFTs
teratogen

64
Q

what can we use if trying to get pregnant and need leflunomide out of the system

A

cholestrymine

65
Q

baseline monitoring leflunomide

A

CBC
SCr
LFTs

66
Q

maintenance monitoring leflunomide

A

CBC
SCr
LFTs
< 3 month: 2-4 weeks
3-6 month: 8-12 weeks
6 month: 12 weeks

67
Q

sulfasalazine is a ____ and inhibits what

A

prodrug, IL-1 inhibitor

68
Q

onset of sulfasalazine

A

1-2 months

69
Q
A
70
Q

sulfasalazine side effects (8)

A

N/V/D
headache
anorexia
rash
thrombocytopenia
hepatotoxicity
anemia
hypersensitivity to sulfa - photosensitivity

71
Q

baseline monitoring sulfasalazine

A

CBC
LFTs
SCr

72
Q

maintenance monitoring sulfasalazine

A

CBC
SCr
LFTs
<3 months: 2-4 weeks
3-6 months: 8-12 weeks
6 months: 12 weeks

73
Q

hydroxychloroquine effectivenss

A

not as good as methotrexate or leflunomide

74
Q

hydroxychloroquine onset

A

2-4 months, d/c if no effect at 6 month

75
Q

HCQ advantage

A

no myelosupression, hepatic, or renal toxicities

76
Q

HCQ adverse effects

A

retinal toxicity
N/V/D
rash, alopecia

77
Q

HCQ monitoring

A

vision exam at baseline and every 6-12 months

78
Q

biologic DMARD drugs

A

etanercept
infliximab
adalimumab
golimumab
certolizumab

79
Q

TNF inhibitors class side effects (7)

A

infections
risk malignancy
HSTCL
demyelinating disease
CHF exacerbation
hepatotoxicity
Hep B reactivation
no live vaccine admin
headache/rash

80
Q

etanercept dosage form

A

SQ

81
Q

etanercept can be used with what

A

methotrexate
or monotherapy

82
Q

monitoring for etanercept, infliximab, adalidumab, certolizumab

A

TB skin test befoer therapy
no other lab monitoring

83
Q

infliximab must be used with what

A

methotrexate, if inadequate response to methotrexate alone

84
Q

can infliximab be monotherapy

A

no, use with MTX

85
Q

indication for adalidumab

A

monotherapy or combination with MTX or other DMARDs
use after failure of one or more DMARDs

86
Q

dosing regimen for adalidumab

A

40 mg SQ every other week or every week if not taking MTX with it

87
Q

golimumab indication

A

combo with MTX
mod to severe RA

88
Q

monitoring for golimumab

A

CBC w PLT
LFTs

89
Q

certolizumab indication

A

mod to severe RA
with or without DMARD

90
Q

anakinra MOA

A

IL-1 antagonist

91
Q

anakinra indication

A

mod to severe RA
failure on DMARD
mono or + DMARD

92
Q

anakinra side effects

A

injection site reactions
headache
N/V/ flu sx
hypersensitivity to e. coli proteins
risk infections
decreased neutrophils

93
Q

anakinra monitoring

A

neutrophil count
baseline
monthly x 3 months
quarterly for 1 year

94
Q

abatacept MOA

A

selective T cell co-stimulation modulator

95
Q

abatacept indication

A

mod to severe RA
mono or + DMARD
must fail a DMARD

96
Q

abatacept caution in which pts

A

COPD

97
Q

abatacept adverse effects

A

headache
nausea
upper resp infection
nasopharyngitis
infusion rxns
serious infection
malignancy

98
Q

abatacept monitoring

A

no hematologic monitoring

99
Q

IL-6 inhibitors

A

tocilizumab
sarilumab

100
Q

tocilizumab and sarilumab indication

A

mod to severe RA
mono or with DMARD
after failure of DMARD

101
Q

IL-6 inhibs warning

A

black box for serious infections

102
Q

IL-6 inhibs contraindications

A

liver toxicity
thrombocytopenia
neutropenia

103
Q

IL-6 inhibitors side effects

A

serious infection
liver toxicity
thrombocytopenia
neutropenia
lipid abnormalities
intestinal perforations (toc)
infusion reactions (toc)

104
Q

tocilizumab and sarilumab monitoring

A

neutrophil count
platelet count
LFTs
lipid profile
at 4-8 weeks then every 3 months

105
Q

rituximab indication

A

with methotrexate
mod to severe RA after fail of TNF

106
Q

rituximab MOA

A

Anti CD20

107
Q

rituximab dosage form

A

IV infusion

108
Q

tocilizumab dosage form

A

IV infusion

109
Q

sarilumab dosage form

A

SQ

110
Q

what can be given before retuximab to reduce chance of infusion reaction

A

methylprednisolone IOV

111
Q

black box warning retuximab

A

fatal infusion reaction
tumor lysis syndrome

112
Q

side effects retuximab

A

tumor lysis syndrome
mucocutaneous reaction
viral infection
hypersensitivity
renal tox
bowek obstruction
hep B reactiv
cardiac arrythmia

113
Q

retuximab monitoring

A

CBC w plt
SCr
vital signs during infusion

114
Q

targeted synthetic DMARDs

A

tofacitinib
baricitinib
updacitinib

115
Q

tofacitinib
baricitinib
updacitinib MOAs

A

JAK inhibitors

116
Q

indication for JAK inhibs

A

mod to severe RA after fail TNF
mono or with MTX / DMARD

117
Q

JAK inhibs cant be used with what

A

cyclosporine
azathioprine
biologics

118
Q

warnings of JAK inhibs

A

CYP 450
hepatic impairment - do not use
risk infection
risk malignancies
risk CV events
risk thrombosis
no live vaccines

119
Q

do not use JAK inhibitors if what

A

Hg < 9
ANC < 1000
ALC < 500

120
Q

adverse effects JAK inhibs

A

upper respiratory
headache
nausea

121
Q

JAK inhibitors monitoring

A

lymphocyte
neutrophil
hemoglobin
LFTs
lipid profile

122
Q

what is early RA considered

A

< 6 months
late > 6 months

123
Q

jfode

A

PHRM 845 (38 decks)

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