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864 > RA > Flashcards

RA Flashcards

1
Q

PHARMACOLOGIC TREATMENT

(5)

A
  • NSAIDs
  • corticosteroids
  • DMARDs
  • Biologic: anti-TNF
  • Biologic: non-TNF
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2
Q

NSAIDs

  • Effective in reducing pain, swelling, and stiffness
  • Do NOT alter disease ___
  • Dose at anti-inflammatory doses
  • Use in combination with ___
A
  • progression
  • DMARDs
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3
Q

CORTICOSTEROIDS

  • Used for anti-inflammatory & ___ properties
  • Not used as ___
  • Use in combination with DMARD
  • Use in ___ flares
  • Use in patients with extra-articular manifestations
A
  • immunosuppressive
  • monotherapy
  • cute
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4
Q

CORTICOSTEROIDS: DOSING

  • ___ and ___ have steroid sparing effects
    ■ Low dose: < 10mg/day of prednisone
    ■ High dose: > 10mg/day up to 60mg daily
    ■ Short-term: < ___ months of therapy

Intraarticular injections
o Do NOT use > every __ - __ months
o Use 10 – 25 mg/injection of HC per joint

A
  • NSAIDs, DMARDs
  • 3
  • 2-3
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5
Q

CORTICOSTEROID ADVERSE EFFECTS

Short Term
- ___ glycemia
- gastritis
- ___ changes
- elevated ___

Long Term
- ___ necrosis
- cataracts
- ___
- growth failure
- ___

A
  • hyperglycemia
  • mood
  • BP
  • aseptic
  • obesity
  • osteoporosis
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6
Q

DMARDs

Disease Modifying Anti-Rheumatic Drugs
- Potential to decrease/ ___ joint damage & ___ joint integrity
- ___ of initiation is critical
- Onset of action is ___

A
  • prevent, preserve
  • timing
  • delayed
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7
Q

Conventional Synthetic DMARDs

(4)

A
  • Methotrexate (MTX)
  • Sulfasalazine (SSZ)
  • Hydroxychloroquine (HCQ)
  • Leflunomide
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8
Q

METHOTREXATE

  • Most predictable benefit
  • DMARD of ___
  • DMARD with best ___ outcome
  • MOA: inhibit ___ acid reductase (inhibits neutrophil adhesion and chemotaxis)
A
  • choice
  • long-term
  • dihydrofolic
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9
Q

METHOTREXATE

Dosing Regimen
■ 2.5 mg tablets
■ Dose: ___ mg per ___ by mouth or intramuscularly (up to 15-20 mg – weekly dose can be taken in one day)
■ Onset: __ - __ months

Pharmacokinetics
■ 35- 50% bound to ___
■ Hepatic metabolism with some renal excretion

A
  • 7.5, week
  • 1-2
  • albumin
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10
Q

MTX: ADVERSE EFFECTS

Hematologic
- Bone ___ suppression

Gastrointestinal
- N/V/D*
- Stomatitis/mucositis

Hepatic
- Cirrhosis
- Hepatitis
- Fibrosis
* = prescribe 1mg/day of ___ acid to reduce symptoms

Pulmonary
- Pneumonitis
- Fibrosis

Dermatologic
- Rash
- Urticaria
- Alopecia

Teratogenic
– Wait one cycle on BCP
– Wait __ months before considering conception

A
  • marrow
  • folic
  • 3
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11
Q

MTX: CONTRAINDICATIONS

  • pregnancy
  • chronic ___ disease ( ___ abuse)
  • immunodeficienncy
  • Pre-existing blood dyscrasias
  • Pleural/peritoneal effusions
  • Leukopenia/ ___
  • CrCL < ___ ml/min
A
  • liver, EtOH
  • thrombocytopenia
  • 40
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12
Q

MTX: MONITORING

baseline:
- ___
- CBC
- ___
- ___
- albumin

maintenance: CBC, SCr, LFT
- < 3 months: 2-4 weeks
- 3-6 months: 8-12 weeks
- > 6 months: 12 weeks

A
  • CXR
  • SCr
  • LFTs
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13
Q

LEFLUNOMIDE (Arava®)

Prodrug
■ MOA:
– inhibit de novo biosynthesis of ___
– Interferes with ___ kinase activity
– Inhibit cell cycle progression

A
  • pyrimidines
  • tyrosine
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14
Q

LEFLUNOMIDE (Arava®)

Dosage Regimen
■ 10 mg and 20 mg tablets
■ Dose: ___ mg by mouth x 3 days; then 20 mg daily
■ Onset: 1 month
■ Caution: if also taking MTX b/c ___ toxicity

Pharmacokinetics
■ t ½ = 14 – 16 ___
■ ___ clearance

A
  • 100
  • liver
  • daysLEFLUNOMIDE (LEF):
    ADVERSE EFFECTS
  • Hepatobiliary
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15
Q

LEFLUNOMIDE (LEF): ADVERSE EFFECTS

  • Diarrhea
  • Rash
  • Alopecia
  • Increased ___
  • ___
A
  • LFTs
  • Teratogenicity
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16
Q

LEF: MONITORING

___ , ___ , and ___

Baseline

Maintenance
- < 3 months: 2-4 weeks
- 3-6 months: 8-12 weeks
- >6 months: 12 weeks

A

CBC, SCr, LFT

17
Q

SULFASALAZINE

Prodrug: cleaved in colon to ___ and ___
■ MOA: inhibits ___

Dosing Regimen:
– 500 mg tablets
– Dose: 500mg by mouth twice daily
– 1g 2-3 times daily
– Onset: 1-2 months

A
  • sulfpyradine, 5-ASA
  • IL-1
18
Q

SSZ: ADVERSE EFFECTS

Gastrointestinal
- N/V/D, anorexia

Dermatologic
- ___ / Urticaria/ Photosensitivity

Hematologic
- Leukopenia, ___
- Rare: Hemolytic and aplastic anemia

Caution for ___

A
  • Rash
  • thrombocytopenia
  • allergy
19
Q

SSZ: MONITORING

___ , ___ , and ___

Baseline
Maintenance
- < 3 months: 2-4 weeks
- 3-6 months: 8-12 weeks
- >6 months: 12 weeks

A

CBC, SCr, LFT

20
Q

HYDROXYCHLOROQUINE

MOA: modification of ___ infiltration in joint

Dosing Regimen
– 200 mg tablets
– Dose: 200 mg by mouth twice daily
– Onset: 2-4 months (D/C if not efficacious in ___ months)

Pharmacokinetics
– ___ metabolism
– ___ excretion

A
  • cytokine
  • 6
  • hepatic
  • renal
21
Q

HCQ: ADVERSE EFFECTS

Advantage
- No ___, hepatic, renal toxicities

Ocular
- ___ toxicity
- > 70 yo, cumulative dose > 800 g, night/peripheral
changes

Gastrointestinal
– N/V/D (take with ___ )

Dermatologic
– Increase skin ___ , rash, alopecia

monitoring: ___ exam every 6-12 months

A
  • myelosuppression
  • retinal
  • food
  • pigment
  • vision
22
Q

TNF NEUTRALIZERS (5)

A
  • Etanercept
  • Infliximab
  • Adalimumab
  • Golimumab
  • Certolizumab
23
Q

TNF NEUTRALIZERS: WARNINGS/PRECAUTIONS

Risk of ___

Do not use in combination with ___ inhibitors or ___ co-stimulation modulators

Black Box warnings
■ Neurologic / ___ disorders
■ Malignancies
■ Congestive heart failure
■ ___ reactivation
■ No concurrent ___ vaccination administration

A
  • infection
  • IL-1, t-cell
  • demyelinating
  • Hepatitis B
  • live
24
Q

TNF NEUTRALIZERS: ADVERSE EFFECTS

  • ___ and rash
  • Risk of ___ (upper respiratory most common)
  • ___ site reaction
  • Exacerbations of ___
  • Risk of ___
  • Risk of evidence of ___ disease
A
  • HA
  • infection
  • injection
  • CHF
  • malignancy
  • demyelinating
25
Q

ETANERCEPT (Enbrel®)

Mechanism of Action
– ___ protein with two soluble TNF receptors fused to the IgG1 molecule
– Binds to and inhibits ___
– Binding occurs before the ___ can interact with cell-surface TNF receptors that would produce an
inflammatory response

Dosage Regimen
– 50mg ___ once weekly

A
  • dimeric
  • TNF
  • cytokine
  • SC
26
Q

INFLIXIMAB (Remicade®)

Mechanism of Action
- ___ antibody
- Immunoglobulin
- Mouse & human portions to reduce ___ potential

Dosage regimen
- 3 mg/kg IV at 0,2,& 6 weeks then every 8 weeks
- Can increase dose to 10mg/kg or as often as every 4 weeks
- Indicated in combination with ___

A
  • chimaric
  • antigenic
  • MTX
27
Q

ADALIMUMAB (Humira®)

Mechanism of Action
- Recombinant ___ IgG1 monoclonal antibody specific for human ___
- Binds to ___ and blocks interaction with the p55 and p75 cell surface TNF receptors

Indications
- Patients who have inadequate response to one or more ___
- Can be used ___ OR in ___

Dosage Regimen
■ 40mg SC every ___ week
■ If not taking ___ can increase to 40mg SC every week for improved response

A
  • human, TNF
  • TNF-a
  • DMARDs
  • alone, combination
  • other
  • MTX
28
Q

GOLIMUMAB (Simponi®)

Indications
- Moderate to severe RA
- Used in combination with ___

Mechanism of Action
- ___ monoclonal antibody specific for ___
- Prevents binding of TNF-alpha to receptors

Dosage Regimen
- 50mg SC once ___

Monitoring Parameters:
- CBC with PLT
- ____

A
  • MTX
  • human, TNF-a
  • monthly
  • LFTs
29
Q

CERTOLIZUMAB (Cimzia®)

Mechanism of Action
- Binds to membrane associate and soluble ___ and neutralizes

Indications
- RA patients with moderate to severe disease
- Can be used ___ or in ___ with non-BRM DMARDs

Dosage Regimen
- 400mg (2 injections of 200mg) SC at 0,2,4 weeks then 200mg every 2 weeks or 400mg every 4 weeks

A
  • TNF-a
  • alone, combo
30
Q

ANAKINRA (Kineret®)

Indication:
- Moderate to severe RA in patients who have failed one or more ___
- Can use ___ or in ___

Mechanism of Action:
- ___ , non- ___ version of the human ___ receptor antagonist
- Selectivity blocks IL-1 by binding to the IL-1 receptor

A
  • DMARDs
  • alone, combo
  • recombinant, non-glycosylated, IL-1
31
Q

ANAKINRA (Kineret®)

Dosage Regimen
■ 100mg SC daily
■ If CrCl < ___ mL/min, use 100mg SC every ___ day
■ Do not use in ___ with TNF agents or ___ (due to increased risk of ___ )

Adverse Effects
■ ___ site reactions
■ Headache, N/V, flu-like symptoms
■ ___ to e.coli-derived proteins
■ Increased risk of serious ___
■ Decreased ___

A
  • 30, other
  • combo, abatacept, infection
  • injection
  • hypersensitivity
  • infectons
  • neutrophils
32
Q

ANAKINRA: MONITORING

___ count
- Prior to start
- Monthly for 3 months
- ___ for up to one year

A
  • neutrophil
  • Quarterly
33
Q

SELECTIVE T-CELL CO-STIMULATION MODULATOR

___ (Orencia®)

Indication:
- Moderate to severe RA
- If had inadequate response to one or more __
- Monotherapy or in combination with ___ (not with TNF –inhibitors or IL-1 antagonists)

Mechanism of Action:
- Selective ___ modulator
- Inhibits ___ activation

A
  • Abatacept
  • DMARDs
  • DMARDs
  • co-stimulation
  • T-cell
34
Q

ABATACEPT: DOSING

Available in ___ mg vials
- < 60kg: 500mg IV over 30 minutes
- 60-100 kg: 750mg IV over 30 minutes
- >100 kg: 1g IV over 30 minutes
- Dose at 0, 2, and 4 weeks then every ___ weeks thereafter

A
  • 250 mg
  • 4
35
Q

ABATACEPT: WARNINGS

  • Do not use with ___ antagonists or ___ antagonists
  • Increased risk of ___
  • No ___ vaccination administration
  • Caution in patients with ___
A
  • TNF-a, IL-1
  • infection
  • live
  • COPD
36
Q

ABATACEPT: ADVERSE EFFECTS

  • Headache
  • Nausea
  • Upper respiratory ___
  • Nasopharingitis
  • ___ reactions
  • Serious ___
  • ___
A
  • infection
  • infusion
  • infection
  • Malignancy

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