RA Flashcards
1
Q
Nonbiological DMARDs (10)
A
- Methotrexate
- Sulfasalazine
- Lefunomide
- Hydroxychloroquine (Chloroquine)
- Azathioprine
- Gold
- Minocycline
- Cyclosporine
- Penicillamine
- Other antibiotics
2
Q
Biological DMARDs (9)
A
- Infliximab
- Etanercept
- Adalimumab
- Anakinra
- Abatacept
- Rituximab
- Tocilizumab
- Golimumab
- Tofacitinib
3
Q
Methotrexate (MTX)
5 important things
6 ADRs
A
- Drug of choice (60-70% show response)
- Decreases TNFa and increases IL-10, decreases cytokine production
- Monotherapy or with steroids
- Taken weekly
- Folic acid antagonist (may cause stomatitis)
- ADRs: GI, hepatofibrosis/cirrhosis, myelosuppression, intertitial pneumonitis, stomatitis, alopecia
4
Q
Leflunamide
4 important things
5 ADRs
A
- Similar to MTX
- Prevents CD4 proliferation, alters IL-2 and GFs, inhibits leukocyte adhesion
- Has an active metabolite (A77-1726)
- Works well for 2 years
- ADRs: alopecia, rash, diarrhea, increased LFTs, infections
5
Q
Sulfasalazine
5 important things
4 ADRs
A
- Sulfapyradine + aspirin
- Anti-inflammatory and immunosuppressive
- Antimicrobial portion is active
- Suppresses TNFa, IL-1, inhibits chemotazis and neutrophil migration, enhances release of adenosine
- Severe ADRs in 25% (discontinue)
- ADRs: GI, rash, hepatitis, blood dyscrasias
6
Q
Hydroxychloroquine
(Chloroquine)
3 important things
4 ADRs
A
- Additive therapy
- Suppresses lysosomal enzymes, inhibits B and T cells and IL release
- Caution in those with eye problems (causes irreversible retinopathy)
- ADRs: GI, rash, bone marrow suppression, retinopathy
7
Q
Azathioprine (AZA)
5 important things
6 ADRs
A
- Steroid sparing agent (can redoce steroid dose)
- Last resort drug
- Similar to gold and penicillamine but increased toxicity
- Antagonizes purine metabolism and may inhibit DNA, RNA and protein synthesis
- Pro-drug (AZA -> 6 MP -> 6 TG)
- ADRs: hepatic inflammation, lymphoproliferative cancer, N/V/D, bone marrow suppresion
8
Q
Gold
3 important things
6 ADRs
A
- Adjunctive treatment
- Alters macrophage function, inhibits mast cell mediator release and lysosomal enzyme activity
- Several metabolites
- ADRs: metallic taste, peripheral neuropathy, dermatitis, proteinuria, bone marrow suppression, stomatitis
9
Q
Penicillamine
3 important things
5 ADRs
A
- Comparable to IM gold
- Inhibits T-cells and chemotaxis of phagocytes, decreases RF
- Toxic (impedes absorption of other drugs)
- ADRs: bone marrow suppression, proteinuria, autoimmune (SLE), aplastic anemia, taste disturbance
10
Q
Minocycline
2 important things
5 ADRs
A
- Adjunct agent eary in therapy
- Improved inflammatory markers (ESR, CRP, etc)
- ADRs: photosensitivity, vestibular toxicity (dizziness), N/V/D
11
Q
Cyclosporine
2 important things
8 ADRs
A
- Retards appearance of new bony erosions
- Very little bone marrow toxicity
- ADRs: nephrotoxicity**, hypertension, hyperglycemia, hyperkalemia, liver dysfunction, seizures, altered mental status, hirsutism
12
Q
Infliximab
4 important things
8 ADRs
A
- Binds to TNF
- RA, Crohn’s, UC, PA
- Chimeric, IgG1 monoclonal antibody
- Interacts with anakinra
- ADRs: headache, N/V/D, infusion reactions, respiratory problems (infection, sinusitis), development of antinuclear and DNA antibodies
13
Q
Entanercept
2 important things
3 ADRs
A
- Binds TNFa receptor and lymphotoxin alpha
- Recombinant fusion protein
- ADRs: injection site reactions, infections, allergic reactions
14
Q
Adalimumab
4 important things
A
- Binds to TNFa
- Fully human recombinant monoclonal antibody
- Inhibits progression of RA and decreases damage
- Interacts with anakinra
15
Q
Anakinra
3 important things
1 ADR
A
- Blocks IL-1
- Etanercept increases risk of serious infection
- Don’t give with TNF inhibitors or those allergic to E. coli proteins
- ADRs: injection site reactions
